Show Notes — The Peds NP

Show Notes and References

Read an overview of each episode, review references, and click the link to listen.

Season 1: The Basics

When a global pandemic threatens my NP students' ability to complete clinical hours in person, faculty all over the country scrambled to figure out how to reach the academic goals for their students. Join me as I journey through an attempt at conveying my finest clinical pearls using a novel medium. A podcast!
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When constipation enters the acute care setting or is difficult to manage in primary care, use this podcast to consider the evidence-based practice guidelines and a few pearls of wisdom to assess a child’s presentation, diagnose constipation, and manage the cleanout at home with two essential medications.
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References:
Chumpitazi, C.E., Rees, C.A., Camp, E.A., Henkel, E.B, Valdez, K.L., & Chumpitazi, B.P. (2017). Diagnostic approach to constipation impacts pediatric emergency department disposition. American Journal of Emergency Medicine, 35(10), 1490-1493.
Drossman, D.A., Hasler, W.L. (2016) Rome IV-functional GI disorders: disorders of gut-brain interaction. Gastroenterology, 150(6):1257–1261. doi: 10.1053/j.gastro.2016.03.035.
Ferguson, C.C., Gray, M.P., Diaz, M., & Boyd, K.P. (2017). Reducing unnecessary imaging for patients with constipation in the pediatric emergency department. Pediatrics, 140(1), e1-e7.
Freedman SB, Thull-Freedman J, Manson D, et al. Pediatric abdominal radiograph use, constipation, and significant misdiagnoses. The Journal of pediatrics. 2014;164(1):83-88.e82.
North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. (2014). Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of Pediatric Gastroenterology and Nutrition, 58(2), 258-274.
Varni, J.W., Burwinkle, T.M., Katz, E.R., Meeske, K., & Dickinson, P. (2002). The PedsQL™ in pediatric cancer. Cancer, 94(7), 2090-2106.
Youssef, N.N., Langseder, A.L., Verga, B.J., Mones, R.L., & Rosh, J.R. (2005). Chronic childhood constipation is associated with impaired quality of life: A case-controlled study. Journal of Pediatric Gastroenterology and Nutrition, 41(1), 56-60.
Today we talk through the tough decision on what to do when a patient presents at the most inconvenient time with Fever Without Source. Why is this a hard decision? What are the things that you should be thinking about? We review the literature, the rationale, and the options of how to manage these patients using evidence-based practice to guide us.
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References:
AAP. (2011). Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics, 128(3), 595-610.
Baraff, L.J. (2000). Management of fever without source in infants and children. Annals of Emergency Medicine, 36(6), 602-614.
Simon, A.E., Lukacs, S.L., & Mendola, P. (2011). Emergency department laboratory evaluations of fever without source in children aged 3 to 36 months. Pediatrics, 128(6), e1368-e1375.
Rabies is one of those scary words associated with animal bites. But not every situation requires post-exposure prophylaxis. Join us today as we talk about rabies exposure, risk, and post-exposure management in the pediatric patient.
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References:
American Academy of Pediatrics. (2018). Red Book: 31st Ed. American Academy of Pediatrics: Itasca, IL.
Bula-Rusas, F.J., & Olcott, J.L. (2018). Human and animal bites. Pediatrics in Review, 39(10), p. 490-500.
Centers for Disease Control and Prevention. (2019). Wildlife reservoirs for rabies. Retrieved online at https://www.cdc.gov/rabies/exposure/animals/wildlife_reservoirs.html
Mani, C.S., & Murray, D.L. (2006). Rabies. Pediatrics in Review, 27(4), 129-136.
When a marital argument seeks to justify the use of a seemingly antiquated healthcare learning exercise, we find ourselves at the center of an existential question: Is the keyboard mightier than the mouse click?
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Vaccine hesitancy has become a controversial and highly politicized topic in healthcare today. Join us as we discuss the history on how we got here, the current literature and obstacles facing the perpetuation of the issue, and how to talk with vaccine hesitant parents.
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References:
AAP Committee on Community Health Services. (2006). Periodic survey #6: Pediatricians’ attitudes and practices surrounding the delivery of immunizations. Retrieved online from https://www.aap.org/en-us/professional-resources/Research/Pages/PS66_Executive_Summary_PediatriciansAttitudesandPracticesSurroundingtheDeliveryofImmunizationsPart2.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR:+No+local+token.
AAP Committee on Practice and Ambulatory Medicine, Committee on Infectious Diseases, Committee on State Government Affairs, Council on School Health and Section on Administration and Practice Management. (2016). Medical versus nonmedical immunization exemptions for child care and school attendance. Pediatrics, e20162145. DOI: https://doi.org/10.1542/peds.2016-2145
Edwards, K.M., Hackell, J.M., The Committee on Infectious Diseases, & The Committee on Practice and Ambulatory Medicine. (2016). Countering vaccine hesitancy. Pediatrics, 138 (3), e20162146. DOI: https://doi.org/10.1542/peds.2016-214.
McCauley, M.M., Kennedy, A., Basket, M., & Sheedy, K. (2012). Exploring the choice to refuse or delay vaccines: A national survey of parents of 6- through 23-month-olds. Academic Pediatrics, 12(5),375–383.
Meissner, H.C. (2020). Ask the Expert: Why is vaccine development against COVID-19 disease so difficult? AAP News. Retrieved from https://www.aappublications.org/news/2020/06/17/covid19vaccines061720
Opel, D.J., Heritage, J., Taylor, J.A., Mangione-Smith, R., Salas, H.S., DeVere, V.,… & Robinson, J.D. (2013) The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics, 132(6), p. 1037-1046. Doi: DOI: https://doi.org/10.1542/peds.2013-2037
Reiland, R. (2018). Searching for a vaccine against mistrust. Johns Hopkins Magazine, online. Retrieved from https://hub.jhu.edu/magazine/2018/winter/vaccines-mistrust-and-misinformation/.
CDC. (2020). Africa kicks out wild polio. Retrieved from https://www.cdc.gov/polio/why-it-matters/africa-kicks-out-wild-polio.htm#:~:text=On%20August%2025%2C%202020%2C%20the,certified%20as%20wild%20poliovirus%2Dfree.
Practical tips for the APRN student on selecting the article, reading it, then writing a literature review for discussion with classmates or colleagues.
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Get started on documentation with pearls of wisdom on the different pieces of an outpatient note.
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Reference:
The Joint Commission. (2017). Inadequate hand-off communication. Sintenel Event Alert(58), p. 1-6.
In this episode of The Peds NP we use a bad example of calling a consult to demonstrate "what not to do" before discussing some good examples and help to develop the critical skill of asking a clinical question.
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Season 2: Primary Care

As my primary care pediatrics students finish their first week of class, we review some questions on the newborn and discuss some key principles of clinical notes to get ready for next week.
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Join us as we pick apart the pieces of a well child check and discuss the ideal head-to-toe exam.
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References:
Leske, D., Hatt, S., Castaneda, Y. (2019) Eye-related quality of life and functional vision in children wearing glasses. Journal of American Association for Pediatric Ophthalmology and Strabismus,24(2). https://doi.org/10.1016/j.jaapos.2019.12.010.
Zabbidi-Hussin, Z.A. (2016). Practical way of creating differential diagnoses through expanded VITAMINS ABCDEK mnemonic. Advances in Medical Education and Practice, 7, 247-248.
Join us as we unpack the ddx and discuss common and severe problems of the eye in pediatric patients. Later, we talk about journal club reviews of the literature and note one of my favorite ways to appraise an article.
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Prick up your ears for this week's discussion on some favorite principles at The Peds NP. We use acute otitis media as an example of taking it back to the patho and spending an extra 5 minutes teaching the parents.
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References:
American Academy of Pediatrics (2013). Ten things physicians and patients should question. Released February 21, 2013 (1-5) and March 17, 2014 (6-10); #1, 3, 9 updated July 13, 2016; #1, 2, 4, 5 and 10 updated June 12, 2018. Retrieved online https://www.choosingwisely.org/wp-content/uploads/2015/02/AAP-Choosing-Wisely-List.pdf
FDA. (2017). Use of cough suppressants in children. Retrieved online at https://www.fda.gov/files/drugs/published/Use-of-Cough-Suppressants-in-Children--April-27--2017-Meeting-Summary.pdf
Green JL, Wang GS, Reynolds KM, et al. Safety Profile of Cough and Cold Medication Use in Pediatrics. Pediatrics. 2017;139(6):e20163070
Rosa-Olivares, J., Porro, A., Rodriguez-Varela, M., Riefkohl, G., & Niroomand-Rad, I. (2015). Otitis media: To treat, to refer, to do nothing: A review for the practitioner. Pediatrics in Review, 36(11), 480–488. https://doi.org/10.1542/pir.36-11-480
Join us today as we discuss how to identify acute disease by recognizing illness scripts written in test questions or in the medical record, then apply these concepts beyond the classroom.
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Diagnosis is the easy part. Deciding whether to send the comfortably tachypneic bronchiolitic is the hard part. Join us today as we unpack how to make that very decision and hear some pearls on supportive care.
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References:
Cloutier, M.M., Dixon, A.E., Krishnan, J.A., Lemanske, R.F., Pace, W., Schatz, M. (2020) Managing asthma in adolescents and adults: 2020 asthma guideline update from the National Asthma Education and Prevention Program. JAMA, 324(22):2301–2317. doi:10.1001/jama.2020.21974NHLBI asthma guidelines 2007
National Heart, Lung, Blood Institute’s National Asthma Education and Prevention Program. (2012). Guidelines for the diagnosis and management of asthma 2007 (EPR-3). The Journal of Allergy and Clinical Immunology, 120(5), S94-138. Doi: DOI: 10.1016/j.jaci.2007.09.043
What is one of the unique features of pediatric health care? Monitoring their growth! Join us today as we discuss important primary and acute care issues surrounding pediatric growth.
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References:
CDC. (2010). Use of the World Health Organization and CDC growth charts for children aged 0-59 months in the United States. MMWR Recomm Rep. 2010;59(RR-9);1-15.
What's the difference between a pediatric patient who needs an LP and one that goes home? Find out on today's episode as we pick apart the presentation of fever without source.
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Reference:
Nadeem, S., Badawy, M., Oke, O.K., Filkins, L.M., Park, J.Y., & Hennes, H.M. (2021). Pyuria and urine concentration for identifying urinary tract infection in young children. Pediatrics, 147(2), e2020014068. doi: 10.1542/peds.2020-014068. PMID: 33514634.
Patients with acute diagnoses often start, and always end, in primary care. Today we discuss primary care implications of cardiac disease in children.
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References:
AAP. (2017). Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics, 140(3), e20171904.
McCrindle, B.W., Rowley, A.H., Newburger, J.W., Burns, J.C., Bolger, A.F., Gewitz, M., … & Pahl, E. (2017). Diagnosis, treatment, and long-term management of Kawasaki Disease: A scientific statement for health professionals from the American Heart Association. Circulation, 135, e927-e999.
A novel is to the clinical note what a summary statement is to Cliff's Notes. A summary statement is a concise phrase of synthesized patient information that transforms your assessment, and formulating one is a critical skill for any provider to learn. Understand the essential components of a summary statement and hear a few good and bad examples on this episode.
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References:
Siegel, M. (2017). Concise summaries only, please. Yale School of Medicine News. Retrieved online at https://medicine.yale.edu/news-article/15646/
University of Florida Department of Medicine. (2021). Instructions for write-ups. Retrieved online at https://clerkship.medicine.ufl.edu/clerkship-requirements/write-ups/instructions-for-write-ups/
Whatever your social life looks like when you go home, I want you to know how important your work in pediatrics is to so many children! Fever is common, the presentation is simple, and this episode reinforces the management of simple febrile seizures according to the 2011 AAP guidelines.

Catgories: guidelines discussion, medical decision making, Family interaction/education, system-based diseases (neuro), primary and acute care
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References:
(AAP), Subcommittee on Febrile Seizures, American Academy of Pediatrics. (2011). Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics, 127(2), 389-394.
Abolfazl, N.-Z., Francois, D., Valerie, H., Pruvost, I., Bennour, A., & Martinot, A. (2013). Risk of bacterial meningitis in young children with a first seizure in the context of fever: a systematic review and meta-analysis. PloS one, 8(1), 55270. doi:10.1371/journal.pone.0055270
Natsume, J., Hamano, S.-I., Iyoda, K., Kanemura, H., Kubota, M., Mimaki, M., . . . Sugie, H. (2017). New guidelines for management of febrile seizures in Japan. Brain & development, 39(1), 2-9. doi:https://dx.doi.org/10.1016/j.braindev.2016.06.003
Seattle Children’s Hospital. (2019). Febrile seizure: Acute presentation v2.0. Retrieved online from https://www.seattlechildrens.org/pdf/febrile-seizures-pathway.pdf.
Once the exams are all taken, the papers submitted, and the grades are in... you've still got work to do. Healthcare professions require career-long learning, so join me as I discuss some options for staying current and engaged in pediatric learning after you walk off the stage and into clinical practice.
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Season 3: Primary Care

On this Mother's Day edition of The Peds NP podcast, we consider the perfect baby shower present for an expecting mother. By using your knowledge of pediatric physiology, growth, and development, you can turn that baby registry into an opportunity to promote health and wellness for a new family.
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Thank you preceptors for your tireless support of students who cannot learn the art of pediatric healthcare without your bedside teaching. This relationship born out of duty, generosity, and mutual respect can create lifelong collegial friendships. But what should students do if they notice problems in clinical? Today we explore how you should think, do, and say when evidence-based practice gets put in a corner.
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References:
American Academy of Pediatrics. (2020). Tips for successful clerkships. Retrieved online from https://services.aap.org/en/career-resources/medical-students/tips-for-successful-clerkships/
Grenny, J., Patterson, K., Switzler, A., & McMillan, R. (2011). Crucial Conversations: Tools for talking when stakes are high (2nd ed.). McGraw Hill Professional.
Maaks, D., Starr, N.B., Brady, M.A., Gaylord, N.M., Driessnack, M., & Duderstadt, K.G. (2020). Burn’s Pediatric Primary Care (7th ed.). Elsevier.
ThriveAP. (2018). How do you deal with a bad clinical placement. Retrieved from https://thriveap.com/blog/how-do-you-deal-bad-clinical-placement.
As summer approaches and kids spend more time playing outside, pediatric providers need to be ready to recognize heat-related illness and offer savvy perspectives on how to protect kids from the sun's harmful rays.
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References:
American Academy of Pediatrics. (2011). Ultraviolet radiation: A hazard to children and adolescents. Pediatrics, 127(3), 588-597. doi:10.1542/peds.2010-3501
Center for Biological Diversity. (2021, March 9). Hawai’I senate bill bans harmful sunscreen chemicals. https://biologicaldiversity.org/w/news/press-releases/hawaii-senate-bill-bans-harmful-sunscreen-chemicals-2021-03-09/
Mangus, C.W., & Canares, T.L. (2019). Heat-related illness in children in an era of extreme temperatures. Pediatrics in Review, 40(3), 97-107. doi: 10.1542/pir.2017-0322
U.S. Food & Drug Administration. (2017). Sun protective factor (SPF). Retrieved online from https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/sun-protection-factor-spf
Having a sense of fashion and listening to what the style gurus tell us "what not to wear" is similar to provider practice and the clinical practice guidelines published by our national authorities. Yet, somehow jorts came back into fashion and albuterol trials remain common practice for bronchiolitis. What will you wear and do?
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References
Condella, A., Mansbach, J.M., Hasegawa, K., Dayan, P.S., Sullivan, A.F., Espinola, J.A., & Camargo, C.A. (2018). Multicenter study of albuterol use among infants hospitalized with bronchiolitis. Western Journal of Emergency Medicine, 19(3), 475-483. doi: 10.5811/westjem.2018.3.35837
Ralston, S.L., Lieberthal, A.S., Meissner, H.C., Alverson, B.K., Baley, J.E., Gadomski, A.M… & Hernandez-Cancio, S. (2014). Clinical practice guideline: The diagnosis, management, and prevention of bronchiolitis. Pediatrics, 134(5), e1474-e1502. doi: 10.1542/peds.2014-2742
When patients (or parents!) use unique phrasing of a phenomenon, we must interpret their description of the experience in laymen's terms using clarifying questions while being attentive to inaccurate use of medical terms. Let a kid tell you their story and you'll learn everything you need to know. Hear what I mean with a couple of real GI examples from my week.
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References
Tate, J.E., & Bresee, J.S. (2012). Principles and Practice of Pediatric Infectious Diseases (Fourth ed.). Elsevier: China.
I've got incredible burrito-eating skills like you've never seen. These epic Tex-Mex talents translate to test-taking strategies that are a sure-fire way to effectively implement critical thinking.
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References:
Fernandez-Plaza, A., Saiz-Mendiguren, R., Garcia-Lallana, A., Viteri-Ramirez, G., Etxano, J., & Bondia Garcia, J.M. (2012). Ileo-ileal intussusceptions in a child complainting of abdomnial pain. Eurorad, Case 10092. doi: 10.1594/EURORAD/CASE.10092
Maaks, D.L.G., Starr, N.B., Brady, M.A., Gaylord, N.M., Driessnack, M., & Duderstadt, K.G. (2019). Pediatric Primary Care (7th ed). St Louis: Saunders Elsevier.
PNCB. (2019). PNCB announces unprecedented action for CPNP-AC exam integrity. Retrieved online from https://www.pncb.org/sites/default/files/resources/CPNP-AC_Exam_Press_Release_FINAL_3-4-2019.pdf
Wiersma, F., Allema, J.H., & Holscher, H.C. (2006). Ileoileal intussusception in children: ultrasonographic differentiation from ileocolic intussusception. Paediatric Radiology, 36(11), 1177-1181. doi: 10.1007/s00247-006-0311-2
Ten percent of Americans report an allergy to amoxicillin, yet most of these don't represent a true allergy. Today we discuss the types of drug allergies, how to determine if the allergy can be removed, and second line drugs for true PCN allergy with the goal of being outstanding stewards of antimicrobial stewardship.
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References
American Academy of Pediatrics. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), p. e964-e999. doi:10.1542/peds.2012-3488
Chaudry, S.B., Veve, M.P., & Wagner, J.L. (2019). Cephalosporins: A focus on side chains and beta-lactam cross reactivity. Pharmacy, 7(3), p. 103. doi: 10.3390/pharmacy7030103
Mill, C., Primeau, M.N., Medoff, E., Lejtenyi, C., O’Keffe, A., Netchiporouk, E., … & Ben-Shoshan, M. (2016). Assessing the diagnostic properties of a graded oral provocation challenge for the diagnosis of immediate and nonimmediate reactions to amoxicillin in children. JAMA Pediatrics, 170(6), e160033. doi:10.1001/jamapediatrics.2016.0033
Shenoy, E.S., Macy, E., Rowe, T., & Blumenthal, K.G. (2019). Evaluation and management of penicillin allergy: A review. JAMA, 321(2), p. 188-199. doi:10.1001/jama.2018.19283
Shulman, S.T., Bisno, A.L., Clegg, H.W., Gerber, M.A., Kaplan, E.L., Lee, G., … & Van Beneden, C. (2012) Clinical practice guideline for the diagnosis and management of Group A Streptococcal pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 55(10), p. e86-102. DOI: 10.1093/cid/cis629
Vyles, D., Chiu, A., Routes, J., Castells, M., Phillips, E.J., Kibicho, J., & Brousseau, D.C. (2018). Antibiotic use after removal of penicillin allergy label. Pediatrics, 141(5), e20173466. doi: 10.1542/peds.2017-3466.
"What's wrong with your legs?' 'Nothin' at all, thank you. My legs are just fine and dandy.'" This episode takes a line from Forrest Gump and RUNS with it. It's important for providers to know normal MSK development from an intrauterine fetus to the running child so that you can give parents reassurance for normal, expected defects while referring true deformities.
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References:
Espandar, R., Mortazavi, S.M.J., & Baghdadi, T. (2010). Angular deformities of the lower limb in children. Asian Journal of Sports Medicine, 1(1), p. 46-53. doi: 10.5812/asjsm.34871
Gupta, P., Gupta, V., Patil, B., & Verma, V. (2020). Angular deformities of lower limb in children: Correction for whom, when and how? Journal of Clinical Orthopedics and Trauma, 11(2020), p. 196-201. https://doi.org/10.1016/j.jcot.2020.01.008
Scherl, S.A. (2004). Common lower extremity problems in children. Pediatrics in Review, 25(2), p. 52-62. doi: 10.1542/pir.25-2-52

Season 4: Acute Care

Whether you're presenting in class, for colleagues, or on a national stage, it's important to have the tools and skills to disseminate your work in a scholarly way. This week's show focuses on helping you with presentation format, PowerPoint visuals, and presentation skills to help you stand out and confidently demonstrate your expertise.
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References:
Cuddy, A. (2012). Your body language may shape who you are. Retrieved online from https://www.ted.com/talks/amy_cuddy_your_body_language_may_shape_who_you_are?language=en#t-603306
Morgan, N. (2011). Why we fear public speaking and how to overcome it. Retrieved online from https://www.forbes.com/sites/nickmorgan/2011/03/30/why-we-fear-public-speaking-and-how-to-overcome-it/?sh=5a85243f460b
Nutrition is arguably the most important component of care in children with critical illness, yet its importance often falls down the list of priorities. Many questions remain on how best to manage nutrition in pediatric critical care, but this episode addresses many best practices from the SCCM and ASPEN's Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient.
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References
Mehta NM, Bechard LJ, Zurakowski D et al. Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study. Am J Clin Nutr. 2015;102:199-206.
Mehta NM, Skillman HE, Irving SY, Coss-Bu JA, Vermilyea S, Farrington EA, McKeever L, Hall AM, Goday PS, Braunschweig C. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Pediatr Crit Care Med. 2017 Jul;18(7):675-715. doi: 10.1097/PCC.0000000000001134. PMID: 28691958.
The 2014 AAP guidelines on the treatment of bronchiolitis are a provider's medical decision-making and management compass, but how can we interpret the vague or absent recommendations involving advanced care of patients requiring hospitalization? This episode covers the recent evidence published since the 2014 guidelines and helps to provide some direction on key issues for patients in need of greater respiratory support.
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References:
Coletti, KD, Bagdure DN, Walker LK, Remy KE, Custer JW. High flow nasal cannula utilization in pediatric critical care: an observational study. Respir Care 2017;62(8):1023-1029.
Elliott, S.A., Gaudet, L.A., Fernandes, R.M., Vandermeer, B., Freedman, S.B., Johnson, D.W., &… Hartling, L. (2021) Comparative efficacy of bronchiolitis interventions in acute care: A network meta-analysis. Pediatrics, 147(5), e2020040816. doi: 10.1542/peds.2020-040816.
Kalburgi, S., & Halley, T. (2020). High-flow nasal cannula use outside of the ICU setting. Pediatrics, 146(5), e20194083. doi: 10.1542/peds.2019-4083.
Leyenaar, J.K., & Ralston, S.L. (2020). Widespread adoption of low-value therapy: The case of bronchiolitis and high-flow oxygen. Pediatrics, 146(5), e2020021188. doi: 10.1542/peds.2020-021188.
Mahant, S., Wahi, G., Bayliss, A., Giglia, L., Kanani, R., Pound, C.M., & … Canadian Paediatric Inpatient Research Network (PIRN). (2021). Intermittent vs continuous pulse oximetry in hospitalized infants with stabilized bronchiolitis: A randomized clinical trial. JAMA Pediatrics, 175(5), p. 466-474. doi: 10.1001/jamapediatrics.2020.6141.
Mallory, M.D., Shay, D.K., Garrett, J., & Bordley, W.C. (2003) Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit. Pediatrics, 111(1), e45-51. doi: 10.1542/peds.111.1.e45.
Cardiogenic shock occurs in children for a variety of reasons, and there are a variety of vasoactive drugs available to treat the critical condition. But first we need to understand the pathophysiology and pharmacology to best select the drug for the job, which is no easy task.
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References
Bolick, B.N., Reuter-Rice, K., Madden, M.A., Severin, P.N. (2020). Pediatric Acute Care: A guide for Interprofessional Practice (2nd ed.). Jones & Barlett Learning. Burlington, MA.
CDC. (2020). Data and statistics on congenital heart defects. Retrieved online from https://www.cdc.gov/ncbddd/heartdefects/data.html
Hughes, H.K., & Kahl, L.K. (2021). Harriet Lane Handbook. Manual for Pediatric House Officers (22nd ed.). Philadelphia, PA: Mosby.
Manaker, S., Parsons, P.E., & Finlay, G. (2020). Use of vasopressors and inotropes. Retrieved online from https://www.uptodate.com/contents/use-of-vasopressors-and-inotropes?csi=40383b7b-fb7e-48d4-a09d-2d8706878bb1&source=contentShare
Pringle, C.L. (2017). PICU Essentials (1.4.0.305) [Mobile application software]. Retrieved from https://apps.apple.com/us/app/picu-essentials/id1207366521.
In the first ever guest interview on The Peds NP, pediatric gastroenterologist John Lyles talks with us about pathologic hyperbilirubinemia and inflammatory bowel disease.
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Infections in the central nervous system can be very dangerous in children, so prompt recognition and treatment is important to avoid morbidity and mortality. A review of various etiologies of CNS infections and their workup yields a valuable discussion on a pearl of wisdom that any provider needs to understand.
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References
American Academy of Pediatrics. (2018). Meningococcal infections. In Kimberlin, D.W., Brady, M.T., Jackson, M.A., & Long, S.S. Red Book (31st ed., pp. 550-561). American Academy of Pediatrics.
Centers for Disease Control and Prevention. (2021). Immunization schedules. Retrieved online from https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
Pantell, R.H., Roberts, K.B., Adams, W.G., Dreyer, B.P., Kupperman, N., O’Leary, S.T., Okechukwu, K… & The Subcommittee on Febrile Infants. (2021). Evaluation and management of well-appearing febrile infants 8-60 days old. Pediatrics, 148(2), p. 1-40. doi: https://doi.org/10.1542/peds.2021-052228
Roy, A.G., Panicker, J., & Kumar, A. (2014). Acute CNS infections. Amrita Journal of Medicine, 10(2), p. 1-44.
Swanson, D. (2015). Meningitis. Pediatrics in Review, 36(12), p. 514-526. doi: 10.1542/pir.36-12-514
Recognition of anaphylaxis can be difficult for some providers, and the courage to give epinephrine for treatment can be even more so. Johns Hopkins Allergy & Immunology fellow, Dr. Mansi Kotwal, discusses the anaphylaxis presentation and diagnosis in ways you may not have considered. And she reviews adjunct drugs for management in a way that might just change your practice.
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References:
Sampson, H.A., Muñoz-Furlong, A., Campbell, R.L., Adkinson, N.F., Bock, S.A., Branum, A., et al. (2006). Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Journal of Allergy and Clinical Immunology, 117, p. 391–397.
Human trafficking, specifically sex trafficking, is a worrisome reality that pediatric providers need to recognize and manage with speed and grace. With tools to better understand the at risk populations that may present as hidden victims of this terrible human rights violation, we can better protect our vulnerable child and youth populations.
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References:
Greenbaum, J., & Bodrick, N. (2017). Global human trafficking and child victimization. Policy statement. American Academy of Pediatrics, 140, e20173138.
National Association of Pediatric Nurse Practitioners (Executive Producer). (2021). Child trafficking: Case studies and tools on identifying warning signs [Audio podcast]. TeamPeds Talks. https://anchor.fm/teampeds-talks/episodes/Child-Trafficking-Case-Studies-and-Tools-on-Identifying-Warning-Signs-S3-E3-e1833t0
Peck, J.L., Meadows-Oliver, M., Hays, S.M., & Maaks, D.G. (2020). White paper: Recognizing child trafficking as a critical emerging health threat. Journal of Pediatric Health Care, 35(3), p. 260-269. DOI:https://doi.org/10.1016/j.pedhc.2020.01.005
Philips, A. (2021). 8 terms you should know about human trafficking. Retrieved from https://restorationhousekc.org/6-human-trafficking-terms-you-should-know/
Shared Hope. (2019). Report trafficking. Retrieved from https:// sharedhope.org/join-thecause/report-trafficking/
U.S. Department of Justice. (2020). Child sex trafficking. Retrieved online from https://www.justice.gov/criminal-ceos/child-sex-trafficking
Provider variation has plagued the management of febrile neonates for decades, but the wait for standardization is over! The AAP published its long-awaited recommendations on the evaluation and management of well-appearing febrile infants 8 to 60 days old in August 2021. This episode picks apart the nuances and key features to help pediatric providers provide fast, safe, and effective care to this population. Follow along with full guideline available at https://doi.org/10.1542/peds.2021-052228
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References:
Pantell, R.H., Roberts, K.B., Adams, W.G., Dreyer, B.P., Kupperman, N., O’Leary, S.T., … & Subcommittee on Febrile Infants. (2021). Evaluation and management of well-appearing febrile infants 8 to 60 days old. Pediatrics, 148(2), p. 1-38. https://doi.org/10.1542/peds.2021-052228

Season 5: Primary Care

Season 5 of The Peds NP returns with an introduction to the first exam a person will ever get: The newborn exam. This episode focuses on that first encounter from the prenatal and birth history to the exam and screenings. Learn to concentrate on the unique features of a newborn and consider how to document the findings on this ever-changing patient.
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References:
Chiocca, E. (2019). Advanced pediatric assessment (3rd ed.). Springer Publishing Company.
Hagan, J.F., Shaw, J.S., & Duncan, P. (2017). Bright futures: Guidelines for health supervision of infants, children, and adolescents (4th ed.). American Academy of Pediatrics.
Maaks, D.L.G., Starr, N.B., Brady, M.A., Gaylor, N.M., Driessnack, M., & Duderststadt, K.G. (2019). Burn’s Pediatric Primary Care (7th ed.). Saunders Elsevier.
Dr. Mansi Kotwal, Allergy and Immunology fellow at Johns Hopkins, joins The Peds NP podcast again to talk about a few dermatologic manifestations of allergy. She discusses how history is an essential component of diagnosis and goes on to discuss management of these common and benign conditions in pediatrics.
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The well visit is time to screen for issues in primary care, which includes diet and nutrition. Picky eating is a common problem that often plagues parents, especially when parenting styles or child development clashes with recommended feeding practices. Dr. John Lyles joins The Peds NP to discuss evaluation and recommendations for feeding difficulties in primary care.
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References:
Boruta, M.K.R., Lyles, J., Mavis, A.M., & Morgan, S. (in press). Pediatric gastrointestinal and liver disorders. In Encyclopedia of Child and Adolescent Health.
Kerzner, B., Milano, K., MacLean, W.C., Berall, G., Stuart, S., & Chatoor, I. (2015). A practical approach to classifying and managing feeding difficulties. Pediatrics, 135(2), p. 344-353. doi: 10.1542/peds.2014-1630
Menella, J.A., & Bobowski, N.K. (2015). The sweetness and bitterness of childhood: Insights from basic research on taste preferences. Physiology & Behavior, 152(0), p. 502-507. doi: 10.1016/j.physbeh.2015.05.015
Children with acute gastroenteritis and mild or moderate dehydration can be managed at home with oral rehydration. Learn how to partner with families and take an extra five minutes in your visit to explain the reasoning, detailed instructions, and expectations of home care as we discuss the evidence behind the rationale.
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References:
Carson, R.A., Mudd, S.S., & Madati, P.J. (2016). Clinical practice guideline for the treatment of pediatric acute gastroenteritis in the outpatient setting. Journal of Pediatric Health Care, 30(6), p. 610-616. http://dx.doi.org/10.1016/j.pedhc.2016.04.012
Carson, R.A., Mudd, S.S., & Madati, P.J. (2017). Evaluation of a nurse-initiated acute gastroenteritis pathway in the pediatric emergency department. Journal of Emergency Nursing, 43(5), p. 406-412. doi: 10.1016/j.jen.2017.01.001
Fedorowicz, Z., Jagannath, V. A., & Carter, B. (2011). Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. The Cochrane Collaboration, 9. doi: 10.1002/144651858.CD005506.pub5.
Freedman, S.B., Ali, S., Oleszczuk, M., Gouin, S., & Hartling, L. (2013). Treatment of acute gastroenteritis in children: An overview of systematic reviews of interventions commonly used in developed countries. Evidence-Based Child Health: A Cochrane Review Journal, 8, 1123-1137. doi: 10.1002/ebch.1932
Freedman, S. B., Gouin, S., Bhatt, M., Black, K. J., Johnson, D., Guimont, C.,…Plint, A. (2011). Prospective assessment of practice pattern variations in the treatment of pediatric gastroenteritis. Pediatrics, 127(2), e287-95. doi: 10.1542/peds.2010-2214
Freedman SB, Willan AR, Boutis K, Schuh S. Effect of dilute apple juice and preferred fluids vs electrolyte maintenance solution on treatment failure among children with mild gastroenteritis: a randomized clinical trial. JAMA. 2016;315(18):1966–1974.
Hartman, S., Brown, E., Loomis, E., & Russell, H.A. (2019). Gastroenteritis in children. American Family Physician, 99(3), p. 159-165. PMID: 30702253.
Nir, V., Nadir, E., Schechter, Y., & Kline-Kremer, A. (2013). Parents’ attitudes toward oral rehydration therapy in children with mild-to-moderate dehydration. The Scientific World Journal, 2013, 1-3. http://dx.doi.org/10.1155/2013/828157
Schnadower, D., Tarr, P.I., Casper, T.C., Gorelick, M.H., Dean, J.M., O’Connell, K.J., Mahajan, P., Levine, A.C., Bhatt, S.R., Roskind, C.G., Powell, E.C., Rogers, A.J., & The PECARN Probiotics Study Group. (2018). Lactobacillus rhamnosus GG versus placebo for acute gastroenteritis in children. New England Journal of Medicine, 379(21), p. 2002-2014. doi: 10.1056/NEJMoa1802598
World Health Organization. (2005). The treatment of diarrhoea: A manual for physicians and other senior health workers. 2005. http://apps.who.int/iris/bitstream/10665/43209/1/9241593180.pdf. Accessed March 3, 2022.
Two of the most common over-the-counter medications in pediatrics are not as simple and benign as you might think. This episode uncovers the dark past of acetaminophen, the pearls and pitfalls of prescribing them, and how to talk to families about giving the medications safely.
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References:
Clark, E., Plint, A.C., Correll, R., Gaboury, I., & Passi, B. (2007). A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma. Pediatrics , 119 (3): 460–467. doi: 10.1542/peds.2006-1347
Jones, K., Engler, L., Fonte, E., et al. (2021). Opioid reduction through postoperative pain management in pediatric orthopedic surgery. Pediatrics, 148(6):e2020001487
Kleinman, K., McDaniel, L., & Molloy, M. (2021). The Harriet Lane handbook (the Johns Hopkins Hospital) (22nd ed.). Elsevier.
Miller, T.C. & Gerth, J. (2013). Dose of confusion. Propublica. https://www.propublica.org/article/tylenol-mcneil-fda-kids-dose-of-confusion
National Capital Poison Center. (2020). Poison statistics. https://www.poison.org/poison-statistics-national.
Sullivan, J.E., Farrar, H.C., & the Section on Clinical Pharmacology and Therapeutics, Committee on Drugs. (2011). Fever and antipyretic use in children. Pediatrics , 127(3): 580–587. doi: 10.1542/peds.2010-3852
Trippella, G., Ciarcià, M., de Martino, M., & Chiappini, E. (2019). Prescribing controversies: An updated review and meta-analysis on combined/alternating use of ibuprofen and paracetamol in febrile children. Frontiers in Pediatrics, 7:217. doi: 10.3389/fped.2019.00217.
Yin, H.S., Neuspiel, D.R., Paul, I.M., et al. (2021). Preventing home medication administration errors. Pediatrics,148(6): e2021054666

Season 6: Babies (Primary Care)

With national formula shortages over 40% and growing, the pediatric provider can encourage the establishment and maintenance of breastfeeding in moms who have chosen this path. Breastfeeding isn't without struggles and woes, so providers can help support mothers by understanding these tips and advising the pair when the process isn't as easy as it seems.
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References:
American Academy of Pediatrics. (2021). Breastfeeding overview. Retrieved from https://www.aap.org/en/patient-care/breastfeeding/breastfeeding-overview/
La Lache League. (2022). Breastfeeding info A to Z. Retrieved from https://www.llli.org/breastfeeding-info/
Laura R. Kair, Daniel Kenron, Konnette Etheredge, Arthur C. Jaffe, Carrie A. Phillipi (2013). Pacifier restriction and exclusive breastfeeding. Pediatrics, 131 (4): e1101–e1107. 10.1542/peds.2012-2203
Nice, F.J., & Francell, M. (2020). Selection and use of galactogogues. Leader Today. Retrieved from https://www.llli.org/selection-and-use-of-galactagogues-2/
Pisani, J. (2022). Why is there a baby formula shortage? What to know and what is being done about it. The Wall Street Journal. https://www.wsj.com/articles/why-baby-formula-shortage-11652188230
Thompson, D. (2022). What’s behind America’s shocking baby-formula shortage? The Atlantic. https://www.theatlantic.com/ideas/archive/2022/05/baby-formula-shortage-abbott-recall/629828
Vision screening is one of the most important preventative health screenings that a primary care provider does at well visits. But the infant eye exam can feel obtuse and complicated if you don't understand vision development, physical exam maneuvers, and red flags for referral. Because of the risk of significant amblyopia if ocular pathology is left untreated, every pediatric provider should know how to complete an age-appropriate vision screening in an infant.
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References:
American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. (2012). Preferred practice pattern guidelines. Pediatric eye evaluations. American Academy of Ophthalmology.
Bell, A.L., Rodes, M.E., & Collier Kellar, L. (2013). Childhood eye examination. American Family Physician, 88(4), p. 241-248.
Brookman K. E. (1983). Ocular accommodation in human infants. American journal of optometry and physiological optics, 60(2), 91–99. https://doi.org/10.1097/00006324-198302000-00001
Loh, A.R., & Chiang, M.F. (2018). Pediatric vision screening. Pediatrics in Review, 39(5), 225-234.
Rosenfield, M. Development of accommodation in human infants. Retrieved from https://entokey.com/development-of-accommodation-in-human-infants/
Wang, J., & Candy, T. R. (2010). The sensitivity of the 2- to 4-month-old human infant accommodation system. Investigative ophthalmology & visual science, 51(6), 3309–3317. https://doi.org/10.1167/iovs.09-4667
Infant dyschezia refers to the discomfort an infant experiences when bearing down against a closed anal sphincter, and is often misidentified as constipation by parents. As long as red flags are absent, this functional, self-limited condition is easily diagnosed using the Rome IV Criteria. In this episode, you will learn how to reassure parents and what contraindicated treatments should be discussed.
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References:
Children’s Wisconsin. (2020). Infants straining to move bowels. https://childrenswi.org/-/media/chwlibrary/publication-media-library/2020/03/30/20/48/2144en.pdf
LeLeiko, N. S., Mayer-Brown, S., Cerezo, C., & Plante, W. (2020). Constipation. Pediatrics in review, 41(8), 379–392. https://doi.org/10.1542/pir.2018-0334
Tabbers, M. M., DiLorenzo, C., Berger, M. Y., Faure, C., Langendam, M. W., Nurko, S., Staiano, A., Vandenplas, Y., Benninga, M. A., European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, & North American Society for Pediatric Gastroenterology (2014). Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of pediatric gastroenterology and nutrition, 58(2), 258–274. https://doi.org/10.1097/MPG.0000000000000266
Zeevenhooven, J., Koppen, I. J., & Benninga, M. A. (2017). The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers. Pediatric gastroenterology, hepatology & nutrition, 20(1), 1–13. https://doi.org/10.5223/pghn.2017.20.1.1
When accelerated BSN student Sam Mahaney wanted more practical bedside application of his knowledge of pediatric cardiology, we sat down to discuss the approach to assessment and management of undiagnosed and undifferentiated congenital heart disease from a primary care perspective. The primary care clinician should be on the lookout for red flags in the history and physical exam that might suggest critical congenital heart disease and screen appropriately. This episode has helpful perspectives for both the nurse and advanced practice provider.
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References:
Abdurrahman, L., Bockoven, J. R., Pickoff, A. S., Ralston, M. A., & Ross, J. E. (2003). Pediatric cardiology update: Office-based practice of pediatric cardiology for the primary care provider. Current problems in pediatric and adolescent health care, 33(10), 318–347. https://doi.org/10.1016/s1538-5442(03)00137-8
CDC. (2022). Critical congenital heart defects. Retrieved from https://www.cdc.gov/ncbddd/heartdefects/cchd-facts.html.
Cleveland Clinic. (2022). Cyanotic heart disease. Retrieved from https://my.clevelandclinic.org/health/diseases/22441-cyanotic-heart-disease
Glidewell, J., Grosse, S.D., Riehle-Colarusso, T., Pinto, N., Hudson, J., Daskalov, R., Gaviglio, A., Darby, E., Singh, S., & Sontag, M. (2019) Actions in support of newborn screening for critical congenital heart disease — United States, 2011–2018. Morbity and Mortality Weekly Report, 68:107–111. DOI: http://dx.doi.org/10.15585/mmwr.mm6805a3external icon
Mahle, W. T., Martin, G. R., Beekman, R. H., 3rd, Morrow, W. R., & Section on Cardiology and Cardiac Surgery Executive Committee (2012). Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics, 129(1), 190–192. https://doi.org/10.1542/peds.2011-3211
Martin, G. R., Ewer, A. K., Gaviglio, A., Hom, L. A., Saarinen, A., Sontag, M., Burns, K. M., Kemper, A. R., & Oster, M. E. (2020). Updated Strategies for Pulse Oximetry Screening for Critical Congenital Heart Disease. Pediatrics, 146(1), e20191650. https://doi.org/10.1542/peds.2019-1650
Puri, K., Allen, H. D., & Qureshi, A. M. (2017). Congenital Heart Disease. Pediatrics in review, 38(10), 471–486. https://doi.org/10.1542/pir.2017-0032
Strobel, A. M., & Lu, l. (2015). The Critically Ill Infant with Congenital Heart Disease. Emergency medicine clinics of North America, 33(3), 501–518. https://doi.org/10.1016/j.emc.2015.04.002
Developmental surveillance and screening work best to identify delays when used together. The AAP and CDC teamed up to create a standardized developmental milestone checklist in order to improve the longitudinal monitoring of pediatric milestones at home by caregivers. This episode reviews their publication and discusses what went into the checklist, its strengths, and areas for further research.
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References:
CDC. (2022). Developmental surveillance resources for healthcare providers. Retrieved from https://www.cdc.gov/ncbddd/actearly/hcp/index.html.
Zubler JM, Wiggins LD, Macias MM, et al. Evidence-InformedMilestones for Developmental Surveillance Tools. Pediatrics. 2022;149(3):e2021052138

Season 7: Cognitive Bias in Healthcare

This episode is the first installment on a new mini series on cognitive bias in pediatric healthcare. We begin by discussing what cognitive bias is, how it becomes diagnostic error, and the impact on healthcare in America. Begin to think about how you think and explore the interesting ways our brains use mental shortcuts to arrive at an answer.
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References:
Balogh, E. P., Miller, B. T., Ball, J. R., Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine, & The National Academies of Sciences, Engineering, and Medicine (Eds.). (2015). Improving Diagnosis in Health Care. National Academies Press (US).
Berkwitt, A., & Grossman, M. (2014). Cognitive bias in inpatient pediatrics. Hospital pediatrics, 4(3), 190–193. https://doi.org/10.1542/hpeds.2014-0002
Bordini, B. J., Stephany, A., & Kliegman, R. (2017). Overcoming Diagnostic Errors in Medical Practice. The Journal of pediatrics, 185, 19–25.e1. https://doi.org/10.1016/j.jpeds.2017.02.065
Carberry, A. R., Hanson, K., Flannery, A., Fischer, M., Gehlbach, J., Diamond, C., & Wald, E. R. (2018). Diagnostic Error in Pediatric Cancer. Clinical pediatrics, 57(1), 11–18. https://doi.org/10.1177/0009922816687325
CRICO. (2014). Malpractice risks in the diagnostic process. Retrieved from
https://www.rmf.harvard.edu/Malpractice-Data/Annual-Benchmark-Reports/Risks-in-the-Diagnostic-Process
Institute of Medicine (US) Committee on Quality of Health Care in America. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press (US).
Institute of Medicine (US) Committee on Quality of Health Care in America, Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To Err is Human: Building a Safer Health System. National Academies Press (US).
National Geographic Kids. (No date). 10 facts about great white sharks! Retrieved from https://www.natgeokids.com/uk/discover/animals/sea-life/great-white-sharks/
Royce, C.S., Hayes, M.M., & Schwartzstein, R.M. (2019). Teaching critical thinking: A case for instruction in cogntitive biases to reduce diagnostic errors and improve patient safety.
There are many factors that contribute to the way we perceive and interpret information... and lots of ways that our brains skew our perspectives that can lead to cognitive bias. The second episode in our Cognitive Bias in Healthcare mini-series discusses the features of information delivery that impact our decision-making and how our brains distort them to cause diagnostic error.
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References:
Arokszallasi, T., Balogh, E., Csiba, L., Fekete, I., Fekete, K., & Olah, L.. (2019). Acute alcohol intoxication may cause delay in stroke treatment – case reports. BMC Neurology, 19, 14. https://doi.org/10.1186/s12883-019-1241-6
Berkwitt, A., & Grossman, M. (2014). Cognitive bias in inpatient pediatrics. Hospital pediatrics, 4(3), 190–193. https://doi.org/10.1542/hpeds.2014-0002
Clark, B. W., Derakhshan, A., & Desai, S. V. (2018). Diagnostic Errors and the Bedside Clinical Examination. The Medical clinics of North America, 102(3), 453–464. https://doi.org/10.1016/j.mcna.2017.12.007
Croskerry, P., Singhal, G., & Mamede, S. (2013). Cognitive debiasing 2: impediments to and strategies for change. BMJ quality & safety, 22 Suppl 2(Suppl 2), ii65–ii72. https://doi.org/10.1136/bmjqs-2012-001713
Galvani, A. P., Parpia, A. S., Foster, E. M., Singer, B. H., & Fitzpatrick, M. C. (2020). Improving the prognosis of health care in the USA. Lancet (London, England), 395(10223), 524–533. https://doi.org/10.1016/S0140-6736(19)33019-3
Mamede, S., Splinter, T.A.W., Gog, T., Rikers, R., & Schmidt, H.G. (2012). Exploring the role of salient distracting clinical features in the emergence of diagnostic errors and the mechanisms through which reflection counteracts mistakes. BMJ Quality & Safety, 21, p. 295-300. doi:10.1136/bmjqs-2011-000518
Marshall, T.L., Rinke, M.L., Olson, A.P.J., Brady, P.W. (2022). Diagnostic error in pediatrics: A narrative review. Pediatrics, 149 (Supplement 3): e2020045948D. 10.1542/peds.2020-045948D
In the first case study of our mini-series on Cognitive Bias in Health Care, we meet a 4 month old female referred to the emergency department for constipation. Spoiler alert: We know it's not constipation... so we explore how her presentation and physical exam clash with the initial medical decision making. Try to spot the cognitive bias and test yourself on building a differential diagnosis. Lastly, we explore 4 best practice techniques to help you avoid bias in the first place.
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References
Abimanyi-Ochom, J., Bohingamu Mudiyanselage, S., Catchpool, M., Firipis, M., Wanni Arachchige Dona, S., & Watts, J. J. (2019). Strategies to reduce diagnostic errors: a systematic review. BMC medical informatics and decision making, 19(1), 174. https://doi.org/10.1186/s12911-019-0901-1
Benninga, M. A., Faure, C., Hyman, P. E., St James Roberts, I., Schechter, N. L., & Nurko, S. (2016). Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology, S0016-5085(16)00182-7. https://doi.org/10.1053/j.gastro.2016.02.016
Bolick, B.N., Reuter-Rice, K., Madden, M.A., & Severin, P.A. (2021). Pediatric Acute Care: A Guide for Interprofessional Practice (2nd ed). Elsevier.
Centers for Disease Control and Prevention. (2021). Botulism: Diagnosis and treatment. https://www.cdc.gov/botulism/testing-treatment.html
Committee on Diagnostic Error in Health Care; Board on Health Care Services; Institute of Medicine; The National Academies of Sciences, Engineering, and Medicine; Balogh EP, Miller BT, Ball JR, editors. Improving Diagnosis in Health Care. Washington (DC): National Academies Press (US); 2015 Dec 29. 3, Overview of Diagnostic Error in Health Care. Available from: https://www.ncbi.nlm.nih.gov/books/NBK338594/
Ely, J. W., & Graber, M. A. (2015). Checklists to prevent diagnostic errors: a pilot randomized controlled trial. Diagnosis (Berlin, Germany), 2(3), 163–169. https://doi.org/10.1515/dx-2015-0008
Graber, M. L., Sorensen, A. V., Biswas, J., Modi, V., Wackett, A., Johnson, S., Lenfestey, N., Meyer, A. N., & Singh, H. (2014). Developing checklists to prevent diagnostic error in Emergency Room settings. Diagnosis (Berlin, Germany), 1(3), 223–231. https://doi.org/10.1515/dx-2014-0019
Marshall, T.L., Rinke, M.L., Olson, A.P.J., Brady, P.W. (2022). Diagnostic error in pediatrics: A narrative review. Pediatrics, 149 (Supplement 3): e2020045948D. 10.1542/peds.2020-045948D
O’Hagan, T., Fennell, J., Tan, K., Ding, D., & Thomas-Jones, I. (2019). Cognitive bias in the clinical decision making of doctors. Future Healthcare Journal, 6(1), s113.
Tabbers, M. M., DiLorenzo, C., Berger, M. Y., Faure, C., Langendam, M. W., Nurko, S., Staiano, A., Vandenplas, Y., Benninga, M. A., European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, & North American Society for Pediatric Gastroenterology. (2014). Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of Pediatric Gastroenterology and Nutrition, 58(2), 258–274. https://doi.org/10.1097/MPG.0000000000000266
The Canadian Medical Protection Authority. Common cognitive biases: Influences on decision making. Good Practices Guide. https://www.cmpa-acpm.ca/serve/docs/ela/goodpracticesguide/pages/human_factors/Cognitive_biases/common_cognitive_biases-e.html
Zabidi-Hussin Z. A. (2016). Practical way of creating differential diagnoses through an expanded VITAMINSABCDEK mnemonic. Advances in medical education and practice, 7, 247–248. https://doi.org/10.2147/AMEP.S106507
The next case study in our series on cognitive bias in healthcare follows an obese adolescent female with arm and neck pain who felt unheard during the 4 prior emergency room visits that week. Listen as the differential diagnosis takes on a completely different angle and the pressure of making the diagnosis goes sky high! We will unpack additional forms of cognitive bias and 2 more best practices for avoiding diagnostic error in the clinical setting.
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References:
Hulens, M., Rasschaert, R., Vansant, G., Stalmans, I., Bruyninckx, F., & Dankaerts, W. (2018). The link between idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome: exploration of a shared pathophysiology. Journal of pain research, 11, 3129–3140. https://doi.org/10.2147/JPR.S186878
Mondragon J, Klovenski V. Pseudotumor Cerebri. [Updated 2022 Sep 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536924/
Norris, D., Clark, M. S., & Shipley, S. (2016). The Mental Status Examination. American family physician, 94(8), 635–641.
Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity reviews : an official journal of the International Association for the Study of Obesity, 16(4), 319–326. https://doi.org/10.1111/obr.12266
The Canadian Medical Protection Authority. Common cognitive biases: Influences on decision making. Good Practices Guide. https://www.cmpa-acpm.ca/serve/docs/ela/goodpracticesguide/pages/human_factors/Cognitive_biases/common_cognitive_biases-e.html
Villines, Z. (2021). What to know about obesity discrimination in health care. Medical News Today. https://www.medicalnewstoday.com/articles/obesity-discrimination-in-healthcare
In the last case study in our series on Cognitive Bias in Healthcare, attribution error (among others) of an adolescent female with foot burning reveals how two more best practices for avoiding cognitive bias can help providers think metacognitively. Review all 8 best practices and start to implement them to reduce diagnostic error.
Listen here

References:
Marshall, T.L., Rinke, M.L., Olson, A.P.J., Brady, P.W. (2022). Diagnostic error in pediatrics: A narrative review. Pediatrics, 149 (Supplement 3): e2020045948D. 10.1542/peds.2020-045948D
The Canadian Medical Protection Authority. Common cognitive biases: Influences on decision making. Good Practices Guide. https://www.cmpa-acpm.ca/serve/docs/ela/goodpracticesguide/pages/human_factors/Cognitive_biases/common_cognitive_biases-e.html
Yale, S. C., Cohen, S. S., Kliegman, R. M., & Bordini, B. J. (2022). A pause in pediatrics: implementation of a pediatric diagnostic time-out. Diagnosis (Berlin, Germany), 9(3), 348–351. https://doi.org/10.1515/dx-2022-0010

Season 8: Primary Care

If you've been looking for a New Year's Resolution to make a real difference in your practice, stop prescribing diphenhydramine. Despite being a common over-the-counter medication, its potent anticholinergic side effects and sedation make it a poor choice for children. Review the common misuses for the drug and practical, evidence-based alternatives to help get diphenhydramine out of your prescribing practice in 2023.
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References:
Bachur RG, Monuteaux MC, Neuman MI. A comparison of acute treatment regimens for migraine in the emergency department. Pediatrics 2015;135:232-238.
Brady, K.B. (2020). 'Benadryl challenge": What pediatricians need to know. AAP News. Retrieved from https://publications.aap.org/aapnews/news/6210/Benadryl-Challenge-What-pediatricians-need-to-know
Chehab, H., Fischer, P. R., & Christenson, J. C. (2021). Preparing Children for International Travel. Pediatrics in Review, 42(4), 189–202. https://doi.org/10.1542/pir.2018-0353
Ghossein N, Kang M, Lakhkar AD. Anticholinergic Medications. [Updated 2022 May 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555893/
Green, J.L., Wang, G.S., Reynolds, K.M., Banner, W., Bond, G.R., Kauffman, R.E., Palmer, R.B., Paul, I.M., Dart, R.C. (2017). Safety profile of cough and cold medication use in pediatrics. Pediatrics, 139(6), e20163070. doi: 10.1542/peds.2016-3070
Guthrie, C.C., & Nathani, Y. (2019). Acute treatment of pediatric migraine. Pediatric Emergency Medicine Reports. Relias Media. Retrieved https://www.reliasmedia.com/articles/144150-acute-treatment-of-pediatric-migraine
Palmer, R. B., Reynolds, K. M., Banner, W., Bond, G. R., Kauffman, R. E., Paul, I. M., Green, J. L., & Dart, R. C. (2020). Adverse events associated with diphenhydramine in children, 2008-2015. Clinical toxicology (Philadelphia, Pa.), 58(2), 99–106. https://doi.org/10.1080/15563650.2019.1609683
Paul, I.M., Yoder, K.E., Crowell, K.R., Shaffer, M.L., McMillan, H.S., Carlson, L.C., Dilworth, D.A., Berlin, C.M. (2004). Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents. Pediatrics, 114(1), e85-e90. doi: 10.1542/peds.114.1.e85
Shaker, M. S., Wallace, D. V., Golden, D. B. K., Oppenheimer, J., Bernstein, J. A., Campbell, R. L., Dinakar, C., Ellis, A., Greenhawt, M., Khan, D. A., Lang, D. M., Lang, E. S., Lieberman, J. A., Portnoy, J., Rank, M. A., Stukus, D. R., Wang, J., Collaborators, Riblet, N., Bobrownicki, A. M. P., … Wang, J. (2020). Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. The Journal of allergy and clinical immunology, 145(4), 1082–1123. https://doi.org/10.1016/j.jaci.2020.01.017
Stern J, Pozun A. Pediatric Procedural Sedation. [Updated 2022 Sep 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572100/
Trottier ED, Bailey B, Lucas N, Lortie A. Prochlorperazine in children with migraine: A look at its effectiveness and rate of akathisia. Am J Emerg Med 2012;30:456-463
Not all bacterial infections need an antibiotic. It may sound hard to believe, but if we all followed the AAP guidelines on the management of otitis media in children and actually used a watch-and-wait approach in appropriate patients, upwards of 75% of the antibiotics prescribed for otitis media could be avoided. Why? Because the microbiology of AOM has changed, but our prescribing practices haven't. This episode is a great guideline refresher and microbiology update while learning how to talk parents into partnership on watchful waiting.
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References:
American Academy of Pediatrics. (2019). Chapter quality network improving antibiotic prescribing for children: Change package. Retrieved from https://downloads.aap.org/DOCCSA/CQN%20ABX%20Change%20Package%20Final%20October%202019.pdf
Frost, H. M., & Hersh, A. L. (2022). Rethinking Our Approach to Management of Acute Otitis Media. JAMA pediatrics, 176(5), 439–440. https://doi.org/10.1001/jamapediatrics.2021.6575
Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., Joffe, M. D., Miller, D. T., Rosenfeld, R. M., Sevilla, X. D., Schwartz, R. H., Thomas, P. A., & Tunkel, D. E. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964–e999. https://doi.org/10.1542/peds.2012-3488
Sanchez, G.V., Fleming-Dutra, K.E., Roberts, R.M., & Hicks, L.A. (2016). Core elements of outpatient antibiotic stewardship. MMRW Recomm Rep., 65(6), p. 1-12. doi: 10.15585/mmrw.rr.6506a1
Smolinski, N. E., Antonelli, P. J., & Winterstein, A. G. (2022). Watchful Waiting for Acute Otitis Media. Pediatrics, 150(1), e2021055613. https://doi.org/10.1542/peds.2021-055613
Sun, D., McCarthy, T. J., & Liberman, D. B. (2017). Cost-Effectiveness of Watchful Waiting in Acute Otitis Media. Pediatrics, 139(4), e20163086. https://doi.org/10.1542/peds.2016-3086
Venekamp, R. P., Sanders, S. L., Glasziou, P. P., Del Mar, C. B., & Rovers, M. M. (2015). Antibiotics for acute otitis media in children. The Cochrane database of systematic reviews, 2015(6), CD000219. https://doi.org/10.1002/14651858.CD000219.pub4
Just because you can, doesn't mean you should. In the depths of respiratory virus season, providers often order unnecessary tests that won't alter the course of treatment for the child presenting with upper respiratory symptoms. This episode covers 5 common pathogens, the indications to test a child presenting with symptoms, and how to talk to families requesting tests.
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References:
Centers for Disease Control and Prevention (2022). Influenza antiviral medications: Summary for clinicians. Retrieved from https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#Table1
Frost, H. M., & Hersh, A. L. (2022). Rethinking Our Approach to Management of Acute Otitis Media. JAMA pediatrics, 176(5), 439–440. https://doi.org/10.1001/jamapediatrics.2021.6575
Giovanni Piedimonte, Miriam K. Perez; Respiratory Syncytial Virus Infection and Bronchiolitis. Pediatr Rev December 2014; 35 (12): 519–530. https://doi.org/10.1542/pir.35-12-519
Liu, J. W., Lin, S. H., Wang, L. C., Chiu, H. Y., & Lee, J. A. (2021). Comparison of Antiviral Agents for Seasonal Influenza Outcomes in Healthy Adults and Children: A Systematic Review and Network Meta-analysis. JAMA network open, 4(8), e2119151. https://doi.org/10.1001/jamanetworkopen.2021.19151
Parikh R, Mathai A, Parikh S, Chandra Sekhar G, Thomas R. Understanding and using sensitivity, specificity and predictive values. Indian J Ophthalmol. 2008 Jan-Feb;56(1):45-50. doi: 10.4103/0301-4738.37595. PMID: 18158403; PMCID: PMC2636062.
Spencer D. Johnson, Jennifer S. Harthan, Tammy Than, Mary K. Migneco, Ellen Shorter, Meredith M. Whiteside, Christina E. Morettin, Christian K. Olson, Crystal A. Rosemann, Mathew S. Margolis, Leonard W. Haertter, Julia B. Huecker, Bojana Rodic-Polic, Richard S. Buller, Gregory A. Storch, Mae O. Gordon, Andrew T. E. Hartwick; Predictive Accuracy and Densitometric Analysis of Point-of-Care Immunoassay for Adenoviral Conjunctivitis. Trans. Vis. Sci. Tech. 2021;10(9):30. doi: https://doi.org/10.1167/tvst.10.9.30.
Stanford T. Shulman, Alan L. Bisno, Herbert W. Clegg, Michael A. Gerber, Edward L. Kaplan, Grace Lee, Judith M. Martin, Chris Van Beneden, Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 55, Issue 10, 15 November 2012, Pages e86–e102, https://doi.org/10.1093/cid/cis629
Stanford Medicine. (2022). Common cold in children. Retrieved from https://www.stanfordchildrens.org/en/topic/default?id=upper-respiratory-infection-uri-or-common-cold-90-P02966
Walsh, P. S., Schnadower, D., Zhang, Y., Ramgopal, S., Shah, S. S., & Wilson, P. M. (2022). Association of Early Oseltamivir With Improved Outcomes in Hospitalized Children With Influenza, 2007-2020. JAMA pediatrics, 176(11), e223261. https://doi.org/10.1001/jamapediatrics.2022.3261
World Health Organization. (2019). WHO launches new global influenza strategy. https://www.who.int/news-room/detail/11-03-2019-who-launches-new-global-influenza-strategy
Got milk? The answer is complicated. While plant-based beverages are accused of posing as animal by-product imposters, the FDA claims that consumers know the difference. But most parents don't recognize that plant-based milks lack the same micro and macronutrient profile as cow's milk or soy milk. This leaves pediatric providers with the very important job of assessing nutrition and guiding parents on what beverages their infants and toddlers should be drinking.
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Season 9: Health Equity in Pediatrics

Welcome to the Health Equity in Pediatrics series! In the first installment of our series, we define health equity and review some communities often affected by health disparities that limit a person’s opportunity to be as healthy as possible. While health equity can seem like a seismic public health crisis that is too big for one person to tackle, each episode in this series will give listeners tangible best practices that can be implemented immediately to provide more equitable care in your workplace. As you learn to view every patient encounter through a lens of health equity, you’ll be able to apply these concepts to the evaluation and management of the diverse children for whom you care and improve their journey toward health. When you become a partner in the health equity care plan, rather than just an authority in health care, you bring practicality to your recommendations and interventions that augment the expert knowledge you share. Apply these concepts to a challenging example with a historical precedent that shapes how you understand the approach to overcoming obstacles on the journey to health equity.
Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant. For more information, please community.napnap.org/northcarolinachapter.
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References:
American Psychological Association. (2022). Racial and ethnic identity. https://apastyle.apa.org/style-grammar-guidelines/bias-free-language/racial-ethnic-minorities
Braveman, P., Arkin, E., Orleans, T., Proctor, D., & Plough, A. (2017). What is health equity? Achieving health equity. The Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html
Centers for Disease Control and Prevention. (2022, August 2). Health equity guiding principles for inclusive communication. https://www.cdc.gov/healthcommunication/Health_Equity.html
Duke Health. (2020). Weight management for children and teens. Duke Health. https://www.dukehealth.org/pediatric-treatments/childhood-obesity
Jindal, M., Trent, M., & Mistry, K. B. (2022). The Intersection of Race, Racism, and Child and Adolescent Health. Pediatrics in review, 43(8), 415–425. https://doi.org/10.1542/pir.2020-004366
Pediatric Nursing Certification Board. (2022). Pediatric Nursing Workforce Report 2022: A Demographic Profile of 53,000 PNCB-Certified Nursing Professionals. https://pncb.org/ sites/default/files/resources/PNCB_2022_Pediatric_Nursing_Workforce_Demographic_ Report.pdf
Zippia. (2022, September 9). Family nurse practitioner demographics and statistics in the US. https://www.zippia.com/family-nurse-practitioner-jobs/demographics/
In the second episode of the Health Equity in Pediatrics series, we explore implicit bias as unconscious attitudes and stereotypes held against a group that may even be contrary to one’s stated beliefs. Identifying your implicit bias is a best practice that can enable you to limit its impact on your behavior and prevent harm from altered clinical decision making that is based on preconceived notions. In this episode, we discuss examples of how implicit bias can impact health care in children and the skills that provider’s can hone to combat its influence.
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References:
FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC medical ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8
Gonzalez, C. M., Lypson, M. L., & Sukhera, J. (2021). Twelve tips for teaching implicit bias recognition and management. Medical teacher, 43(12), 1368–1373. https://doi.org/10.1080/0142159X.2021.1879378
Goyal, M. K., Johnson, T. J., Chamberlain, J. M., Cook, L., Webb, M., Drendel, A. L., Alessandrini, E., Bajaj, L., Lorch, S., Grundmeier, R. W., Alpern, E. R., & PEDIATRIC EMERGENCY CARE APPLIED RESEARCH NETWORK (PECARN) (2020). Racial and Ethnic Differences in Emergency Department Pain Management of Children With Fractures. Pediatrics, 145(5), e20193370. https://doi.org/10.1542/peds.2019-3370
Greenwald, A. G., Dasgupta, N., Dovidio, J. F., Kang, J., Moss-Racusin, C. A., & Teachman, B. A. (2022). Implicit-Bias Remedies: Treating Discriminatory Bias as a Public-Health Problem. Psychological science in the public interest : a journal of the American Psychological Society, 23(1), 7–40. https://doi.org/10.1177/15291006211070781
Jindal, M., Trent, M., & Mistry, K. B. (2022). The Intersection of Race, Racism, and Child and Adolescent Health. Pediatrics in review, 43(8), 415–425. https://doi.org/10.1542/pir.2020-004366
Mossey J. M. (2011). Defining racial and ethnic disparities in pain management. Clinical orthopaedics and related research, 469(7), 1859–1870. https://doi.org/10.1007/s11999-011-1770-9
Pediatric Nursing Certification Board. (2022). Pediatric Nursing Workforce Report 2022: A Demographic Profile of 53,000 PNCB-Certified Nursing Professionals. https://pncb.org/ sites/default/files/resources/PNCB_2022_Pediatric_Nursing_Workforce_Demographic_ Report.pdf
Project Implicit. (2011). Take a test. https://implicit.harvard.edu/implicit/takeatest.html
Raphael, J. L., & Oyeku, S. O. (2020). Implicit Bias in Pediatrics: An Emerging Focus in Health Equity Research. Pediatrics, 145(5), e20200512. https://doi.org/10.1542/peds.2020-0512
Sabin J. A. (2022). Tackling Implicit Bias in Health Care. The New England journal of medicine, 387(2), 105–107. https://doi.org/10.1056/NEJMp2201180
Smiley, R. A., Ruttinger, C., Oliveira, C. M., Hudson, L. R., Allgeyer, R., Reneau, K. A., Silvestre, J. H., & Alexander, M. (2021). The 2020 National Nursing Workforce Survey. Journal of Nursing Regulation, 12(1). https://doi.org/10.1016/s2155-8256(21)00027-2.
U.S. Equal Employment Opportunity Commission. (2023). Religious garb and grooming in the workplace: Rights and responsibilities. https://www.eeoc.gov/laws/guidance/religious-garb-and-grooming-workplace-rights-and-responsibilities#_ftn17
The third episode in the Health Equity in Pediatrics series focuses on Microaggressions, which are subtle slights, snubs, and digs that are seemingly innocent, innocuous, and naive at first glance. But their roots in harmful stereotypes and assumptions are psychologically disparaging and invalidating to the people from marginalized groups they offend. They reflect implicit bias that is unconsciously embedded into language and behavior. As an ally, interrupting microaggressions can be a challenge that requires curiosity to confront. The decision to interrupt is individual and complex, but this episode will provide allies with the skills to intervene through role play in several scenarios.
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References:
Acholonu, R. G., Cook, T. E., Roswell, R. O., & Greene, R. E. (2020). Interrupting Microaggressions in Health Care Settings: A Guide for Teaching Medical Students. MedEdPORTAL : The journal of teaching and learning resources, 16, 10969. https://doi.org/10.15766/mep_2374-8265.10969
FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC medical ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8
Kanter, J. (2020). Microaggressions aren’t just innocent blunders– research links them with racial bias. The Conversation. https://theconversation.com/microaggressions-arent-just-innocent-blunders-research-links-them-with-racial-bias-145894
Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: implications for clinical practice. The American psychologist, 62(4), 271–286. https://doi.org/10.1037/0003-066X.62.4.271
Sue, D. W., Alsaidi, S., Awad, M. N., Glaeser, E., Calle, C. Z., & Mendez, N. (2019). Disarming racial microaggressions: Microintervention strategies for targets, White allies, and bystanders. The American psychologist, 74(1), 128–142. https://doi.org/10.1037/amp0000296
Turner, J., Higgins, R., & Childs, E. (2021). Microaggression and Implicit Bias. The American Surgeon, 87(11), 1727–1731. https://doi.org/10.1177/00031348211023418
The fourth episode in our Health Equity in Pediatrics series highlights one of the simplest individual actions a provider can take to be an ally in health equity. Saying a person’s name correctly validates their identity, family, culture, and heritage. Whether the name is difficult to pronounce or varies from the name given at birth, providers can use simple tools to correctly pronounce and address their patients in a way that honors the patient and their caregivers. Together we can prove that a rose by another name would smell just as sweet.
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References
Dali, S., Atasuntseva, A., Shankar, M., Ayeroff, E., Holmes, M., Johnson, C., Terkawi, A. S., Beadle, B., Chang, J., Boyd, K., & Dunn, T. (2022). Say My Name: Understanding the Power of Names, Correct Pronunciation, and Personal Narratives. MedEdPORTAL : the journal of teaching and learning resources, 18, 11284. https://doi.org/10.15766/mep_2374-8265.11284
Keister, A. (2022). Can I still use sir and ma’am? When should I use Mr., Mrs., Ms., and Mx? What to do when you don’t know someone’s gender. The Diversity Movement. Retreived from https://thediversitymovement.com/sir-maam-mr-mrs-ms-mx-what-to-do-when-you-dont-know-someones-gender/
Lebensohn-Chialvo F. (2021). That's not my name. Families, systems & health : the journal of collaborative family healthcare, 39(1), 163–164. https://doi.org/10.1037/fsh0000588
The seminal publication of the AAP’s Guideline on the Evaluation and Treatment of Children and Adolescents with Obesity serves as the source of our fifth episode in the miniseries on Health Equity in Children. The best practices for providers managing obesity go beyond discussions of beauty and body image to include systemic racism, obesity as a chronic disease, and the reckoning that children and adolescents with obesity are people first.
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References
Bell, C. N., Kerr, J., & Young, J. L. (2019). Associations between Obesity, Obesogenic Environments, and Structural Racism Vary by County-Level Racial Composition. International journal of environmental research and public health, 16(5), 861. https://doi.org/10.3390/ijerph16050861
Centers for Disease Control and Prevention. (2022). Inclusive communication principles. Gateway to Health Communication. https://www.cdc.gov/healthcommunication/Key_Principles.html
Gmeiner, M. S., & Warschburger, P. (2020). Intrapersonal predictors of weight bias internalization among elementary school children: a prospective analysis. BMC pediatrics, 20(1), 408. https://doi.org/10.1186/s12887-020-02264-w
Hadjiyannakis, S., Ibrahim, Q., Li, J., Ball, G. D. C., Buchholz, A., Hamilton, J. K., Zenlea, I., Ho, J., Legault, L., Laberge, A. M., Thabane, L., Tremblay, M., & Morrison, K. M. (2019). Obesity class versus the Edmonton Obesity Staging System for Pediatrics to define health risk in childhood obesity: results from the CANPWR cross-sectional study. The Lancet. Child & adolescent health, 3(6), 398–407. https://doi.org/10.1016/S2352-4642(19)30056-2
Hampl, S. E., Hassink, S. G., Skinner, A. C., Armstrong, S. C., Barlow, S. E., Bolling, C. F., Avila Edwards, K. C., Eneli, I., Hamre, R., Joseph, M. M., Lunsford, D., Mendonca, E., Michalsky, M. P., Mirza, N., Ochoa, E. R., Sharifi, M., Staiano, A. E., Weedn, A. E., Flinn, S. K., Lindros, J., … Okechukwu, K. (2023). Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics, 151(2), e2022060640. https://doi.org/10.1542/peds.2022-060640
Haqq, A. M., Kebbe, M., Tan, Q., Manco, M., & Salas, X. R. (2021). Complexity and Stigma of Pediatric Obesity. Childhood obesity (Print), 17(4), 229–240. https://doi.org/10.1089/chi.2021.0003
Puhl, R. M., & Himmelstein, M. S. (2018). Adolescent preferences for weight terminology used by health care providers. Pediatric obesity, 13(9), 533–540. https://doi.org/10.1111/ijpo.12275
Puhl, R. M., Peterson, J. L., & Luedicke, J. (2011). Parental perceptions of weight terminology that providers use with youth. Pediatrics, 128(4), e786–e793. https://doi.org/10.1542/peds.2010-3841
Yan J, Liu L, Zhu Y, Huang G, Wang PP. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health. 2014 Dec 13;14:1267. doi: 10.1186/1471-2458-14-1267. PMID: 25495402; PMCID: PMC4301835.
It’s good advice for any pediatric provider to not assume anything. In the sixth episode of the miniseries on Health Equity in Children, we understand how not making assumptions is a best practice for pediatric providers from the evaluation and management of LGBTQ patients, to communicating with diverse families, and serving as an ally in health promotion.
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References
Brown, C., Frohard-Dourlent, H., Wood, B. A., Saewyc, E., Eisenberg, M. E., & Porta, C. M. (2020). "It makes such a difference": An examination of how LGBTQ youth talk about personal gender pronouns. Journal of the American Association of Nurse Practitioners, 32(1), 70–80. https://doi.org/10.1097/JXX.0000000000000217
Centers for Disease Control and Prevention. (2019). Health disparities among LTGBQ youth. Adolescent and School Health. https://www.cdc.gov/healthyyouth/disparities/health-disparities-among-lgbtq-youth.htm
Coulter-Thompson, E. I., Matthews, D. D., Applegate, J., Broder-Fingert, S., & Dubé, K. (2023). Health Care Bias and Discrimination Experienced by Lesbian, Gay, Bisexual, Transgender, and Queer Parents of Children With Developmental Disabilities: A Qualitative Inquiry in the United States. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 37(1), 5–16. https://doi.org/10.1016/j.pedhc.2022.09.004
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., Lowry, R., Chyen, D., Whittle, L., Thornton, J., Lim, C., Bradford, D., Yamakawa, Y., Leon, M., Brener, N., & Ethier, K. A. (2018). Youth Risk Behavior Surveillance - United States, 2017. Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), 67(8), 1–114. https://doi.org/10.15585/mmwr.ss6708a1
Kyriakou, A., Nicolaides, N. C., & Skordis, N. (2020). Current approach to the clinical care of adolescents with gender dysphoria. Acta bio-medica : Atenei Parmensis, 91(1), 165–175. https://doi.org/10.23750/abm.v91i1.9244
National Association of Pediatric Nurse Practitioners, Evans, S.C., Derouin, A.L., Fuller, M.G., Heighway, S., & Schapiro, N.A. (2018). NAPNAP position statement on health risks and needs of lesbian, gay, bisexual, transgender, and questioning youth. The Journal of Pediatric Health Care, 33(2), p. A12-A14. doi: https://doi.org/10.1016/j.pedhc.2018.12.005
Roth, L. T., Friedman, S., Gordon, R., & Catallozzi, M. (2020). Rainbows and "Ready for Residency": Integrating LGBTQ Health Into Medical Education. MedEdPORTAL : the journal of teaching and learning resources, 16, 11013. https://doi.org/10.15766/mep_2374-8265.11013
Simons, L. K., Leibowitz, S. F., & Hidalgo, M. A. (2014). Understanding gender variance in children and adolescents. Pediatric annals, 43(6), e126–e131. https://doi.org/10.3928/00904481-20140522-07
Mental health is one of the greatest health risks encountered by children and adolescents in today’s world. Stigma can be one of the biggest barriers to diagnosis, access to care, and treatment for children, particularly in communities that are marginalized. In the final episode of the miniseries on Health Equity in Children, we bring mental health into your everyday conversations to diminish stigma and give mental health the time it deserves to help your patients grow up happy and healthy.
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References
Bureau of Health Workforce, Health Resources and Services Administration, U. S. Department of Health & Human Services. (2019). Designated health professional shortage areas statistics. Retrieved from https://bhw.hrsa.gov/shortage-designa tion/hpsa-criteria
Cotton, N. K., & Shim, R. S. (2022). Social Determinants of Health, Structural Racism, and the Impact on Child and Adolescent Mental Health. Journal of the American Academy of Child and Adolescent Psychiatry, 61(11), 1385–1389. https://doi.org/10.1016/j.jaac.2022.04.020
Harris, T. B., Udoetuk, S. C., Webb, S., Tatem, A., Nutile, L. M., & Al-Mateen, C. S. (2020). Achieving Mental Health Equity: Children and Adolescents. The Psychiatric clinics of North America, 43(3), 471–485. https://doi.org/10.1016/j.psc.2020.06.001
National Association of Pediatric Nurse Practitioners, Developmental and Behavioral Health Special Interest Group, Frye, L., Van Cleve, S., Heighway, S., & Johnson-Smith, A. (2020). NAPNAP position statement on the integration of mental health care in pediatric primary care settings. Journal of Pediatric Health Care, 34(5), p. 514-517, https://doi.org/10.1016/j.pedhc.2020.04.013
Pumariega, A. J., Rothe, E., Mian, A., Carlisle, L., Toppelberg, C., Harris, T., Gogineni, R. R., Webb, S., Smith, J., & American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI) (2013). Practice parameter for cultural competence in child and adolescent psychiatric practice. Journal of the American Academy of Child and Adolescent Psychiatry, 52(10), 1101–1115. https://doi.org/10.1016/j.jaac.2013.06.019
Song, J., Mailick, M. R., & Greenberg, J. S. (2018). Health of parents of individuals with developmental disorders or mental health problems: Impacts of stigma. Social science & medicine (1982), 217, 152–158. https://doi.org/10.1016/j.socscimed.2018.09.044
Telesia, L., Kaushik, A., & Kyriakopoulos, M. (2020). The role of stigma in children and adolescents with mental health difficulties. Current opinion in psychiatry, 33(6), 571–576. https://doi.org/10.1097/YCO.0000000000000644
Waid, J., & Kelly, M. (2020). Supporting family engagement with child and adolescent mental health services: A scoping review. Health & social care in the community, 28(5), 1333–1342. https://doi.org/10.1111/hsc.12947
Walter, H. J., Vernacchio, L., Trudell, E. K., Bromberg, J., Goodman, E., Barton, J., Young, G. J., DeMaso, D. R., & Focht, G. (2019). Five-Year Outcomes of Behavioral Health Integration in Pediatric

Season 10: Primary Care

Nirsevimab is the new FDA-approved monoclonal antibody RSV vaccine for the prevention of severe lower respiratory illness in infants. In this episode, we discuss the current recommendations on who gets the vaccine and when, how to use a lens of health equity to approach the current vaccine shortages, and how to discuss safety and efficacy with vaccine hesitant parents. Now that nirsevimab is on the routine infant immunization schedule, it’s extremely important and pediatric providers understand the recommendations and science behind the monoclonal antibody.
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References:
CDC Health Alert Network. (2023). Limited availability of nirsevimab in the United States—Interim CDC recommendations to protect infants from Respiratory Syncytial Virus (RSV) during the 2023–2024 respiratory virus season. Emergency Preparedness and Response. https://emergency.cdc.gov/han/2023/han00499.asp?c

Centers for Disease Control and Prevention. (2023). Frequently asked questions about RSV immunization with monoclonal antibody for children 19 months and younger. Vaccines and Preventable Diseases. https://www.cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html

Centers for Disease Control and Prevention. (2022). Vaccines for Children Program. https://www.cdc.gov/vaccines/programs/vfc/index.html

Centers for Disease Control and Prevention. (2023). General best practice guidelines for immunization. Vaccine Recommendations and the Guidelines of the ACIP. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html

Jones, J. M., Fleming-Dutra, K. E., Prill, M. M., Roper, L. E., Brooks, O., Sánchez, P. J., Kotton, C. N., Mahon, B. E., Meyer, S., Long, S. S., & McMorrow, M. L. (2023). Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR. Morbidity and mortality weekly report, 72(34), 920–925. https://doi.org/10.15585/mmwr.mm7234a4

Hill, D., & Parga-Belinkie, J. (Host). (2023, August 29). Immunizations special: RSV, Covid, pneumococcal disease, influenza (No. 170) [Audio podcast episode]. In Pediatrics on call. American Academy of Pediatrics. www.aap.org/podcast

Rha, B., Curns, A. T., Lively, J. Y., Campbell, A. P., Englund, J. A., Boom, J. A., Azimi, P. H., Weinberg, G. A., Staat, M. A., Selvarangan, R., Halasa, N. B., McNeal, M. M., Klein, E. J., Harrison, C. J., Williams, J. V., Szilagyi, P. G., Singer, M. N., Sahni, L. C., Figueroa-Downing, D., McDaniel, D., … Gerber, S. I. (2020). Respiratory Syncytial Virus-Associated Hospitalizations Among Young Children: 2015-2016. Pediatrics, 146(1), e20193611. https://doi.org/10.1542/peds.2019-3611

Suh, M., Movva, N., Jiang, X., Bylsma, L. C., Reichert, H., Fryzek, J. P., & Nelson, C. B. (2022). Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009-2019: A Study of the National (Nationwide) Inpatient Sample. The Journal of infectious diseases, 226(Suppl 2), S154–S163. https://doi.org/10.1093/infdis/jiac120
At the peak of respiratory virus season, bronchiolitis is one of the most common presentations in infants and young toddlers. The characteristic wheeze and prolonged duration of illness can be distressing for parents, who may lack the practical knowledge of how to effectively implement supportive care. When the mainstay of treatment is supportive care without any single curative intervention, you need to be able to discuss the etiology, management, and anticipatory guidance on a level that the parents can understand. This episode introduces the idea of capacity-building family-centered care and takes a granular, detailed approach to improving family understanding and home care education so that you can facilitate better evidence-based care in the unrestricted environment of the home. By arming parents with the knowledge and skills needed to care for their infant at home and the clear, objective return criteria, you’re providing family-centered care and reducing unnecessary visits.
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References
Justice NA, Le JK. Bronchiolitis. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441959/

Rha, B., Curns, A. T., Lively, J. Y., Campbell, A. P., Englund, J. A., Boom, J. A., Azimi, P. H., Weinberg, G. A., Staat, M. A., Selvarangan, R., Halasa, N. B., McNeal, M. M., Klein, E. J., Harrison, C. J., Williams, J. V., Szilagyi, P. G., Singer, M. N., Sahni, L. C., Figueroa-Downing, D., McDaniel, D., … Gerber, S. I. (2020). Respiratory Syncytial Virus-Associated Hospitalizations Among Young Children: 2015-2016. Pediatrics, 146(1), e20193611. https://doi.org/10.1542/peds.2019-3611

Suh, M., Movva, N., Jiang, X., Bylsma, L. C., Reichert, H., Fryzek, J. P., & Nelson, C. B. (2022). Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009-2019: A Study of the National (Nationwide) Inpatient Sample. The Journal of infectious diseases, 226(Suppl 2), S154–S163. https://doi.org/10.1093/infdis/jiac120

Season 11: Acute Care PNP Faculty Series

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Season 12: Coming soon

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