UC Davis Health
Department of Pediatrics

Pediagogy Podcast | Department of Pediatrics | UC Davis Health

A pediatric education podcast

Pediagogy™

Pediagogy™ is an evidence-based podcast, reviewed by expert specialists, and made by UC Davis Children’s Hospital physicians.

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Pediagogy, a pediatric education podcast

About the Pediagogy™ Podcast

Pedagogy is the art and science of teaching. In this same regard, Pediagogy was created with the goal of teaching on-the-go medical students, residents, and any other interested learners about bread-and-butter pediatrics. Pediagogy is an evidence-based podcast, reviewed by expert specialists, and made by UC Davis Children’s Hospital physicians.

Let’s learn about kids!

Dr. Tammy Yau and Dr. Lindia Park
Dr. Lidia Park and Dr. Tammy Yau

Learn about asthma management in the outpatient and acute setting including 2020 NIH guideline changes.

This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Rory Kamerman-Kretzmer, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

  • Ask about common triggers for asthma like smoke or allergens as well as medication adherence
  • Asthma is a clinical diagnosis but ancillary tests like PFTs may help
  • Symptom frequency and severity can help you classify asthma as intermittent versus persistent
  • Learn about controller/maintenance therapy, including the new SMART therapy
  • Learn about steroid use for acute exacerbations as well as next line medications like magnesium, ipratropium, and epinephrine

Supplemental Information:

Listen to this episode’s topic on bronchiolitis and how we manage it in the hospital!

This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Rory Kamerman-Kretzmer, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

  • Bronchiolitis is seen in kids under the age of 2 and most commonly caused by RSV
  • Treatment is supportive including fluids, oxygen, and suction
  • Learn about palivizumab and other new preventive therapies against bronchiolitis

Supplemental Information:

Today we talk about BRUE – brief, resolved, unexplained, events – and try to breakdown what it is and what we do for low-risk versus high-risk cases.

This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Eunice Kim, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

  • Brief, resolved, unexplained events in patients <1 year of age with color change, tone change, abnormal breathing, or altered level of consciousness.
  • BRUE can be classified as low versus high risk based on age of patient, frequency of events, and exam or history findings
  • Only brief observation is needed in low risk BRUE.
  • High risk BRUE requires more extensive workup.

Supplemental Information:

Part 2 of our TORCH series discusses CMV, the most common infectious cause of hearing loss in the US.

Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Dean Blumberg. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key points:

  • Findings include blueberry muffin rash, microcephaly, periventricular calcifications, sensorineural hearing loss, and jaundice.
  • Infection persists lifelong and treatment with valganciclovir is meant to prevent long term sequelae
  • Monitor for myelosuppression with treatment.
  • Frequent hearing screening is needed.

Sources:

  • AAP Red Book CMV chapter
  • Fowler KB, Boppana SB. Congenital cytomegalovirus infection. Semin Perinatol. 2018 Apr;42(3):149-154. doi: 10.1053/j.semperi.2018.02.002. Epub 2018 Mar 2. PMID: 29503048.

We are starting our mini-series on TORCH infections with congenital rubella, a rare disease nowadays in the US but prevalent still worldwide.

Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Dean Blumberg. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key points:

  • Think of this disease in infants of immigrant or under-immunized mothers.
  • Findings include cataracts, retinopathy, PDA, hearing loss, blueberry muffin rash
  • Treatment is supportive, with patients needing to isolate for at least several months.
  • There is little evidence for immunoglobulin to prevent disease

Sources:

This week on our series on TORCH infections, we are discussing syphilis, an increasingly prevalent disease in the pediatric population.

Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Elizabeth Partridge. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key points:

  • Most congenital syphilis is asymptomatic. Less commonly will present with rash, snuffles, hepatosplenomegaly, anemia, and jaundice.
  • Untreated disease can cause neurosyphilis and bone defects
  • Compare mother's RPR titers to baby's and look for findings consistent with syphilis.
  • Workup is based on whether mother was adequately treated and includes CBC, LP, skeletal survey, and LFTs.
  • Treatment is with IV penicillin G for 10 days.

Sources:

  • AAP Red Book Syphilis chapter
  • Sankaran D, Partridge E, Lakshminrusimha S. Congenital Syphilis-An Illustrative Review. Children (Basel). 2023 Jul 29;10(8):1310. doi: 10.3390/children10081310. PMID: 37628309; PMCID: PMC10453258.
  • Fang J, Partridge E, Bautista GM, Sankaran D. Congenital Syphilis Epidemiology, Prevention, and Management in the United States: A 2022 Update. Cureus. 2022 Dec 27;14(12):e33009. doi: 10.7759/cureus.33009. PMID: 36712768; PMCID: PMC9879571.
  • https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf

Join us as we go through this “sweet” episode on diabetic ketoacidosis (DKA) causes, presentation, and management, while learning a fun UC Davis hospital historical fact!

This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Nicole Glaser, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

  • DKA presents with hyperglycemia, ketosis, and anion gap metabolic acidosis, which if severe can cause cerebral edema and CNS dysfunction
  • Initial management includes fluid resuscitation and IV insulin -Learn about the 2-bag IV fluid system for DKA
  • Correct for hyponatremia in hyperglycemia
  • Learn about how to manage potassium, bicarbonate, and phosphorus in DKA

Supplemental Information:

Want to quickly become a pro at family centered rounds? Learn the basics as well as the tips and tricks on how to navigate presenting in a patient-first and family-friendly way.

Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com.

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Jessica Witkowski. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key points:

  • Family centered rounds should involve the patient, family, and all relevant medical team members. Allow space for everyone to be heard and opportunity for questions.
  • Make sure to include all the same important information as a traditional presentation, but without medical jargon. Direct your presentation at the patient and family.

Sources:

Listen up! Today we talk about the management of well-appearing febrile infants aged 8-60 days old including work-up algorithms and treatment. It's a lot of information so pay close attention and you might even want to pull up the AAP guideline diagrams to follow along!

Follow us on Twitter @Pediagogypod.

This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Nathan Kuppermann, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key points:

  • New strategies for management of febrile infants depending on age (1-3 weeks, 3-4 weeks, or 4-8 weeks)
  • Inflammatory markers like CRP and procalcitonin help to determine if LP is needed in older patients
  • Learn about common bugs that cause infection in infants and the antibiotics we use to treat them
  • Observation of febrile infants is now reduced from 48 hours to 24-36 hours

Supplemental information:

Seizures can be scary and fevers aren't fun but we'll teach you why simple febrile seizures aren't so bad in this episode!

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Shannon Liang, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key points:

  • Simple febrile seizures are generalized, less than 15 minutes, and occur no more than once in a 24-hour period.
  • No work-up or treatment is recommended for simple febrile seizures

Supplemental information:

In this hot topic summer episode, listeners will learn about the management of infectious gastroenteritis.

Follow us on Twitter @Pediagogypod

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Christopher Kim, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key points:

  • Gastroenteritis is a major cause of pediatric morbidity annually due to dehydration
  • Learn about oral rehydration with balanced electrolyte solutions vs water or sports drinks
  • Understand why we avoid testing and antibiotics
  • Other supportive measures that are available

Supplemental information:

Join us today where we discuss one of the most common causes of microcytic anemia in pediatric patients.

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Anjali Pawar, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key points:

  • Excessive milk consumption inhibits iron absorption. Limit to 16-24 oz/day
  • Iron supplementation dosing depends on gestational age and major food source. Prevention vs treatment dosing also differ.
  • Mentzer index greater than 13 indicates iron deficiency anemia

Supplemental information:

In this episode, we have some special guests, Dr. Daniel Dodson, and one of our medical students, Aneri Patel, talk to us about Kawasaki disease. Special thanks to Dr. Natasha Nakra for content review.

Key points:

  • Vasculitis with the clinical features in the mnemonic CRASH and Burn
  • Incomplete Kawasaki has lab features including elevated ESR and CRP, thrombocytosis, hypoalbuminemia, anemia, elevated ALT, leukocytosis, and sterile pyuria.
  • Treatment is to prevent coronary artery aneurysms with IVIG and aspirin.

References:

In this episode, listeners will learn about the intricacies of how the AAP guidelines came to be on maintenance intravenous fluids for pediatric patients. Get ready to learn about the 4-2-1 rule and breakdown some misconceptions about fluids based on adult data!

This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Alexis Toney, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

  • Remember the 4-2-1 rule for calculating maintenance fluids in children
  • Use of hypotonic fluids is based on historical data in healthy children
  • Data now supports use of isotonic fluids like NS or LR to reduce risk of hyponatremia and SIADH
  • Newer data may support LR over NS

Supplemental Information:

In the first installment of this 2-part episode, we break down the causes of unconjugated (indirect) and conjugated (direct) hyperbilirubinemia.

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Daphne Say, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key points:

  • Unconjugated hyperbilirubinemia causes are due to increased bilirubin production, decreased liver conjugation, or decreased clearance
  • Conjugated hyperbilirubinemia can be due to outflow or transport problem, infection, metabolic disorders, liver dysfunction, and parenteral nutrition
  • Always consider biliary atresia in a newborn with pale white stools. The earlier the surgical treatment, the better outcomes

Supplemental Information:

Learn about management of newborn jaundice in our 2-part series.

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Daphne Say, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key points:

  • Unconjugated bilirubin is fat soluble so can cross the blood brain barrier and cause kernicterus
  • Check bilirubin levels at least every 24 hours while a newborn is first hospitalized
  • New AAP guidelines on hyperbilirubinemia management raised phototherapy and exchange transfusion thresholds
  • Transcutaneous bilirubin monitoring has a +/- 3 margin of error

Supplemental Information:

Let’s briefly discuss the new 2023 AAP obesity guidelines in this episode.

Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com.

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Sean Munoz. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key points:

  • Obesity is now the most common chronic disease of childhood
  • Children 10 years of age and older with obesity should have lipid, A1c, and ALT checked.
  • Children ages 2-9 with obesity should have lipid checked and potentially ALT
  • Treatment is multimodal and includes lifestyle modification, medications, and surgery.

AAP 2023 obesity guidelines:

In this *shocking​* episode, we discuss identifying and managing sepsis and septic shock in the pediatric population. This episode features two of our 2nd year pediatric residents, Victoria and Kat. We are so excited to have them join us and teach us about this very common chief complaint, especially for patients getting admitted to the hospital.

Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com.

This episode was written by Drs. Victoria Tran, Katrina Marks, Tammy Yau, and Lidia Park, with content support from Dr. Moonjoo Han. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key points

  • Defining and differentiating SIRS, sepsis, and septic shock. Identifying the symptoms of sepsis is important for appropriate patient triage.
  • SIRS comprises of constellation of symptoms. For SIRS criteria, 2 or more criteria must be met, which include hyper/hypothermia, leukocytosis/leukopenia, tachycardia/bradycardia, tachypnea.
  • SIRS + infectious source = sepsis
  • Initial management of sepsis includes broad-spectrum antibiotics and fluid resuscitation with isotonic fluids (typically 10-20 cc/kg)

Sources:

  • Weiss, Scott L. MD, MSCE, FCCM (Co-Vice Chair) et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatric Critical Care Medicine 21(2):p e52-e106, February 2020. | DOI: 10.1097/PCC.0000000000002198
  • Link: https://journals.lww.com/pccmjournal/Fulltext/2020/02000/Surviving_Sepsis_Campaign_International_Guidelines.20.aspx
  • Menon, Kusum et al. “A Prospective Multicenter Study of Adrenal Function in Critically Ill Children.” American journal of respiratory and critical care medicine: an official journal of the American Thoracic Society, medical section of the American Lung Association. 182.2 (2010): 246–251. Web.

Learn how to be a mini-endocrinologist as we talk about how to differentiate Type 1 from Type 2 diabetes and how to create a starter insulin regimen, among other things in today's podcast!

This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Nicole Glaser, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

  • There are specific clinical criteria for diabetes
  • There are some differences to help distinguish between type 1 versus type 2 diabetes
  • Learn about how to manage diabetes on the inpatient floor, including how to calculate total daily insulin dose, correction factors, and carbohydrate ratios.

Supplemental Information:

Got diabetes? Well, which one? With rising childhood obesity rates, we’re getting more of a mix of both! Today we talk about type 2 diabetes and how management can include both medications and lifestyle management.

This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Nicole Glaser, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

  • First line management is insulin when in DKA
  • First line management is lifestyle modification and metformin when not in DKA
  • Consider adding insulin and GLP-1 agonists if still in poor control

Supplemental Information:

Help my kid has a UTI! Does cranberry juice have any benefit for UTIs? Find out with us in today’s episode about urinary tract infections (UTIs)!

Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com.

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Natasha Nakra. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key points:

  • A fever may be your only symptom in a young child with a UTI
  • If you think it’s a UTI, get a clean specimen for culture. A positive culture has more than 50k CFUs/ml on a catheter sample and more than 100k CFUs/ml on a clean catch/void sample.
  • Most common bacteria causing UTIs are E. coli, Klebsiella, Proteus, Enterococcus, and Enterobacter
  • Simple cystitis may only need 3-10 days of treatment depending on age, whereas pyelonephritis needs 10-14 days.

Sources

Today we talk about the management of well-appearing febrile infants aged 8-60 days old including work-up algorithms and treatment. Pay close attention, you might even want to pull up the AAP guideline diagrams to follow along!

This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Nathan Kuppermann, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

  • New strategies for management of febrile infants depending on age (1-3 weeks, 3-4 weeks, or 4-8 weeks)
  • Inflammatory markers like CRP and procalcitonin help to determine if LP is needed in older patients.
  • Learn about common bugs that cause infection in infants and the antibiotics we use to treat them
  • Observation of febrile infants is now reduced from 48 hours to 24-36 hours

Supplemental Information: