Clerkship Ready: Pediatrics

In this episode, we will discuss everything you need to know before seeing your first pediatric patient with eczema. We will review its pathogenesis, who gets eczema, what to look for on exam, and potential differential diagnoses. We will also elaborate upon the most recent AAP guidelines for treatment of eczema, which focuses on skin care maintenance, topical steroids, and avoidance of triggers. Show Outline: Introduction to Eczema Description of dermatologic terms Defining eczema and atopic dermatitis Pathogenesis Immune dysfunction Histological differences Involvement of filaggrin Racial disparities Who gets eczema? Age of onset Demographics of patients with eczema Atopic disease & “The Atopic March” Clinical Presentation / Diagnosis Characterization of eczematous lesions What to look for in people of color Most likely locations of eczema based on patient age Differential diagnoses Sleep disturbances Utilizing the Patient-Oriented Eczema Measure (POEM) Treatment AAP recently updated treatment guidelines…

In this episode, we will discuss all things related to food allergies, including the difference between IgE-mediated and non-IgE-mediated allergies, clinical manifestations, the important questions to ask when taking a history, the options for doing allergy testing, and treatment. Definition of food allergies Rates of food allergies Possible pathophysiology of food allergies Clinical manifestations of food allergies IgE mediated food allergies Cutaneous symptoms Ocular symptoms Respiratory symptoms GI symptoms Neurological and cardiovascular symptoms Anaphylaxis = involvement of 2 or more systems Non-IgE mediated food allergies Symptoms after 4 hours after ingestion Eosinophilic esophagitis Alpha-gal Food protein induced enterocolitis syndrome (FPIES) Food protein induced proctocolitis (FPIAP) Questions to ask to hone your clinical history Presenting symptoms When did symptoms occur Foods ingested Other symptoms, other exposures Any prior allergy testing Family history? Any food avoidance Testing options for…

In this episode, we will discuss when and how to advise parents on introducing complementary foods (aka “solids”), including foods that are potentially allergenic. This is a topic that will invariably come up for you during your rotation. We’ll discuss the timing and sequence of introducing solids, and then talk about the rationale behind early introduction of potentially allergenic foods. Definition of “complementary” foods” - a catch all category for “all solid and liquid foods other than breast milk or infant formula”. Also referred to as “solid foods” Definition of potentially allergenic foods - eggs, peanut butters, nut butters, fish, shellfish, etc. When to Introduce solid foods We will start recommending the introduction of solid foods in the form of puree, around the time an infant turns 4-6 months old – Baby should be able to demonstrate adequate head control in the office with us An infant’s renal and gastrointestinal systems can only start to metabolize complementary foods around the age of 4…

In this episode, we will be reviewing what you need to know before your first discussion about infant formula. We will cover the characteristics and types of formulas, why infants might require different types, the correct way to prepare formula and how much infants need, common concerns from parents, indications for changing formulas, and when to transition away from it. Reasons for formula feeding Human milk is first choice for most infants Concern about lactating parent’s milk supply Workplace conditions make it difficult to sustain human milk feeding Parent preference There are few true contraindications to breastfeeding. Galactosemia Maternal HIV infection that has not achieved an undetectable viral load Maternal phencyclidine (also known as PCP) or cocaine use Active Herpes Simplex virus lesion Active tuberculosis Types of formula: 3 characteristics Caloric density: calories per ounce. Standard term formula is 20 calories/oz. Infants born preterm or have growth failure may need 22-27 calories/oz.…

Listen along as we dive into the many causes of sore throat. Learn about the common causes such as allergies and viral illnesses while also what to do when a child with epiglottitis comes in. We will cover CENTOR criteria as well and when you should think about Group A strep testing. Common Causes Viral Presentation HSV Mononucleosis Allergic Presentation Group A Strep CENTOR Criteria Emergency Causes Peritonsillar Abscess Retropharyngeal Abscess Epiglottitis Wrap Up & Conclusion Resources/Links: https://www.chop.edu/conditions-diseases/throat-anatomy-and-physiology https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitis References Aluma Chovel-Sella, Amir Ben Tov, Einat Lahav, Orna Mor, Hagit Rudich, Gideon Paret, Shimon Reif; Incidence of Rash After Amoxicillin Treatment in Children With Infectious Mononucleosis. Pediatrics May 2013; 131 (5): e1424–e1427. 10.1542/peds.2012-1575 Becker JA, Smith JA. Return to play after infectious mononucleosis. Sports Health. 2014 May;6(3):232-8.…

Asthma is a common chronic disease of childhood that affects 1 in 12 children in the United States. It can range from mild respiratory symptoms to life threatening respiratory failure, with a range of treatment options in-between from the primary care setting to the pediatric ICU. In this episode, we will discuss the underlying pathophysiology, diagnosis, evaluation, and management of patients with asthma, along with some useful clinical pearls to help you take care of these patients! Cause of asthma Genetics: “Atopic triad” of asthma, atopic dermatitis or eczema, and allergic rhinitis Prenatal and childhood environmental factors: maternal smoking and allergen exposure Pathophysiology and diagnosis AAP definition: “episodic and reversible airway constriction and inflammation in response to infection, environmental allergens, and irritants. It is a complex, multifactorial, and immune-mediated process that presents with various clinical phenotypes.” Airway hyperreactivity leads to inflammation of bronchi,…

In this episode, we discuss lead toxicity and lead screening. We will talk about what lead is, what happens when a child is exposed to lead, what to ask parents about if you’re worried about lead exposure, how to screen for lead toxicity, and what to do if your patient has an elevated lead level. Sources of lead exposure Ingestion of contaminated food or water Ingestion or breathing in of lead dust Other sources: lead-acid batteries, ammunition, lead-based pigments and paints, stained glass, lead crystal glasses, ceramic glazes, jewelry, toys For families from other cultures, think about ceramic glazes, traditional cosmetics, traditional medicines Government policies to decrease lead exposure Unleaded gasoline Lead-free paint Lead-free solder in food cans Lead-free water pipes Why young children are at risk for lead toxicity Hand-to-mouth behavior Increased absorption of lead Developing nervous system is vulnerable Calcium or iron deficiency increase absorption of lead Effects of lead toxicity in children…

In this episode of Clerkship Ready – Pediatrics Dr. Jared Barkes, a Child Neurology resident at The University of Virginia, will be walking you through how to complete the neurologic exam! Throughout the episode he will cover in detail the different parts of a formal neuro exam while also providing useful tips for remembering commonly tested facts, reviewing specific examples of abnormal findings and common neurologic conditions, and offering helpful advice for completing a neuro exam on a pediatric patient. After listening to this podcast you will have all the tools necessary to shine on your first day of your neurology clerkship! Introduction What is the neuro exam? Review of the “Map” of the neuro system Cortex, Brainstem, Spinal Cord, Motor neuron How to complete a neuro exam and what to look for! General Assessment Mental Status Language Cranial Nerves Strength Sensation Coordination Reflexes Special consideration for pediatrics Closing Resources/Links: “NeuroLogic Exam”, A complete in-depth guide of…

Sepsis is a clinical syndrome in which an infection leads to an inflammatory response throughout the body that rapidly progresses to organ dysfunction or even death. Worldwide, neonatal sepsis affects 2,202 infants per 100,000 live births, and has a mortality rate of >11%. In the United States, early onset sepsis affects 50 in 100,000 live births, with a mortality rate of about 3%. So it’s a big problem that we don’t want to miss. In this episode, we will define neonatal sepsis, talk about the presentation of sepsis, what a sepsis workup entails, how to make the diagnosis and treatment of neonatal sepsis. Defining Neonatal Sepsis Early Onset Sepsis Late Onset Sepsis Neonatal Early Onset Sepsis Calculator - https://neonatalsepsiscalculator.kaiserpermanente.org/ Presentation of Illness and Physical Exam Pathogenesis Group B Strep Screening and prophylaxis E coli Strep viridans Klebsiella Enterococcus Listeria HSV Screening and prophylaxis Types of Infection Bacteremia Pneumonia Meningitis Work up CBC with…

This episode will prepare you to see well newborn babies in the newborn nursery on day 1. We will talk about the typical newborn stay, the information you need to gather to successfully give oral presentations on your patients, the newborn physical exam, and the tests and procedures commonly performed on all newborns. Nursery orientation: family expectations and goals of the healthcare team, expected length of stay History Maternal History: Gs and Ps Prenatal Care: prenatal labs and ultrasounds Past Medical History & medications Social situation/support Baby History: Gestational Age Delivery type and why, resuscitation efforts and complications Growth parameters The complete newborn exam: head to toe During the newborn stay: Ins and Outs Medications and vaccines Routine screening labs and tests Parental discharge education Discharge criteria and follow up About the Speaker: Host: Shakun Gupta, MD – Shakun Gupta, MD is an Associate Professor of Pediatrics and Associate Clerkship Director at the University of…

Pediatrics is different from any other rotation that you will do. Children are not just small adults. There is a huge range of ages and developmental stages. This episode will provide you with some general tips and tricks for all clerkships in general and the Pediatrics clerkship specifically, and essential resources that will help you to succeed in your clerkship. Essential Resources Podcasts: Clerkship Ready-Pediatrics Charting Pediatrics - Weekly podcast with lots of bread-and-butter pediatrics discussed. Pediatrics on Call - The most recent research and the newest policy updates from the American Academy of Pediatrics. Books: Red Book (also an app for AAP members) - the definitive source for pediatric infectious diseases. Harriet Lane Handbook (also an app) - has drug doses, commonly used charts, and algorithms. Websites: Peditools for bilirubin Uptodate CDC website is a great source for vaccine guidelines Apps: PedsScripts App: specifically to work on illness scripts General Tips and Tricks: Be…

Iron deficiency is the most common nutritional deficiency that occurs in children in United States. Iron plays a vital role in cellular function in all organ systems. Today, we will be reviewing what you need to know before you first see a patient with possible iron deficiency. We will discuss why iron is so important, when and why iron deficiency occurs, screening, diagnosis, and treatment for iron deficiency. Importance of Iron Iron and Hemoglobin Iron and Neurodevelopment Iron and the Immune System What happens in iron deficiency Reasons that children are at high risk for iron deficiency Rapid Growth . Insufficient dietary intake and limited absorption Increased losses Peaks of Incidence Other risk factors for iron deficiency. Preterm infants Children who suffer from neuro-motor disorders as they often have nutritional deficiency related to swallowing impairment G.I. diseases that cause malabsorption, Diseases predisposing them to bleeding. Lead toxicity. Screening for IDA History: Asking about…

Ear pain is one of the most common chief complaints pediatricians encounter in the outpatient setting and there are quite a few things you need to consider to make a thoughtful diagnosis, assessment, and plan. In this episode, we will discuss the differential diagnosis of ear pain in children, physical exam findings that will help you make a diagnosis, and treatment for the most common causes of ear pain. Ear anatomy Outer ear, tympanic membrane (TM), middle ear, inner ear Eustacian tube in children is smaller in diameter and angled more horizontally than in adults. This makes it more difficult to drain fluid behind the middle ear and why kids are more prone to get ear infections when they get a cold than adults are. The adenoids also are thought to play a role in fluid collection and buildup. Taking a history for patient with chief complaint of ear pain How old is this child? Have they had a fever? Are there any other viral symptoms such as cough, runny nose, or sore throat? Has the child been swimming…

Child abuse, which is sometimes called non-accidental trauma, is a public health problem with life-long health consequences for survivors and their families. In this episode, we will review what you need to know before you encounter your first patient who may have or has been abused. We will focus on physical and sexual abuse of children. Long term health consequences of child abuse Why identification of child abuse is difficult It is often difficult to distinguish an accidental injury from a non-accidental injury A caregiver who has abused a child rarely confesses to harming the child Child may be brought to medical care by unsuspecting parent It is emotionally difficult for us to confront parents when there are concerns for abuse Mandated reporting of child abuse Potential clues that a child may have been physically abused Medical record review History Physical exam Differential diagnosis of physical abuse Labs and other tests that you may get The role of the child protection team and child protective…

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

In today’s episode, we are talking about normal child development. We will talk about why this is important and how you will be evaluating children’s development. We will go over major milestones in the 4 developmental domains: movement/physical development – or gross and fine motor, language/communication, cognitive, and social/emotional. We will go over some common cases. Finally, we will briefly discuss what you should do if you suspect developmental delay. Why it is important to learn about developmental delay. Why it is important to learn about development Developmental surveillance versus developmental screening versus diagnosis of developmental issues Developmental domains/categories: Expressive language Receptive language Gross motor: this is how you use all of your big muscles Fine motor: hand/eye coordination Social/emotional: how children interact with others and show emotion. Language/Communication: how children express their needs and share what they are thinking, as well as understand what is…

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

Attention deficit-hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. In this episode, we will discuss ADHD, including the different types, evaluation, management, and follow up. General definition of ADHD and its types Preparing for your first visit Initial evaluation of ADHD vs. med check Reviewing prior visits During an initial visit: Evaluating historical features Behaviors at home, behaviors at school Common misconceptions about ADHD Surrounding factors and comorbidities/misdiagnosis Physical Exam Important features of the exam Observing the child’s behavior Role of the Vanderbilt Scoring a Vanderbilt Treatment Medication vs. non-pharmacologic interventions Overview of different medications Stimulants Nonstimulants Choosing a medication Family history Comorbidities Titrating medications Follow-up visits Symptoms to look for Resources/Links: Vanderbilt Scoring: https://www.uwmedicine.org/sites/stevie/files/2019-11/sodbp_vanderbilt_scoringinstructions.pdf…

In this episode, we discuss things you’ll need to know and think about before seeing an infant with jaundice. We will focus on infants from birth to 2 months of age. We will discuss the pathophysiology of hyperbilirubinemia, the difference between unconjugated and conjugated hyperbilirubinemia, the differential diagnosis, key elements of the history and physical exam, laboratory and imaging workup, and management. Introduction to jaundice and hyperbilirubinemia Jaundice is the yellowing of skin, sclerae, and mucous membranes caused by hyperbilirubinemia Hyperbilirubinemia can be further separated into unconjugated or conjugated forms, which allows us to further differentiate etiology Review of bilirubin breakdown pathway, to include enterohepatic circulation Unconjugated hyperbilirubinemia etiologies: Excessive or increased production of bilirubin Cephalohematomas Hemolysis: ABO and Rh incompatibilities; Red Blood Cell (RBC) membrane or enzyme defects, RBC oxidative stress (secondary to sepsis, asphyxia, and…

Many of the pediatric inpatients you care for will need intravenous fluids and electrolytes. This episode describes what you need to know before you order fluids or electrolyte replacement for your patient. We will discuss maintenance fluid needs and talk more in depth about what fluids to order and at what rate. We will also talk about managing patients with dehydration and how to replete fluids. Then we will discuss a few cases where we will work through some more common electrolyte derangements and discuss how to manage them. We will end with additional clinical pearls that will be helpful during your time on the inpatient pediatric service. Introduction Definition of maintenance fluid needs Important considerations about maintenance fluids Discussion regarding which fluids to order for different patient populations and at what rate to administer Role of ADH in hospitalized patients How to order a fluid bolus—amount, composition, and rate administered Assessing your patient with dehydration utilizing…

This episode is a follow-up to “Before Your First Time Working with a Breastfeeding Mother”. We’ll be reviewing additional details about breastfeeding that can help you to answer some of the most common questions that come up for families. We will discuss strategies to improve milk production, newborn stomach volumes, how to know if baby is getting enough milk, what to do if baby isn’t getting enough milk, and breastfeeding complications. Strategies to improve milk production Latching Newborn stomach volumes How to know if baby is getting enough milk What to do if baby isn’t getting enough milk Manual expression and pumping Breastfeeding complications Resources/Links: Bella Breastfeeding Curriculum on Open Pediatrics (free): www.openpediatrics.org Virginia Department of Health/Breastfeeding Education Consortium Online Course (free for those who live or work in Virginia): https://bfconsortium.org American Academy of Pediatrics Residency Breastfeeding Curriculum:…

This episode describes what you need to know before your first time working with a breastfeeding parent. This will include topics such as how to ensure families feel comfortable, benefits of and contraindications to breastfeeding, how to approach conversations about breastfeeding, and the science behind lactation or milk production. Making families feel comfortable Benefits of breastfeeding for mom and baby Contraindications to breastfeeding Approaching conversations about breastfeeding with families The process of lactogenesis (milk production) Resources/Links: Bella Breastfeeding Curriculum on Open Pediatrics (free): www.openpediatrics.org Virginia Department of Health/Breastfeeding Education Consortium Online Course (free for those who live or work in Virginia): https://bfconsortium.org American Academy of Pediatrics Residency Breastfeeding Curriculum: https://www.aap.org/en/learning/breastfeeding-curriculum/ ACOG Statement on Optimizing Support for Breastfeeding:…

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

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

Antibiotic selection can be complicated. In this episode, we discuss how you should approach choosing the appropriate antibiotic for your pediatric patient. There are multiple considerations, including: What organisms do you want to treat? What does anatomy have to do with antibiotic selection? You also have to think about individual circumstances, such as immunzation status, chronic disease, drug allergies, and environmental exposures. Know what organisms you want to treat Because we often treat empirically, we need to know organisms that typically case this typical infection Narrow-spectrum antibiotics if possible Anatomy of the infection For fever in first 4-6 weeks, think about organisms that infant was exposed to during pregnancy and delivery For respiratory infections, think about organisms that live in the respiratory tract Abnormal anatomy Immunization status of child may change your differential diagnosis Drug allergies Look in medical record and ask patient and family about allergies Consider…

Prescribing medicines in pediatrics is different than prescribing medicines for adults. In this episode, we discuss what you need to know before prescribing medications for the pediatric population, including calculating dose for the child’s weight, choosing IV vs PO medications, and other considerations. 1) References to look up pediatric drug doses and frequencies. 2) Calculating weight-based doses 3) Maximum daily doses 4) Different formulations of medications 5) Prescribing oral medicines Pills vs Liquid Consider taste Use the most concentrated suspension Use milliliters instead of spoonfuls 6) What if the medicine is not available in liquid form 7) Options if oral medications are not easily available in liquid form. 8) Medicine dosing frequency – use the least frequent option 9) Acetaminophen and Ibuprofen Resources/Links: Up to date: uptodate.com Harriet Lane Handbook: https://evolve.elsevier.com/cs/product/9780323876988?role=student Lexi-Comp: https://apps.apple.com/ca/app/lexicomp/id313401238 Links:…

Many of our patients and their families are not proficient in English, and it's important to be able to communicate effectively with them. In this episode, you’ll learn about how to work with an interpreter during encounters with patients who are not proficient in English. We’ll discuss dos and don’ts, common challenges, and tips for interacting with interpreters and families. Definitions Interpretation vs translation Modes of interpretation When do I need an interpreter? III. Who should not serve as an interpreter? Non-certified team members Patient’s non-certified friends or community members Patient’s family members Getting started Verify preferred language Positions in the room Introductions, including of the interpreter and recording interpreter’s information Conducting the visit How long to speak before awaiting interpretation During the physical exam Teach-back method via interpreter Trouble-shooting When the patient declines interpreter services When you think the interpreter is misinterpreting When…

Following safe sleep guidelines is the best way to protect a baby from dying suddenly and unexpectedly from sudden infant death syndrome (SIDS), accidental suffocation or strangulation, and deaths with unknown cause. Today we’re going to talk about what you need to know before you talk to a family about what safe sleep looks like for their infant. We’re going to talk about the importance of safe sleep habits, the AAP safe sleep recommendations, guidelines for infant sleep products, and tummy time. Why do we talk about safe sleep for infants? What causes infants to die suddenly and unexpectedly? Goals of safe sleep recommendations are to increase infant arousability and decrease asphyxiating environments Asking about sleep practices ABCs of safe sleep: Alone, Back, Crib Safe sleep recommendations: Infants should be on their backs Infants should sleep on a firm, flat, noninclined sleep surface There should be no bedding, such as pillows, blankets, bumper pads, stuffed toys, or fur-like materials in the…

The sexual history is an important part of the adolescent visit. In this episode, we will discuss the importance of the sexual history and how to handle patient confidentiality. We will introduce the 5Ps framework for the sexual history. We will also brieflyy discuss screening for sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). Sexual History - why it is important Confidentiality 5 Ps Framework Partners Practices Protection of STIs Past history of STIs Pregnancy Intention STI Screening and Treatment HIV screening algorithm References: 5 Ps Framework: https://www.cdc.gov/std/treatment/SexualHistory.htm STI Screening and Treatment: https://www.cdc.gov/std/treatment-guidelines/provider-resources.htm#MobileApp https://www.cdc.gov/std/treatment-guidelines/default.htm HIV screening algorithm: https://stacks.cdc.gov/view/cdc/50872 Links: https://www.cdc.gov/std/treatment/SexualHistory.htm https://www.cdc.gov/std/treatment-guidelines/provider-resources.htm#MobileApp…

Today, we will be reviewing what you need to know to examine your pediatric patients. Examining children is a bit of an art form and is often unfamiliar to clerkship students who may have a varied degree of experience being around children, may never have worked with children and may not have been exposed to pediatric patients in the pre-clinical years. In this episode, we discuss tips and tricks to get the exam you need on your pediatric patient with as little crying as possible. How to examine a baby/infant How to examine a toddler/preschool aged child Focused information on the ear exam/otoscopy How to examine a school aged child/teen Engaging older children in your exam Focused information on the genitourinary exam Presenting your physical exam during oral presentation Resources/Links: Bates' Guide to Physical Examination and History Taking by Lynn Bickley (your pediatric clinics will generally have a copy) https://batesvisualguide.com Links: https://batesvisualguide.com/ https://batesvisualguide.com…

Providing vaccines is one of the most important health promotion activities that we do. However, it involves much more than just putting in the orders for the various vaccines. In this podcast episode, we will briefly review how vaccines work, the types of vaccines, what you need to do before the visit, what you should review with families before ordering the vaccines (including precautions and contraindications), and anticipatory guidance about vaccines. We will also talk a little bit about how to handle vaccine hesitancy. List of pediatric vaccines How vaccines work Harmless piece of the pathogen that is enough to create immune response Explaining how vaccines work to parents Emphasis on protecting the community, not just one person Analogy of vaccine being like a software update Analogy of vaccine being like a flame retardant that stops a fire from spreading Analogy of vaccine being like an insecticide that stops bugs from spreading Types of vaccines Live, attenuated vaccines – cannot be given to patients…

In this episode, we discuss how to best prepare for your time on the inpatient wards, including how to prepare before the rotation, how to pre-round, how to present a patient, and how to be an effective team member. Before the Rotation Reach out to your team.. Understand what first day expectations are. Peruse the patient list. Identify what study materials and resources will help you excel. Come ready to learn and have fun! How to Pre-round Collect information on previous day and overnight events - includes talking with resident or night team, reading all notes from day prior Review all vitals from past day Review and calculate “Ins and Outs” Review all labs Check to see what medications, including PRN meds, your patient got Introduce yourself to patient and family - get their input on how patient is doing Collect your thoughts, interpret your data, and formulate your assessment and plan for your presentation and note How to Present a Patient on the inpatient wards service Begin with one liner Subjective:…

The goal of the adolescent well visit is to empower the adolescent in starting to take ownership of their health with the support of their parent/caregiver and their health provider. There are thus specific ways in which the adolescent well visit differs from well visits for younger children. We will discuss how you can approach these visits, how to handle patient confidentiality, and how to ask those sensitive questions. Before visit: Review normal psychosocial development of adolescence Review sexual maturity rating (SMR) (previously referred to as Tanner Staging) of adolescence Review past medical history, medications, vaccines, labs, prior concerns from previous visits, and their last well visit if available. Vital signs (including BP), height weight, BMI. Any screening questionnaires (e.g., PHQ-9A) During visit: Introduce yourself; ask how they would like to be addressed Review structure of visit, including genital exam and interviewing adolescent alone; importance of confidentiality Direct questions to…

This episode describes how to prepare for a newborn’s first outpatient visit after they have been discharged from the birth hospital, including the information that you need to obtain from the medical record before the visit, the topics you need to discuss during the visit, and how to approach the physical examination in a newborn. Introduction Socio-emotional state of parents Before the visit, you should review Prenatal history Delivery history, gestational age Physical exam at time of birth Preventative treatments Course in newborn nursery or NICU Type of feeding Concerns for infection Bilirubin Screening tests Newborn visit Parental questions and concerns Feeding history and any problems with feeding Elimination Sleep and safe sleep Social history and parental support system Review of systems – irritability, fever, rashes. Normal newborn vital signs Infant growth parameters and weight trajectory Physical exam General Head size and shape Eyes – pupil shape, red light reflex, scleral icterus Cardiovascular…

In Pediatric Gastroenterology (or GI) clinic, you will see patients with a host of gastrointestinal, pancreatic, liver, and nutrition issues. This episode will discuss specific questions that you will want to cover in your history and the elements of a complete GI exam - which is a lot more than just an abdominal exam! Peds GI clinic covers a host of gastrointestinal, pancreatic, liver and nutrition issues -3yr fellowship after peds residency Before Clinic Review what types of patients you will be seeing. It may be a mix of lots of issues, or just a liver transplant clinic. This will tell you what type of prep you should do (conditions to read up on, medications to review, etc) before the day of clinic. On the day of clinic, review expectations with the attending, fellow or resident physician. Do they want you to see patient independently and write notes, just shadow or somewhere inbetween. Review what questions they always want asked, what exams you should do alone vs with your whole team. Setting…

This episode will prepare you for your first well child visit. In primary care, about half of a pediatrician's time will be spent in well child visits. We will talk about what you need to review before you walk into the patient's room, the elements of the history (diet, sleep, elimination, development, etc.) that you need to ask about in well child visits, tips to approaching the physical exam in children, and anticipatory guidance. Finally, we will provide an example of an oral presentation for a well child visit. About the Speakers: Host: Rachel Moon, MD – Rachel Moon, MD is the Harrison Distinguished Professor of Pediatrics at UVA Health Children's. She is an internationally recognized researcher in sudden unexpected infant death and chairs the AAP Task Force on SIDS. She is also the Chief of General Pediatrics at UVA. Host: Jeremy Middleton, MD – Jeremy Middleton, MD is an Associate Professor of Pediatrics and Pediatric Gastroenterologist at UVA Health. He serves as the Pediatrics Clerkship Director and…