Explore every episode of the podcast Clerkship Ready: Pediatrics
Dive into the complete episode list for Clerkship Ready: Pediatrics. Each episode is cataloged with detailed descriptions, making it easy to find and explore specific topics. Keep track of all episodes from your favorite podcast and never miss a moment of insightful content.
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Title
Pub. Date
Duration
Before You See a Pediatric Patient with Sore Throat
05 Sep 2024
00:15:35
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.
Aluma Chovel-Sella, Amir Ben Tov, Einat Lahav, Orna Mor, Hagit Rudich, Gideon Paret, Shimon Reif; Incidence of Rash After Amoxicillin Treatment in Children With Infectious Mononucleosis. Pediatrics May 2013; 131 (5): e1424–e1427. 10.1542/peds.2012-1575
Becker JA, Smith JA. Return to play after infectious mononucleosis. Sports Health. 2014 May;6(3):232-8. doi: 10.1177/1941738114521984. PMID: 24790693; PMCID: PMC4000473.
Chowdhury MDS, Koziatek CA, Rajnik M. Acute Rheumatic Fever. [Updated 2023 Aug 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK594238/
Esposito, S.; De Guido, C.; Pappalardo, M.; Laudisio, S.; Meccariello, G.; Capoferri, G.; Rahman, S.; Vicini, C.; Principi, N. Retropharyngeal, Parapharyngeal and Peritonsillar Abscesses. Children 2022,9,618. https://doi.org/ 10.3390/children9050618
Martin JM. The Mysteries of Streptococcal Pharyngitis. Curr Treat Options Pediatr. 2015 Jun;1(2):180-189. doi: 10.1007/s40746-015-0013-9. PMID: 26146604; PMCID: PMC4486489.
MCMILLAN, J. A. , WEINER, L. B. , HIGGINS, A. M. & LAMPARELLA, V. J. (1993). Pharyngitis associated with herpes simplex virus in college students. The Pediatric Infectious Disease Journal, 12 (4), 280-283.
Mohseni M, Boniface MP, Graham C. Mononucleosis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470387/
Roggen I, van Berlaer G, Gordts F, et al. Centor criteria in children in a paediatric emergency department: for what it is worth. BMJ Open 2013;3: e002712. doi:10.1136/ bmjopen-2013-002712
Host: Chris Stadnick, MD – Chris Stadnick, MD is a board-certified pediatrician at Metropolitan Pediatrics in Portland, Oregon. He earned his MD from the University of Tennessee Health Science Center and completed his pediatric residency at the University of Virginia.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before You Care for a Pediatric Patient with Asthma
12 Jun 2024
00:15:43
Asthma is a common chronic disease of childhood that affects 1 in 12 children in the United States. It can range from mild respiratory symptoms to life threatening respiratory failure, with a range of treatment options in-between from the primary care setting to the pediatric ICU. In this episode, we will discuss the underlying pathophysiology, diagnosis, evaluation, and management of patients with asthma, along with some useful clinical pearls to help you take care of these patients!
Cause of asthma
Genetics: “Atopic triad” of asthma, atopic dermatitis or eczema, and allergic rhinitis
Prenatal and childhood environmental factors: maternal smoking and allergen exposure
Pathophysiology and diagnosis
AAP definition: “episodic and reversible airway constriction and inflammation in response to infection, environmental allergens, and irritants. It is a complex, multifactorial, and immune-mediated process that presents with various clinical phenotypes.”
Airway hyperreactivity leads to inflammation of bronchi, increased mucus production, bronchial smooth muscle contraction
Key elements of the history – recurrent episodes of cough, wheeze, difficulty breathing, nighttime symptoms, consistent trigger, atopic personal or family history, improvement with asthma treatment.
Identification of triggers is important. Common triggers include respiratory infections, mold or pet dander, pollen, intense crying or laughing, exercise, pollution, and cold air.
Children from minority and lower-income backgrounds experience an increased asthma burden, likely closely tied to a complex interaction of factors such as decreased access to healthcare, increased rates of obesity, and poor air quality in the areas in which they live.
Classification of asthma: determined by the frequency and severity of symptoms when they are not receiving preventative treatment.
New 2022 guidelines for asthma treatment
Albuterol or other beta 2 agonist as needed for symptoms - relaxes bronchial smooth muscles
Daily controller medication (usually inhaled steroid) if symptoms more than twice weekly - inhaled steroid decreases inflammation
Inhaled steroid + long-acting beta 2 agonist combination inhaler preferred for those >5 years
Asthma action plan should be given to every patient
Treatment of acute asthma attack
Quick assessment and stabilization of patient is important
Treat acute symptoms first, then address chronic control of asthma
Albuterol or ipratropium-albuterol, systemic steroids are generally first lines of treatment
Supplemental oxygen as needed
Other options for medications: magnesium, terbutaline, theophylline, epinephrine
Host: Rebecca Hu, MD – Rebecca Hu, MD is a pediatrician at Signature Healthcare in Brockton, Massachusetts. She completed her pediatric residency at the University of Virginia, where she served as a chief resident with interests in adolescent health and developmental-behavioral pediatrics.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before your first day caring for newborns – understanding neonatal hypoglycemia
29 Sep 2023
00:17:17
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:
Host: Joanna Parga-Belinkie, MD – Joanna Parga-Belinkie, MD is an Associate Professor of Clinical Pediatrics in Neonatology at the University of Pennsylvania and Attending Physician at Children's Hospital of Philadelphia (CHOP).
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before Your First ADHD Clinic Visit
22 Sep 2023
00:18:54
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
Host: Lauren Ferguson, MD – Lauren Ferguson, MD is an Assistant Professor of Pediatrics at the University of Utah. She graduated from Virginia Tech Carilion School of Medicine and completed her residency and chief year at UVA, with clinical interests in newborn medicine, breastfeeding, mental health, and ADHD management.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before You See an Infant with Jaundice
11 Sep 2023
00:26:21
In this episode, we discuss things you’ll need to know and think about before seeing an infant with jaundice. We will focus on infants from birth to 2 months of age. We will discuss the pathophysiology of hyperbilirubinemia, the difference between unconjugated and conjugated hyperbilirubinemia, the differential diagnosis, key elements of the history and physical exam, laboratory and imaging workup, and management.
Introduction to jaundice and hyperbilirubinemia
Jaundice is the yellowing of skin, sclerae, and mucous membranes caused by hyperbilirubinemia
Hyperbilirubinemia can be further separated into unconjugated or conjugated forms, which allows us to further differentiate etiology
Review of bilirubin breakdown pathway, to include enterohepatic circulation
Unconjugated hyperbilirubinemia etiologies:
Excessive or increased production of bilirubin
Cephalohematomas
Hemolysis: ABO and Rh incompatibilities; Red Blood Cell (RBC) membrane or enzyme defects, RBC oxidative stress (secondary to sepsis, asphyxia, and acidosis)
Decreased clearance of bilirubin
Breast milk jaundice
Prematurity
Hypothyroidism
Gilbert Syndrome
Crigler-Najjar Syndrome
Suboptimal Intake Jaundice
Medications
Combination of both
Physiologic jaundice
Conjugated hyperbilirubinemia etiologies:
Always pathologic
Biliary atresia
Briefly mentioned the vast range of other etiologies: infectious, genetic, metabolic, and anatomic
Key elements of history and physical examination for a jaundiced infant
History:
Onset
Feeding patterns (what, how much/often, quality of feeding)
Urine and stool diapers
Prenatal history
Delivery history
Family history
Physical exam:
Growth curves
Assessing liver size: percussion vs scratch test
Neurologic exam
Review of laboratory and imaging work up for a jaundiced infant
Brief discussion on management of unconjugated hyperbilirubinemia etiologies
Feeding
Phototherapy
Review of neurotoxicity risk factors
Brief discussion on management of conjugated hyperbilirubinemia, specifically biliary atresia
Early referral to Pediatric Gastroenterology
Kasai portoenterostomy
Liver transplant
Maximizing nutrition
Resources/Links:
Kemper, A. R., Newman, T. B., Slaughter, J. L., Maisels, M. J., Watchko, J. F., Downs, S. M., ... & Russell, T. L. (2022). Clinical practice guideline revision: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 150(3).
Pan, D. H., & Rivas, Y. (2017). Jaundice: newborn to age 2 months. Pediatrics in Review, 38(11), 499-510.
Chou, J. PediTools. AAP 2022 Hyperbilirubinemia management guidelines. https://peditools.org/bili2022/. Published 2012. Updated 2023. Accessed Aug 18, 2023.
Links:
https://peditools.org/bili2022/
About the Speaker:
Host: Ashlee Commeree, MD – Ashlee Commeree, MD is a pediatric critical care medicine physician at the University of Utah in Salt Lake City. She completed her pediatric residency at the University of Virginia before pursuing fellowship training in pediatric critical care.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before the First Time You Order Fluids or Electrolyte Replacement
11 Sep 2023
00:21:22
Many of the pediatric inpatients you care for will need intravenous fluids and electrolytes. This episode describes what you need to know before you order fluids or electrolyte replacement for your patient. We will discuss maintenance fluid needs and talk more in depth about what fluids to order and at what rate. We will also talk about managing patients with dehydration and how to replete fluids. Then we will discuss a few cases where we will work through some more common electrolyte derangements and discuss how to manage them. We will end with additional clinical pearls that will be helpful during your time on the inpatient pediatric service.
Introduction
Definition of maintenance fluid needs
Important considerations about maintenance fluids
Discussion regarding which fluids to order for different patient populations and at what rate to administer
Role of ADH in hospitalized patients
How to order a fluid bolus—amount, composition, and rate administered
Assessing your patient with dehydration utilizing physical exam findings, vital signs, and other objective data such as weight
Case scenarios: Identification and management of hyperkalemia and hypokalemia
Case #1- 12-year old with hyperkalemia following infection with influenza
Case #2- 2-year old child with history of neglect and malnutrition
Additional clinical pearls including the association between albumin and calcium, acidosis/alkalosis and potassium levels
Host: Lisa Hainstock, MD – Lisa Hainstock, MD is an Associate Professor of Pediatrics and Director of the Pediatric Residency Program at UVA Health. She is board-certified in hospital medicine and general pediatrics with interests in children with medical complexity and medical education.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Breastfeeding 102- Initiation and Management of Common Early Breastfeeding Concerns
11 Sep 2023
00:13:53
This episode is a follow-up to “Before Your First Time Working with a Breastfeeding Mother”. We’ll be reviewing additional details about breastfeeding that can help you to answer some of the most common questions that come up for families. We will discuss strategies to improve milk production, newborn stomach volumes, how to know if baby is getting enough milk, what to do if baby isn’t getting enough milk, and breastfeeding complications.
Strategies to improve milk production
Latching
Newborn stomach volumes
How to know if baby is getting enough milk
What to do if baby isn’t getting enough milk
Manual expression and pumping
Breastfeeding complications
Resources/Links:
Bella Breastfeeding Curriculum on Open Pediatrics (free): www.openpediatrics.org
Virginia Department of Health/Breastfeeding Education Consortium Online Course (free for those who live or work in Virginia): https://bfconsortium.org
American Academy of Pediatrics Residency Breastfeeding Curriculum: https://www.aap.org/en/learning/breastfeeding-curriculum/
ACOG Statement on Optimizing Support for Breastfeeding: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/optimizing-support-for-breastfeeding-as-part-of-obstetric-practice
AAP Policy Statement: Breastfeeding and the Use of Human Milk, 2022: https://publications.aap.org/journal-blogs/blog/20699/Welcome-to-the-AAP-s-2022-Policy-on-Breastfeeding?autologincheck=redirected#
US Breastfeeding Guidelines for Mothers with HIV: https://clinicalinfo.hiv.gov/en/guidelines/perinatal/infant-feeding-individuals-hiv-united-states
Host: Emily Fronk – Emily Fronk is a former UVA School of Medicine student who has published research on virtual reality in pediatrics and pain management in pediatric patients.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before Your First Time Working with a Breastfeeding Mother
11 Sep 2023
00:11:07
This episode describes what you need to know before your first time working with a breastfeeding parent. This will include topics such as how to ensure families feel comfortable, benefits of and contraindications to breastfeeding, how to approach conversations about breastfeeding, and the science behind lactation or milk production.
Making families feel comfortable
Benefits of breastfeeding for mom and baby
Contraindications to breastfeeding
Approaching conversations about breastfeeding with families
The process of lactogenesis (milk production)
Resources/Links:
Bella Breastfeeding Curriculum on Open Pediatrics (free): www.openpediatrics.org
Virginia Department of Health/Breastfeeding Education Consortium Online Course (free for those who live or work in Virginia): https://bfconsortium.org
American Academy of Pediatrics Residency Breastfeeding Curriculum: https://www.aap.org/en/learning/breastfeeding-curriculum/
ACOG Statement on Optimizing Support for Breastfeeding: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/optimizing-support-for-breastfeeding-as-part-of-obstetric-practice
AAP Policy Statement: Breastfeeding and the Use of Human Milk, 2022: https://publications.aap.org/journal-blogs/blog/20699/Welcome-to-the-AAP-s-2022-Policy-on-Breastfeeding?autologincheck=redirected#
US Breastfeeding Guidelines for Mothers with HIV: https://clinicalinfo.hiv.gov/en/guidelines/perinatal/infant-feeding-individuals-hiv-united-states
Host: Emily Fronk – Emily Fronk is a former UVA School of Medicine student who has published research on virtual reality in pediatrics and pain management in pediatric patients.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before Attending Your First Delivery in Labor and Delivery
28 Aug 2023
00:16:55
Today we will talk about what to expect before attending your first delivery as part of the pediatrics team while on the Newborn rotation. Each delivery is different and what is needed for each infant at the delivery can be different depending on the status of the infant at birth. In this episode, we will focus on the lower risk deliveries that you are most likely to attend during your newborn rotation, and what you can expect once the baby is born.
Newborn deliveries: Low Risk
Low-risk delivery team members
What constitutes a low-risk delivery page
Differences in Operating Room (OR) versus labor room deliveries
Differences in attending delivery in the delivery room versus the operating room
Operating room attire
Importance of Apgar (timer button) on radiant warmer
Delayed Cord clamping
Delayed cord clamping: When this happens and the importance
Why it matters if umbilical cord is clamped before 1 minute and infant brought to the radiant warmer
Neonatal Resuscitation
NRP guidelines from American Academy of Pediatrics
Pertinent Physical Exam at delivery
Importance of full, efficient exam in delivery room
Need for Higher Level Intervention: Neonatal Intensive Care
Reasons for calling for NICU: high-risk delivery team
Resources/Links:
Neonatal Resuscitation Program (NRP)/American Academy of Pediatrics
Host: Jolene "Jody" Carlton, DNP, APRN, CPNP-PC/AC, RNC-NIC, EMT-B – Jolene "Jody" Carlton, DNP, APRN is a Pediatric Nurse Practitioner affiliated with UVA Health University Medical Center in Charlottesville. She holds multiple certifications including CPNP-PC/AC and RNC-NIC.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before Your First Patient with an Eating Disorder
28 Aug 2023
00:11:23
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
Laurie L. Hornberger, Margo A. Lane, THE COMMITTEE ON ADOLESCENCE, Laurie L. Hornberger, Margo Lane, Cora C. Breuner, Elizabeth M. Alderman, Laura K. Grubb, Makia Powers, Krishna Kumari Upadhya, Stephenie B. Wallace, Laurie L. Hornberger, Margo Lane, MD FRCPC, Meredith Loveless, Seema Menon, Lauren Zapata, Liwei Hua, Karen Smith, James Baumberger; Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics January 2021; 147 (1): e2020040279. 10.1542/peds.2020-040279
Links:
https://doi.org/10.1176/appi.books.9780890424865
About the Speaker:
Host: Sam Baldazo, MD – Sam Baldazo, MD completed his pediatric residency at UVA, where he was involved with the wellness committee and process improvement initiatives. He is currently a Hospice and Palliative Care Fellow.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before You Choose Antibiotics for a Child or Adolescent
22 Aug 2023
00:12:55
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
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.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before You Prescribe Medicines for a Child or Adolescent
22 Aug 2023
00:13:24
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
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.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before You Order Lead Testing for Your Patient
12 Jun 2024
00:12:07
In this episode, we discuss lead toxicity and lead screening. We will talk about what lead is, what happens when a child is exposed to lead, what to ask parents about if you’re worried about lead exposure, how to screen for lead toxicity, and what to do if your patient has an elevated lead level.
Sources of lead exposure
Ingestion of contaminated food or water
Ingestion or breathing in of lead dust
Other sources: lead-acid batteries, ammunition, lead-based pigments and paints, stained glass, lead crystal glasses, ceramic glazes, jewelry, toys
For families from other cultures, think about ceramic glazes, traditional cosmetics, traditional medicines
Government policies to decrease lead exposure
Unleaded gasoline
Lead-free paint
Lead-free solder in food cans
Lead-free water pipes
Why young children are at risk for lead toxicity
Hand-to-mouth behavior
Increased absorption of lead
Developing nervous system is vulnerable
Calcium or iron deficiency increase absorption of lead
Effects of lead toxicity in children can be seen at levels as low as 3.5 µg/dL
Growth and development delays
Lower IQ
Learning and behavior problems
Hearing and speech problems
School underperformance
At higher levels, you may see
Irritability
Loss of appetite, weight loss, fatigue
Abdominal pain, vomiting, and/or constipation
Anemia
Pica
Seizures, coma, death
Universal lead screening at 1 and 2 years
Screening questionnaires are not very sensitive or specific
Blood lead test
Capillary – get results quickly, but can be falsely elevated
Venous – results more accurate, but may take some time to come back
Management of elevated lead level
Repeat it if it was a capillary sample
Review results with family
Ask about potential exposures – may need to contact health department, landlord, or independent certified lead inspector to test home for lead
Assess risk factors for iron or calcium deficiency
Ask about developmental milestones – may need to refer to early intervention services
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.
Clerkship Ready: Pediatr...
Before Your First Encounter Using an Interpreter
18 Aug 2023
00:16:57
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 you have technical difficulties or ambient noise
VII. At the end of the encounter
Translating written patient materials
Considering variable written and medical literacies
Next steps and follow-up care
VIII. After the visit
Documentation of your use of interpreter services
Verification of preferred language
Resources:
– “Addressing Low Health Literacy and Limited English Proficiency,” American Academy of Pediatrics: https://www.aap.org/en/practice-management/providing-patient--and-family-centered-care/addressing-low-health-literacy-and-limited-english-proficiency/
– “Guidelines for Use of Medical Interpreter Services,” Association of American Medical Colleges: https://www.aamc.org/media/24801/download
– “Appropriate Use of Medical Interpreters,” American Academy of Family Physicians: https://www.aafp.org/pubs/afp/issues/2014/1001/p476.html
– “Working effectively with an interpreter,” U.S. Department of Health and Human Services Office of Minority Health: https://thinkculturalhealth.hhs.gov/assets/pdfs/resource-library/working-effectively-with-interpreter.pdf
Host: Irène Mathieu, MD, MPH, FAAP – Irène Mathieu, MD, MPH, FAAP is an Associate Professor of Pediatrics at UVA and core faculty at the Center for Health Humanities & Ethics. She is a primary care pediatrician, award-winning poet with four published collections, and a Fulbright Fellow who completed her residency at CHOP.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before You Counsel about Infant Safe Sleep
10 Aug 2023
00:16:05
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 infant’s sleep area.
The infant should be breastfed as much and for as long as possible.
The infant should sleep in the parents’ room, close to the parent’s bed but on a separate surface designed for infants, ideally for at least the first 6 months of life.
Couches, sofas, and padded armchairs are extremely dangerous places for infants to sleep.
Offer a pacifier at sleep time
Parents should stay smoke-free during pregnancy and after the infant is born.
Parents should avoid alcohol, marijuana, opioids, and illicit drug use during pregnancy and after birth
Infants should be fully immunized.
Commercial sleep products are only safe if they are consistent with safe sleep recommendations
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.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before You Get a Sexual History
10 Aug 2023
00:13:06
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).
Host: Jennifer Louis-Jacques, MD, MPH – Jennifer Louis-Jacques, MD, MPH is an Associate Professor of Pediatrics specializing in Adolescent Medicine at UVA Health. She trained at Columbia/NYU and completed her fellowship at Boston Children's Hospital, with special interests in eating disorders and menstrual disorders.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before You Examine A Pediatric Patient - Physical Exam Tips & Tricks
03 Jun 2023
00:13:43
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)
Host: Shakun Gupta, MD – Shakun Gupta, MD is an Associate Professor of Pediatrics and Associate Clerkship Director at the University of Virginia. She completed her residency at Lurie Children's Hospital/Northwestern and joined UVA in 2014, where she practices general pediatrics and pediatric hospital medicine.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before You Counsel on Vaccines
02 Jun 2023
00:28:56
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 with immunocompromise
Vaccines without live, attenuated pathogen – includes mRNA vaccines
RSV vaccines
Vaccine for older adults and pregnant adults
Monoclonal antibody for infants
What you need to do before the visit
Review the vaccine record
Review the medical record for vaccine contraindications
What you should review with families before ordering the vaccines (including precautions and contraindications)
Current or recent illness
Allergies
Problems with vaccines in the past
Chronic disease
History of intussusception, seizures, neurological problems
History of blood transfusion, immunoglobulin or antiviral medications
Pregnancy
Anticipatory guidance about vaccines
Shared decision making
Common side effects are a sign that vaccines are working
Treatment of fever
How to handle vaccine hesitancy
Recommend the vaccines
Ask if they have questions that you can answer
Provide reputable resources
Helping older children with their anxiety about being vaccinated
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.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expresse...
Before Your First Day on the Wards
01 Jun 2023
00:21:26
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: interval and overnight events
Any patient or caregiver concern or question noted when you prerounded
Ins and Outs
Vital signs
Head-to-toe physical exam
Labs, microbiology, and radiology
Assessment one-liner
Plan
How to be an effective team member
Touch base with a resident to run through your assessment and plan.
Show initiative
Be honest and direct
On rounds, listen to all patient presentations, not just your own
Follow up on tasks for your patients (and other patients on the team) and make sure they are carried through
Revisit your patients to keep them updated
Write notes and ask for feedback on your notes
About the Speaker:
Host: Krista Roncone, MD – Krista Roncone, MD, FAAP completed her pediatric residency at the University of Virginia. She is a board-certified pediatrician with interests in humanitarian assistance, global health, and medical education.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before Your First Adolescent Well Visit
01 Jun 2023
00:24:19
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 adolescent as much as possible
Concerns from adolescent/parent or from prior visits that require follow up or updates
Psychosocial screening: HEADSS (home, education/employment, activities, drugs, sexuality, suicide/depression/self-image, and safety) or SSHADESS (strength, school, home, activities, drugs/substance use, emotions/eating/depression, sexuality, and safety). NOTE: Some of this will be done during confidential interview.
Nutrition: number of meals/snacks, dairy intake
Sleep: nighttime and naps
Screen time: duration, type(s)
Dental: frequency of brushing, last seen by dentist
Menstrual history: Age of menarche, frequency, length of periods, heaviness of flow, symptoms associated with menses
Confidential interview: any additional questions or concerns; Home, Drugs and substance use; Emotions, eating, and depression; Sexuality; Safety
Physical exam
Head to toe
Discuss acne
Need chaperone for breast and genital exam
Preparation for oral presentation
About the Speaker:
Host: Serwa Ertl, MD – Serwa Ertl, MD is an Assistant Professor of Pediatrics specializing in Adolescent Medicine at UVA Health. She completed her residency at Connecticut Children's Medical Center and fellowship in adolescent medicine at Children's National Medical Center.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before Your First Outpatient Newborn Visit
01 May 2023
00:25:55
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
Host: Augustin Casals, MD – Augustin Casals, MD completed his pediatric residency at the University of Virginia. He is now a practicing pediatrician in Los Angeles, California.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Peds GI Clinic
01 Apr 2023
00:13:46
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 expectations before you start will set you up for success!
Questions: Pain, the PQRST mnemonic is helpful to better understand the pain
Provoked the pain
Quality of the pain
Radiating
Severity
Specific questions to ask in Peds GI:
Does pain wakes the patient at night?
how much school or other activities the Patient has missed because of symptoms?
Does defecation or passage of gas alleviates pain?
Any specific dietary changes already tried?
Poop! understand the:
Quality of the stool
Size and caliber of the bowel movement (Use Bristol stool scale)
GERD vs EoE
A complete GI exam– a lot more than the abdomen!
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 has expertise in children with intestinal failure and aerodigestive disorders.
Host: Shakun Gupta, MD – Shakun Gupta, MD is an Associate Professor of Pediatrics and Associate Clerkship Director at the University of Virginia. She completed her residency at Lurie Children's Hospital/Northwestern and joined UVA in 2014, where she practices general pediatrics and pediatric hospital medicine.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before Your First Well-Child Check
01 Mar 2023
00:14:34
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 has expertise in children with intestinal failure and aerodigestive disorders.
Host: Shakun Gupta, MD – Shakun Gupta, MD is an Associate Professor of Pediatrics and Associate Clerkship Director at the University of Virginia. She completed her residency at Lurie Children's Hospital/Northwestern and joined UVA in 2014, where she practices general pediatrics and pediatric hospital medicine.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before Your First Time Completing a Neuro Exam
12 Jun 2024
00:40:43
In this episode of Clerkship Ready – Pediatrics Dr. Jared Barkes, a Child Neurology resident at The University of Virginia, will be walking you through how to complete the neurologic exam! Throughout the episode he will cover in detail the different parts of a formal neuro exam while also providing useful tips for remembering commonly tested facts, reviewing specific examples of abnormal findings and common neurologic conditions, and offering helpful advice for completing a neuro exam on a pediatric patient. After listening to this podcast you will have all the tools necessary to shine on your first day of your neurology clerkship!
Introduction
What is the neuro exam?
Review of the “Map” of the neuro system
Cortex, Brainstem, Spinal Cord, Motor neuron
How to complete a neuro exam and what to look for!
General Assessment
Mental Status
Language
Cranial Nerves
Strength
Sensation
Coordination
Reflexes
Special consideration for pediatrics
Closing
Resources/Links:
“NeuroLogic Exam”, A complete in-depth guide of the neuro exam complete with references and videos produced by Dr. Paul D. Larsen, M.D. and Suzanne S. Stensaas, Ph.D. at The University of Utah. (https://neurologicexam.med.utah.edu/adult/html/home_exam.html).
Host: Jared Barkes, MD – Jared Barkes, MD is a Child Neurology Resident at the University of Virginia. He graduated from the Brody School of Medicine at East Carolina University and completed his undergraduate studies at UNC Chapel Hill in Mathematics and Biochemistry, with research interests in medical play and reducing patient anxiety.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before Your First Day in Newborn Nursery
01 Feb 2023
00:20:14
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 Virginia. She completed her residency at Lurie Children's Hospital/Northwestern and joined UVA in 2014, where she practices general pediatrics and pediatric hospital medicine.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Your Pediatrics Survival Guide - Tips and Tricks
01 Jan 2023
00:09:37
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 Proactive
Know what the expectations are.
Become familiar with the electronic medical record system.
Be Self-sufficient, but ask for help when appropriate.
Know when you should come in to round, who to pre-round on, and where to meet. Pair up with an intern to pre-round.
Ask for feedback.
Pediatric-specific Tips and Tricks:
Pediatrics is different from any other rotation.
Huge range of ages and developmental stages.
At every age, children act differently - and you need to adjust appropriately.
If you can, get as much of the history from the child, but you will likely need to supplement that with history from the parent or guardian.
When you do your physical exam on younger children, have to adjust the order of exam
Vital signs change with age. Look up or ask about what is a normal vital sign in the age you are seeing.
Check weight, length/height and/or head circumference and report both percentiles and trends.
If an infant has been born prematurely, correct growth and development for gestational age.
Fluids and medication are dosed per kilogram.
Family-centered rounds are a unique, important part of pediatrics. The goal is to get both the team and family up to date on the patient’s diagnosis and overall course, and to formulate a plan for the day together with the family.
Brief summary and plan outside of the patient room.
Invite family to participate.
Conversational language with no medical jargon.
Be concise and clear.
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 has expertise in children with intestinal failure and aerodigestive disorders.
Host: Shakun Gupta, MD – Shakun Gupta, MD is an Associate Professor of Pediatrics and Associate Clerkship Director at the University of Virginia. She completed her residency at Lurie Children's Hospital/Northwestern and joined UVA in 2014, where she practices general pediatrics and pediatric hospital medicine.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their c...
Before Your First Neonatal Sepsis Work Up
01 Apr 2024
00:26:06
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.
Host: Elizabeth (Blair) Davis, MD – Elizabeth Blair Davis, MD, FAAP graduated from the University of Virginia School of Medicine and completed her pediatric residency at UVA. She received her undergraduate education from Washington and Lee University.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before You See a Child With Possible Iron Deficiency
18 Jan 2024
00:20:57
Iron deficiency is the most common nutritional deficiency that occurs in children in United States. Iron plays a vital role in cellular function in all organ systems. Today, we will be reviewing what you need to know before you first see a patient with possible iron deficiency. We will discuss why iron is so important, when and why iron deficiency occurs, screening, diagnosis, and treatment for iron deficiency.
Importance of Iron
Iron and Hemoglobin
Iron and Neurodevelopment
Iron and the Immune System
What happens in iron deficiency
Reasons that children are at high risk for iron deficiency
Rapid Growth .
Insufficient dietary intake and limited absorption
Increased losses
Peaks of Incidence
Other risk factors for iron deficiency.
Preterm infants
Children who suffer from neuro-motor disorders as they often have nutritional deficiency related to swallowing impairment
G.I. diseases that cause malabsorption,
Diseases predisposing them to bleeding.
Lead toxicity.
Screening for IDA
History: Asking about prematurity, low birth weight, exclusive breastfeeding beyond 4 months of age, weaning to whole milk without addition of iron rich foods, feeding problems, and any past medical conditions.
Exposure to lead (i.e. age/ condition of home, recent renovations, a parent who has occupational exposure, concerns about drinking water).
Any possible symptoms of anemia, such as fatigue, breath holding spells, pica
Physical exam: pallor.
Lab testing.
Treatment for iron deficiency
Oral iron: daily dose of 3 to 6 mg per kilogram of elemental iron divided into three doses is adequate.
Give iron supplements with juice - increases iron absorption through the action of ascorbic acid! Juices that are high in ascorbic acid include orange and apple juice.
Supplements should be continued for a minimum of three months to reestablish iron stores. After completion of treatment, reassessment of iron status
In addition to iron supplementation, the other aspect of treatment is encouraging dietary intake of iron rich foods (meat and fish, cereals, legumes, vegetables, soy, eggs)
Follow up
Resources/Links:
Baker RD, Greer FR, et al. Clinical Report – Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0-3 years of age). Pediatrics. 2010; 126(5). www.pediatrics.org/cgi/doi/10.1542/peds.2010-2576
Özdemir N. Iron deficiency anemia from diagnosis to treatment in children. Turk Pediatri Ars. 2015 Mar 1;50(1):11-9. doi: 10.5152/tpa.2015.2337. PMID: 26078692; PMCID: PMC4462328.
Lozoff B, Beard J, Connor J, Barbara F, Georgieff M, Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev. 2006 May;64(5 Pt 2):S34-43; discussion S72-91. doi: 10.1301/nr.2006.may.s34-s43. PMID: 16770951; PMCID: PMC1540447.
Host: Riley Calicchia, MD – Riley Calicchia, MD is a pediatric resident at the University of Rochester Medical Center / Golisano Children's Hospital in Rochester, New York. She completed her medical education and began residency training in 2024.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before You See a Child Who Has Ear Pain
18 Jan 2024
00:14:25
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.
Eustacian tube in children is smaller in diameter and angled more horizontally than in adults. This makes it more difficult to drain fluid behind the middle ear and why kids are more prone to get ear infections when they get a cold than adults are.
The adenoids also are thought to play a role in fluid collection and buildup.
Taking a history for patient with chief complaint of ear pain
How old is this child?
Have they had a fever?
Are there any other viral symptoms such as cough, runny nose, or sore throat?
Has the child been swimming recently?
Has the child put anything in their ears?
Has there been any ear drainage or changes in hearing?
Ear examination
Make sure that the child’s head is as still as possible
How to use the otoscope
What to look for:
Color of the TM.
Fluid behind the TM
Is the TM bulging or not bulging
Light reflex of the TM
Ear canal
Acute otitis media
Infectious causes - bacteria (especially Strep pneumonia, H influenzae, and Moraxella catarrhalis), viruses
Child abuse, which is sometimes called non-accidental trauma, is a public health problem with life-long health consequences for survivors and their families. In this episode, we will review what you need to know before you encounter your first patient who may have or has been abused. We will focus on physical and sexual abuse of children.
Long term health consequences of child abuse
Why identification of child abuse is difficult
It is often difficult to distinguish an accidental injury from a non-accidental injury
A caregiver who has abused a child rarely confesses to harming the child
Child may be brought to medical care by unsuspecting parent
It is emotionally difficult for us to confront parents when there are concerns for abuse
Mandated reporting of child abuse
Potential clues that a child may have been physically abused
Medical record review
History
Physical exam
Differential diagnosis of physical abuse
Labs and other tests that you may get
The role of the child protection team and child protective services
Potential clues that a child may have been sexually abused
History
Physical exam
Lab testing
Medical documentation
Resources/Links:
Christian CW; Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse. Pediatrics. 2015 May;135(5):e1337-54. doi: 10.1542/peds.2015-0356.
Pierce MC, Kaczor K, Lorenz DJ, Bertocci G, Fingarson AK, Makorof K, Berger RP, Bennett B, Magana J, Staley S, Ramaiah V, Fortin K, Currie M, Herman BE, Herr S, Hymel KP, Jenny C, Sheehan K, Zuckerbraun N, Hickey S, Meyers G, Leventhal JM (2021) Validation of a clinical decision rule to predict abuse in young children based on bruising characteristics. JAMA Netw Open 4(4):e215832. https://doi.org/10.1001/jamanetworkopen.2021. 5832. Erratum in: JAMA Netw Open. 2021 Sep 1;4(9):e2130136. PMID: 33852003; PMCID: PMC8047759
Smith T, Chauvin-Kimoff L, Baird B, Ornstein A. The medical evaluation of prepubertal children with suspected sexual abuse. Paediatr Child Health. 2020 Apr;25(3):180-194. doi: 10.1093/pch/pxaa019. Epub 2020 Apr 10. PMID: 32296280; PMCID: PMC7147698
Links:
https://doi.org/10.1001/jamanetworkopen.2021
About the Speaker:
Host: Cindy Christian, MD – Cindy Christian, MD holds the Anthony A. Latini endowed Chair in the Prevention of Child Abuse and Neglect at Children's Hospital of Philadelphia. She is a Professor of Pediatrics at UPenn's Perelman School of Medicine and an internationally recognized expert in child maltreatment.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before You Counsel About Contraception Options
24 Oct 2023
00:16:27
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:
Host: Rebecca Hu, MD – Rebecca Hu, MD is a pediatrician at Signature Healthcare in Brockton, Massachusetts. She completed her pediatric residency at the University of Virginia, where she served as a chief resident with interests in adolescent health and developmental-behavioral pediatrics.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Developmental Milestones for Children
11 Oct 2023
00:30:34
In today’s episode, we are talking about normal child development. We will talk about why this is important and how you will be evaluating children’s development. We will go over major milestones in the 4 developmental domains: movement/physical development – or gross and fine motor, language/communication, cognitive, and social/emotional. We will go over some common cases. Finally, we will briefly discuss what you should do if you suspect developmental delay. Why it is important to learn about developmental delay.
Why it is important to learn about development
Developmental surveillance versus developmental screening versus diagnosis of developmental issues
Developmental domains/categories:
Expressive language
Receptive language
Gross motor: this is how you use all of your big muscles
Fine motor: hand/eye coordination
Social/emotional: how children interact with others and show emotion.
Language/Communication: how children express their needs and share what they are thinking, as well as understand what is said to them. Hearing is important for language/communication development.
Cognitive: how children learn new things and solve problems
Movement/Physical Development: how children use their bodies.
Learning milestones
Learn the schedule for well child visits
Watch children at different ages to see what they can do.
Gross motor milestones: 1 year goal is to be able to walk independently.
Fine motor milestones: 1 year goal is to be able to put food into one’s mouth
Language and communication milestones: 1 year goal is to be able to say a few words
Social and emotional milestones: 1 year goal is to recognize that people are individuals that they can interact withOK, so those are some of the major milestones. Now, let’s go through a few common case scenarios that have some specific teaching points.
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.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before You Counsel on Introducing Complementary Foods, Including Potentially High Allergen Foods
13 Jun 2025
00:15:40
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 months.
An infant will usually develop motor and dental development skills to sufficiently chew and swallow foods around 6 months.
Introducing complementary foods too early can be associated with harmful health side effects, e.g., obesity
Importance of introducing complementary foods
Breastmilk and infant formula do not contain all the nutrients a growing infant will need to continue growing and developing appropriately.
LEAP study – babies less likely to develop peanut allergy if peanut products were introduced at 4-11 months
This study had HUGE implications regarding the introduction of potentially high allergen foods into infant’s diets to reduce the risk of developing a food allergy to them.
The introduction of complementary foods
First offer a variety of single-ingredient foods (such as pureed vegetables, fruits, grains and meats), in any order that parents desire
Iron-fortified cereal is often a good choice as iron stores from mother become depleted by about 4-6 months of age.
Recommend only providing 1-2 new foods per day in case the child has an adverse reaction
The main calorie source for these infants should still be formula or human milkor
Important foods to avoid include: honey (due to the risk of botulism), cow’s milk (we transition to cow’s milk instead of formula / breastfeeding at age 12 months but not prior. This is because it has a low absorbable iron content which can lead to iron deficiency anemia, and doesn’t have all of the nutritional value that infant’s need from breastmilk/formula), choking hazards (such as whole nuts, grapes, popcorn, etc).
Introduction of potentially allergenic foods:
The most common allergenic foods are milk, egg, soy, wheat, fish, shellfish, tree nuts, sesame
Start to introduce these foods after the infant has tried and tolerated a few of the non-allergenic complementary foods (this is to make sure that the infant can tolerate non-allergenic foods first and foremost)
For children with a history of atopy (or a family hx of atopy) it is recommended to start with a small serving of each of these foods, and then gradually increase the serving size as it is tolerated
Avoid cow’s milk in a bottle but instead introduce other cow’s milk based products such as yogurts and cheese
Allergic reactions vs contact dermatitis
Bowel movements change in color and consistency when solid foods are introduced
Summary
Resources/Links:
Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G; LEAP Study Team. Rando...
Before Your First Discussion about Infant Formula
27 Jan 2025
00:12:03
In this episode, we will be reviewing what you need to know before your first discussion about infant formula. We will cover the characteristics and types of formulas, why infants might require different types, the correct way to prepare formula and how much infants need, common concerns from parents, indications for changing formulas, and when to transition away from it.
Reasons for formula feeding
Human milk is first choice for most infants
Concern about lactating parent’s milk supply
Workplace conditions make it difficult to sustain human milk feeding
Parent preference
There are few true contraindications to breastfeeding.
Galactosemia
Maternal HIV infection that has not achieved an undetectable viral load
Maternal phencyclidine (also known as PCP) or cocaine use
Active Herpes Simplex virus lesion
Active tuberculosis
Types of formula: 3 characteristics
Caloric density: calories per ounce. Standard term formula is 20 calories/oz. Infants born preterm or have growth failure may need 22-27 calories/oz.
Carbohydrate source: Lactose (galactose + glucose) or non-lactose
Protein type:
Cow-milk based formula proteins are whey and casein.
Hydrolyzed formulas: proteins are broken down into smaller protein “chunks” or into individual amino acids, which are hypoallergenic and easily digestible.
Other formulas utilize different sources of protein, including soy protein and goat’s milk.
Special formulas for infants with specific metabolic conditions: eg. phenylketonuria, maple syrup urine disease, homocystinuria.
Forms of formula
Powder: most common and least expensive. Usually, 1 scoop of formula powder is mixed with 2 oz water.
Liquid concentrate: mixed 1:1 with water.
Ready to feed: no mixing required, but most expensive.
Be sure that the formula is being mixed correctly! Incorrect formula mixing can result in growth failure or electrolyte abnormalities.
How much formula should be given?
A good rule of thumb is that infants require between 120-150 calories/kilogram per day.
Common myths about formula
Lactose intolerance. True congenital lactase deficiency is rare disorder and, in infants, it will usually present with very severe diarrhea.
What adults experience as lactose intolerance occurs later in childhood.
Developmental lactase deficiency can occur in premature infants, but lasts for a short time after birth and the majority are still able to consume lactose-containing formulas.
Infants can develop a temporary, self-resolving lactase deficiency after suffering from a gastroenteritis
Increased spit ups (often at around 4 months of age): Generally not a sign of formula intolerance.
Gassiness and stomach discomfort after feeding: Normal and usually not a reason to switch formulas.
Medical reasons to switch formula type
Galactosemia: most often diagnosed after abnormal newborn metabolic screen.
Milk protein allergy: usually presents with blood in stool from allergic proctocolitis. Rarely, more severe milk protein allergies can present as hives or even anaphylaxis.
Metabolic disorders
Usually stop infant formula at 1 year of age and switch to cow’s milk, usually whole milk.
Do not switch to cow’s milk before 1 year of age because of solute load on kidneys.
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 food allergies
Clinical history
Oral food challenge - gold standard
Skin prick/puncture test
Serum IgE testing
Treatment of food allergy
Referral to allergy/immunology specialist and avoidance of offending food until appointment
Prescription for epinephrine autoinjector
Second generation antihistamines
Resources/Links:
Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management Scott H. Sicherer, MD, and Hugh A. Sampson, MD New York, NY
Mendonca CE, Andreae DA. Food Allergy. Prim Care. 2023 Jun;50(2):205-220. doi: 10.1016/j.pop.2023.01.002. Epub 2023 Mar 27. PMID: 37105602.
About the Speaker:
Host: Jenna Zuzolo, MD – Jenna Zuzolo, MD is a pediatric resident at the University of Virginia with a focus on allergy and immunology. She attended Marshall University for her undergraduate education.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.
Before You see a Child with Eczema
25 Mar 2026
00:19:08
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)
Roduit C, et al. (the PASTURE study group). Phenotypes of Atopic Dermatitis Depending on the Timing of Onset and Progression in Childhood. JAMA Pediatr. 2017 Jul 1;171(7):655-662. doi: 10.1001/jamapediatrics.2017.0556. PMID: 28531273; PMCID: PMC5710337.
Schoch JJ, Anderson KR, Jones AE, Tollefson MM; Section on Dermatology. Atopic Dermatitis: Update on Skin-Directed Management: Clinical Report. Pediatrics. 2025 Jun 1;155(6):e2025071812. doi: 10.1542/peds.2025-071812. PMID: 40383540.
Host: Carly Pierson, MD – Carly Pierson, MD is a pediatric resident in the Primary Care Track at UVA Health. She graduated from the University of the Incarnate Word School of Osteopathic Medicine and has interests in allergy and immunology.
Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.