Clerkship Ready: Pediatrics

• Before You Counsel on Introducing Complementary Foods, Including Potentially High Allergen Foods

  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 botu...

  --------  

  15:40

  --------

  15:40
• Before Your First Discussion about Infant Formula

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

  --------  

  12:03

  --------

  12:03
• Before You See a Pediatric Patient with Sore Throat

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

  --------  

  15:35

  --------

  15:35
• Before You Care for a Pediatric Patient with Asthma

  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

  --------  

  15:43

  --------

  15:43
• Before You Order Lead Testing for Your Patient

  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

  --------  

  12:07

  --------

  12:07

More Education podcasts

Trending Education podcasts

About Clerkship Ready: Pediatrics