The MCG Pediatric Podcast

What happens when an infant who appeared healthy is suddenly found unresponsive during sleep?

Dr. Jessica Davis, pediatric hospitalist and Medical Director of the Newborn Nursery at the Wellstar Golisano Children’s Hospital of Georgia, joins medical student Katy Stone Sanchez to discuss Sudden Infant Death Syndrome (SIDS). Through a clinical case, they will:

 Differentiate SIDS from Sudden Unexpected Infant Death (SUID) and discuss why SIDS remains a diagnosis of exclusion.

Explore important risk factors and the SIDS Triple-Risk Model.

Review the differential diagnosis for sudden unexpected infant death.

Discuss evidence-based safe-sleep recommendations and strategies for counseling families.

Address common questions about reflux, tummy time, bed-sharing, and home monitoring devices.

Special thanks to Dr. Rebecca Yang and Dr. Isaac Jacks for peer reviewing this episode.

CME Credit: Link Coming Soon!

References:

Carlin RF, Moon RY. Risk factors, protective factors, and current recommendations to reduce sudden infant death syndrome: a review. JAMA Pediatr. 2017;171(2):175-180. doi:10.1001/jamapediatrics.2016.3345

Oltman SP, Rogers EE, Baer RJ, et al. Early newborn metabolic patterning and sudden infant death syndrome. JAMA Pediatr. 2024;178(11):1183-1191. doi:10.1001/jamapediatrics.2024.3033

Keywan C, Poduri AH, Goldstein RD, Holm IA. Genetic factors underlying sudden infant death syndrome. Appl Clin Genet. 2021;14:61-76. doi:10.2147/TACG.S239478

Moon RY, Carlin RF, Hand I; Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. Sleep-related infant deaths: updated 2022 recommendations for reducing infant deaths in the sleep environment. 2022;150(1):e2022057990. doi:10.1542/peds.2022-057990

Moon RY, Carlin RF, Hand I; Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. Evidence base for 2022 updated recommendations for a safe infant sleeping environment to reduce the risk of sleep-related infant deaths. 2022;150(1):e2022057991. doi:10.1542/peds.2022-057991

Machaalani R, Say M, Waters KA. Effects of cigarette smoke exposure on nicotinic acetylcholine receptor subunits α7 and β2 in the sudden infant death syndrome (SIDS) brainstem. Toxicol Appl Pharmacol. 2011;257(3):396-404. doi:10.1016/j.taap.2011.09.023

Centers for Disease Control and Prevention. Data and statistics for SUID and SIDS. Accessed August 11, 2026. https://www.cdc.gov/sudden-infant-death/data-research/data/index.html?

Centers for Disease Control and Prevention. Trends in SUID rates by cause of death, 1990-2022. Accessed August 11, 2026. https://www.cdc.gov/sudden-infant-death/data-research/data/sids-deaths-by-cause.html?

Sodini C, Paglialonga L, Antoniol G, Perrone S, Principi N, Esposito S. Home Cardiorespiratory Monitoring in Infants at Risk for Sudden Infant Death Syndrome (SIDS), Apparent Life-Threatening Event (ALTE) or Brief Resolved Unexplained Event (BRUE). Life (Basel). 2022;12(6):883. Published 2022 Jun 13. doi:10.3390/life12060883

Autism spectrum disorder (ASD) and other intellectual disabilities have become a hot button topic in both medicine and the news as of late, with recent questions about the multifactorial causes of intellectual disabilities, including genetics. Developmental-Behavioral Pediatrician Dr. Kendall Abbas is joined by Liliana Amirhosseini and Zoe Gunthert, two fourth year medical students, to discuss presentation, diagnosis, and management of Fragile X, the most common inherited cause of intellectual disability. Specifically, they will

Explain the genetics and pathophysiology leading to the Fragile X phenotype

Discuss the clinic characteristics associated with Fragile X, allowing for prompt evaluation and management of the symptoms

Share treatment plans and resources available for those with Fragile X and their families

Special thanks to Dr. Rebecca Yang and Dr. Sarah Straka for peer reviewing this episode.

Free CME available:  Link for CME Credit

References:

Bailey DB Jr, Raspa M, Bishop E, Holiday D. No change in the age of diagnosis for fragile X syndrome: Findings from a national parent survey. 2009 Aug;124(2):527-533. 

Hunter JE, Berry-Kravis E, Hipp H, et al. FMR1 Disorders. 1998 Jun 16 [Updated 2024 May 16]. In: Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1384/.

Mendez A, Mendez M. Fragile X Syndrome: A Review for General Pediatricians. Pediatr Ann. 2024;53(7):e269-e271. doi:10.3928/19382359-20240502-08

Malecki, C., Hambly, B.D., Jeremy, R.W. et al. The RNA-binding fragile-X mental retardation protein and its role beyond the brain. Biophys Rev 12, 903–916 (2020). https://doi.org/10.1007/s12551-020-00730-4. 

National Fragile X Foundation. Prevalence. https://fragilex.org/understanding-fragile-x/fragile-x-101/prevalence/. 

Sirois CL, Guo Y, Li M, et al. CGG repeats in the human FMR1 gene regulate mRNA localization and cellular stress in developing neurons. Cell Rep. 2024;43(6):114330. doi:10.1016/j.celrep.2024.114330

Spector, Elaine et al. Laboratory testing for fragile X, 2021 revision: a technical standard of the American College of Medical Genetics and Genomics (ACMG). Genetics in Medicine. 2021;23(5): 799 - 812. doi: 1038/s41436-021-01115-y .

Read out and read – How Stories Build Stronger Families

How can a simple book help shape a child’s brain, strengthen family relationships, and promote lifelong learning? In this episode of the Medical College of Georgia Pediatric Podcast, medical student Megan Garrison, pediatric resident Jessie Foglio, and pediatrician Dr. Erica Sapp explore the powerful impact of Reach Out and Read. Learn how shared reading during early childhood supports language development, strengthens caregiver-child bonds, promotes health equity, and gives pediatric healthcare professionals a unique opportunity to support families—one book at a time.

CME available free with sign up:  Link for CME credit

Did you know that the average age of puberty onset in girls has been declining for decades, and that early puberty can have lasting psychological, social, and physical consequences? Roshni Patel, a fourth-year medical student at the Medical College of Georgia, and Bianca Forte, WHNP, a Women's Health Nurse Practitioner with a specialty in Pediatric and Adolescent Gynecology at Wellstar MCG Health, to discuss the recognition, evaluation, and management of precocious puberty in girls. Specifically, they will:

Review the normal pubertal timeline and define precocious puberty in females

Distinguish between premature thelarche, premature adrenarche, and precocious puberty through history and physical exam findings

Discuss the initial diagnostic workup, including bone age studies, hormone levels, and the GnRH stimulation test

Differentiate central precocious puberty from peripheral precocious puberty and outline appropriate management for each

Address the mental health impact of early puberty and how to support young patients during the clinical encounter

Identify when to refer patients to Pediatric Endocrinology or Pediatric and Adolescent Gynecology

Special thanks to Dr. Rebecca Yang and Dr. Sarah Straka for peer reviewing this episode

Free CME Available: Link Coming Soon!

References:

Aghaee S, Deardorff J, Quesenberry CP, Greenspan LC, Kushi LH, Kubo A. Associations Between Childhood Obesity and Pubertal Timing Stratified by Sex and Race/Ethnicity. Am J Epidemiol. 2022;191(12):2026-2036. doi:10.1093/aje/kwac148

Berberoğlu M. Precocious puberty and normal variant puberty: definition, etiology, diagnosis and current management. J Clin Res Pediatr Endocrinol. 2009;1(4):164-174. doi:10.4274/jcrpe.v1i4.3

Carel JC, Léger J. Clinical practice. Precocious puberty. N Engl J Med. 2008;358(22):2366-2377. doi:10.1056/NEJMcp0800459

Dinkelbach L, Grasemann C, Kiewert C, Leikeim L, Schmidt B, Hirtz R. Central Precocious Puberty and Psychiatric Disorders. JAMA Netw Open. 2025;8(6):e2516679. Published 2025 Jun 2. doi:10.1001/jamanetworkopen.2025.16679

Eckert-Lind C, Busch AS, Petersen JH, et al. Worldwide Secular Trends in Age at Pubertal Onset Assessed by Breast Development Among Girls: A Systematic Review and Meta-analysis. JAMA Pediatr. 2020;174(4):e195881. doi:10.1001/jamapediatrics.2019.5881

Hampl SE, Hassink SG, Skinner AC, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640

Joinson C, Heron J, Lewis G, Croudace T, Araya R. Timing of menarche and depressive symptoms in adolescent girls from a UK cohort. Br J Psychiatry. 2011;198(1):17-2. doi:10.1192/bp.110.080861

Kaplowitz PB. For Premature Thelarche and Premature Adrenarche, the Case for Waiting before Testing. Horm Res Paediatr. 2020;93(9-10):573-576. doi:10.1159/000512764

Klein DA, Emerick JE, Sylvester JE, Vogt KS. Disorders of Puberty: An Approach to Diagnosis and Management. Am Fam Physician. 2017;96(9):590-599.

Kota AS, Sharma L, Ejaz S. Precocious Puberty. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544313/

Parents and clinicians are often faced with an important question: is anesthesia safe for young children? In this episode, medical student Kaavya Gudapati is joined by Dr. Maria Valeria Carrasquero and Dr. Ana Mavarez to review the current evidence on anesthesia exposure and the developing brain, and to provide practical guidance for clinical decision-making and family counseling. Specifically, they will:

Review the FDA warning regarding repeated or prolonged anesthesia exposure in children under 3 years of age

Compare key findings from animal studies and human clinical trials

Summarize major studies including PANDA, MASK, and GAS

Discuss strategies for counseling families and addressing parental concerns

Identify considerations for timing of elective versus urgent procedures

Review approaches to minimize exposure and explore potential neuroprotective strategies

Special thanks to Dr. Heather Byrd and Dr. Rebecca Yang for peer reviewing this episode.

CME available free with sign up: Link coming soon!

References:

1. Vinson AE, Houck CS. Neurotoxicity of Anesthesia in Children: Prevention and Treatment. Curr Treat Options Neurol 2018; 20:1–10. https://doi.org/10.1007/S11940-018-0536-Z/TABLES/1.

2. Hansen TG. Anesthesia-related neurotoxicity and the developing animal brain is not a significant problem in children. Pediatric Anesthesia 2015; 25:65–72. https://doi.org/10.1111/PAN.12548.

3. O’Leary JD. Human Studies of Anesthesia-Related Neurotoxicity in Children: A Narrative Review of Recent Additions to the Clinical Literature. Clin Perinatol 2019; 46:637–45. https://doi.org/10.1016/j.clp.2019.08.001.

4. FDA Drug Safety Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women | FDA n.d. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-review-results-new-warnings-about-using-general-anesthetics-and (accessed August 28, 2025).

5. FDA Drug Safety Communication: FDA approves label changes for use of general anesthetic and sedation drugs in young children | FDA n.d. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-approves-label-changes-use-general-anesthetic-and-sedation-drugs (accessed August 28, 2025).

6. SmartTots. SmartTots consensus statement on the use of anesthetic and sedative drugs in infants and toddlers.Published 2015. Updated 2017. Accessed September 17, 2025. https://smarttots.org

7. Sun LS, Li G, Miller TLK, Salorio C, Byrne MW, Bellinger DC, et al. Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood. JAMA - Journal of the American Medical Association 2016; 315:2312–20. https://doi.org/10.1001/JAMA.2016.6967.

8. Warner DO, Zaccariello MJ, Katusic SK, Schroeder DR, Hanson AC, Schulte PJ, et al. Neuropsychological and behavioral outcomes after exposure of young children to procedures requiring general anesthesia: The mayo anesthesia safety in kids (MASK) study. Anesthesiology 2018; 129:89–105. https://doi.org/10.1097/ALN.0000000000002232.

9. McCann ME, Berde C, Soriano S, Marmor J, Bellinger D, de Graaff JC, et al. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicenter, randomised controlled equivalence trial. Lancet 2019; 393:664. https://doi.org/10.1016/S0140-6736(18)32485-1.

10. Davidson AJ, Disma N, de Graaff JC, Withington DE, Dorris L, Bell G, et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): An international multicentre, randomised controlled trial. The Lancet 2016; 387:239–50. https://doi.org/10.1016/S0140-6736(15)00608-X.

11. Reighard C, Junaid S, Jackson WM, Arif A, Waddington H, Whitehouse AJO, et al. Anesthetic Exposure During Childhood and Neurodevelopmental Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open 2022;5: e2217427. https://doi.org/10.1001/JAMANETWORKOPEN.2022.17427.

12. Jadhav U, Bhanushali J, Sindhu A, Shiv Kiran Reddy B, Toshniwal A, Rashmika M. A Comprehensive Review of Pediatric Obstructive Sleep Apnea: From Assessment to Intervention 2025. https://doi.org/10.7759/cureus.78051.

13. Andropoulos DB. Neuroprotective strategies in anesthesia-induced neurotoxicity. Best Pract Res Clin Anaesthesiol 2023; 37:52–62. https://doi.org/10.1016/J.BPA.2022.11.005.

14. Ji F, Sun J, Sun L, et al. Effects of Dexmedetomidine and Remifentanil on Neurodevelopmental Outcomes After Sevoflurane Anesthesia in Infants: A Randomized Clinical Trial. Anesthesiology. 2025. 143(4), 827–834. https://doi.org/10.1097/ALN.0000000000005634

15. Saynhalath, R, Disma, N, Taverner, FJ et al. on behalf of the TREX (Trial Remifentanil DEXmedetomidine) Consortium. Short-term Outcomes in Infants after General Anesthesia with Low-dose Sevoflurane/Dexmedetomidine/Remifentanil versus Standard-dose Sevoflurane (the TREX Trial). Anesthesiology 141(6): p 1075-1085, December 2024. | DOI: 10.1097/ALN.0000000000005232

16. Ing C, Warner DO, Sun LS, Flick RP, Davidson AJ, Vutskits L, McCann ME, O'Leary J, Bellinger DC, Rauh V, Orser BA, Suresh S, Andropoulos DB. Anesthesia and Developing Brains: Unanswered Questions and Proposed Paths Forward. Anesthesiology. 2022 Mar 1;136(3):500-512. doi: 10.1097/ALN.0000000000004116. PMID: 35015802.