The Peds NP: Pearls of Pediatric Evidence-Based Practice

The seminal publication of the AAP’s Guideline on the Evaluation and Treatment of Children and Adolescents with Obesity serves as the source of our fifth episode in the series on Health Equity in Children.  The best practices for managing obesity go beyond discussions of beauty and body image to include systemic racism, obesity as a chronic disease, and the reckoning that children and adolescents...

The fourth episode in our Health Equity in Pediatrics series highlights one of the simplest individual actions a provider can take to be an ally in health equity: Say your patients’ names correctly.  Saying a person’s name correctly validates their identity, family, culture, and heritage.  Whether the name is difficult to pronounce or varies from the name given at birth, providers can use simple t...

The third episode in the Health Equity in Pediatrics series focuses on microaggressions, which are subtle slights, snubs, and digs that are seemingly innocent, innocuous, and naïve at first glance.  But their roots in harmful stereotypes and assumptions are psychologically disparaging and invalidating to the people from marginalized groups they offend. They reflect implicit bias that is unconsciou...

In the second episode of the Health Equity in Pediatrics series, we explore implicit bias as unconscious attitudes and stereotypes held against a group that may even be contrary to one’s stated beliefs. Identifying your implicit bias is a best practice that can enable you to limit its impact on your behavior and prevent harm from altered clinical decision making that is based on preconceived notio...

Welcome to the Health Equity in Pediatrics series!  In the first installment of our series, we define health equity and review some communities often affected by health disparities that limit a person’s opportunity to be as healthy as possible.  While health equity can seem like a seismic public health crisis that is too big for one person to tackle, each episode in this series will give listeners...

Got milk? The answer is complicated.  While plant-based beverages are accused of posing as animal by-product imposters, the FDA claims that consumers know the difference.  But most parents don't recognize that plant-based milks lack the same micro and macronutrient profile as cow's milk or soy milk.  This leaves pediatric providers with the very important job of assessing nutrition and guiding par...

Just because you can, doesn't mean you should.  In the depths of respiratory virus season, providers often order unnecessary tests that won't alter the course of treatment for the child presenting with upper respiratory symptoms.  This episode covers 5 common pathogens, the indications to test a child presenting with symptoms, and how to talk to families requesting tests.   References: Centers for...

Not all bacterial infections need an antibiotic.  It may sound hard to believe, but if we all followed the AAP guidelines on the management of otitis media in children and actually used a watch-and-wait approach in appropriate patients, upwards of 75% of the antibiotics prescribed for otitis media could be avoided.  Why? Because the microbiology of AOM has changed, but our prescribing practices ha...

If you've been looking for a New Year's Resolution to make a real difference in your practice, stop prescribing diphenhydramine.  Despite being a common over-the-counter medication, its potent anticholinergic side effects and sedation make it a poor choice for children.  Review the common misuses for the drug and practical, evidence-based alternatives to help get diphenhydramine out of your prescr...

In the last case study in our series on Cognitive Bias in Healthcare, attribution error (among others) of an adolescent female with foot burning reveals how two more best practices for avoiding cognitive bias can help providers think metacognitively.  Review all 8 best practices and start to implement them to reduce diagnostic error. References: Marshall, T.L., Rinke, M.L., Olson, A.P.J., Brady, P...

The next case study in our series on cognitive bias in healthcare follows an obese adolescent female with arm and neck pain who felt unheard during the 4 prior emergency room visits that week.  Listen as the differential diagnosis takes on a completely different angle and the pressure of making the diagnosis goes sky high!  We will unpack additional forms of cognitive bias and 2 more best practice...

In the first case study of our mini-series on Cognitive Bias in Health Care, we meet a 4 month old female referred to the emergency department for constipation.  Spoiler alert: We know it's not constipation... so we explore how her presentation and physical exam clash with the initial medical decision making.  Try to spot the cognitive bias and test yourself on building a differential diagnosis. ...

There are many factors that contribute to the way we perceive and interpret information... and lots of ways that our brains skew our perspectives that can lead to cognitive bias.  The second episode in our Cognitive Bias in Healthcare mini-series discusses the features of information delivery that impact our decision-making and how our brains distort them to cause diagnostic error.   References: A...

This episode is the first installment on a new mini series on cognitive bias in pediatric healthcare.  We begin by discussing what cognitive bias is, how it becomes diagnostic error, and the impact on healthcare in America.  Begin to think about how you think and explore the interesting ways our brains use mental shortcuts to arrive at an answer. References: Balogh, E. P., Miller, B. T., Ball, J....

Developmental surveillance and screening work best to identify delays when used together.  The AAP and CDC teamed up to create a standardized developmental milestone checklist in order to improve the longitudinal monitoring of pediatric milestones at home by caregivers.  This episode reviews their publication and discusses what went into the checklist, its strengths, and areas for further research...

When accelerated BSN student Sam Mahaney wanted more practical bedside application of his knowledge of pediatric cardiology, we sat down to discuss the approach to assessment and management of undiagnosed and undifferentiated congenital heart disease from a primary care perspective.  The primary care clinician should be on the lookout for red flags in the history and physical exam that might sugge...

Infant dyschezia refers to the discomfort an infant experiences when bearing down against a closed anal sphincter, and is often misidentified as constipation by parents.  As long as red flags are absent, this functional, self-limited condition is easily diagnosed using the Rome IV Criteria.  In this episode, you will learn how to reassure parents and what contraindicated treatments should be discu...

Vision screening is one of the most important preventative health screenings that a primary care provider does at well visits.  But the infant eye exam can feel obtuse and complicated if you don't understand vision development, physical exam maneuvers, and red flags for referral.  Because of the risk of significant amblyopia if ocular pathology is left untreated, every pediatric provider should kn...

With national formula shortages over 40% and growing, the pediatric provider can encourage the establishment and maintenance of breastfeeding in moms who have chosen this path.  Breastfeeding isn't without struggles and woes, so providers can help support mothers by understanding these tips based on breastfeeding physiology and advising the pair when the process isn't as easy as it seems. Referenc...

Two of the most common over-the-counter medications in pediatrics are not as simple and benign as you might think.  This episode uncovers the dark past of acetaminophen, the pearls and pitfalls of prescribing them, and how to talk to families about giving the medications safely. References: Clark, E., Plint, A.C., Correll, R., Gaboury, I., & Passi, B. (2007). A randomized, controlled trial of...

Children with acute gastroenteritis and mild or moderate dehydration can be managed at home with oral rehydration.  Learn how to partner with families and take an extra five minutes in your visit to explain the reasoning, detailed instructions, and expectations of home care as we discuss the evidence behind the rationale.   References: Carson, R.A., Mudd, S.S., & Madati, P.J. (2016). Clinical...

The well visit is time to screen for issues in primary care, which includes diet and nutrition.  Picky eating is a common problem that often plagues parents, especially when parenting styles or child development clashes with recommended feeding practices.  Dr. John Lyles joins The Peds NP to discuss evaluation and recommendations for feeding difficulties in primary care.  References: Boruta, M.K.R...

Dr. Mansi Kotwal, Allergy and Immunology fellow at Johns Hopkins, joins The Peds NP podcast again to talk about a few dermatologic manifestations of allergy.  She discusses how history is an essential component of diagnosis and goes on to discuss management of these common and benign conditions in pediatrics.  

Season 5 of The Peds NP returns with an introduction to the first exam a person will ever get: The newborn exam.  This episode focuses on that first encounter from the prenatal and birth history to the exam and screenings.  Learn to concentrate on the unique features of a newborn and consider how to document the findings on this ever-changing patient. References: Chiocca, E. (2019). Advanced pedia...

Provider variation has plagued the management of febrile neonates for decades, but the wait for standardization is over!  The AAP published its long-awaited recommendations on the evaluation and management of well-appearing febrile infants 8 to 60 days old in August 2021.  This episode picks apart the nuances and key features to help pediatric providers provide fast, safe, and effective care to th...