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As a child, a nosebleed can be painful and embarrassing. Surprisingly, itās also something primary care providers run into often in their practices. While the great majority of nosebleeds, also called epistaxis, are limited in severity and duration, about 6% of people who experience them will seek medical attention. Interventions range from self-treatment and home remedies to more intensive procedural options and medications. Why are we seeing so many cases of epistaxis in our offices? What is causing the onset of these nosebleeds, and are environmental changes a culprit?
To explore the intricacies of epistaxis, we are joined by Jeremy Prager, MD. Dr. Prager specializes in otolaryngology at Childrenās Hospital Colorado and is a Professor of Otolaryngology at the University of Colorado School of Medicine.
Some highlights from this episode include:
How to differentiate between a nosebleed and a more severe epistaxis diagnosis. The importance of partnership between the specialist and the primary care provider to properly care for a nosebleed. The most common causes of a nose bleed in children by age. How to support patients when outpatient management isnāt working.For more information on Childrenās Colorado, visit: childrenscolorado.org.
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One of the great medical accomplishments of our time is the evolution of precision medicine. The ability to understand a patientās unique genetic profile has become more accessible to our patients, and now, there are multiple mechanisms for using that information to overcome disease.
One of the specialties leading the way in precision medicine is pediatric neurology. According to the World Health Organization, more than one in three people are affected by some type of neurological condition. They are a leading cause of ill health and disability worldwide. This subset of precision medicine will not only help us decrease those numbers but also allow us to treat some of these conditions in ways we have never done before.
To detail this exciting work, weāre joined by two experts. Scott Demarest, MD, and Julie Parsons, MD, are both pediatric neurologists at Childrenās Hospital Colorado and faculty at the University of Colorado School of Medicine. Dr. Demarest focuses on rare epilepsy conditions, and Dr. Parsons specializes in neuromuscular disease. Dr. Demarest is the Clinical Director of the Precision Medicine Institute at Childrenās Colorado.
Some highlights from this episode include:
Understanding precision neurology within the context of precision medicine Why precision neurology positively impacts diagnosis and treatment options How families are more easily accessing important genetic testing The role primary care providers play with caring for these rare diseasesFor more information on Childrenās Colorado, visit: childrenscolorado.org.āÆāÆāÆ
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Many of us avoid talking about suicide, not only because itās a difficult conversation, but also because we donāt know how to. And avoiding that conversation can be a barrier to helping those most at risk.
One family from Colorado is at the forefront of changing the stigma and creating opportunities for fearless conversations. They courageously shared their story in a powerful documentary released earlier this year called āMy Sister Liv.ā In this special episode, we honor Liv Kunikās life and learn about how her story is spurring hundreds of courageous discussions around suicide.
The guests for this episode are family members at the heart and soul of the documentary, as well as mental health advocates. Honey Beuf is Livās mom, and she is the co-founder and Executive Director of The Liv Project. Tess Kunik is Livās sister and the co-founder of The Liv Project. Her voice also narrates the film, taking us through Livās story. Jessica Hawks, PhD, is the Clinical Director of the Pediatric Mental Health Institute at Childrenās Hospital Colorado and a child and adolescent psychologist. She is also an Associate Professor at the University of Colorado School of Medicine.
Some highlights from this episode include:
An overview of how the āMy Sister Livā documentary came together and the impact itās having in the community Ways for friends, family and providers to have āfearless conversationsā A discussion of how providers can best care for suicidal patients and their families, such as asking direct questions A look at advocacy efforts underway and tools created to support courageous conversations A youth suicide prevention resource from the American Academy of Pediatrics and the American Foundation for Suicide Prevention providers can use in their daily practiceVisit The Liv Project website to learn more about their work, how you can access the film and details about the game mentioned in the episode, The Game that Goes There.
For more information on Childrenās Colorado, visit: childrenscolorado.org.āÆāÆāÆ
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In the state of Colorado, cases of Neonatal Abstinence Syndrome (NAS) and Neonatal Opioid Withdrawal Syndrome (NOWS) increased by 120% from 2011 to 2016. Clinicians provide critical support to improve outcomes for these newborns, and thereās been impressive collaboration among healthcare providers around this issue. Two important examples are the Colorado Hospitals Substance Exposed Newborn Quality Improvement Collaborative, otherwise known as CHoSEN QIC, and Kids in Care Setting Clinic (KICKS). In this episode, we learn about these initiatives and how they benefit hospitals like Childrenās Hospital Colorado to provide the best care for our patients.
Joining us for this discussion are two experts. Bird Gilmartin, MD, is the Medical Director for Kids in Care Settings Clinic (KICS) at Childrenās Colorado, as well as an associate professor of clinical pediatrics at the University of Colorado School of Medicine. Sunah (Susan) Hwang, MD, specializes in neonatal and perinatal medicine at Childrenās Colorado and is an associate professor of pediatric neonatology at the University of Colorado School of Medicine.
This episode looks at:
The epidemic of perinatal opioid use, as well as illicit and legally prescribed substance abuse Suggestions on shifting your perspective as a provider about families with substance use issues The ways these substance abuse programs intertwine with our legal systemSome resources our experts recommend utilizing are the Colorado Perinatal Care Quality Collaborative (CPCQC), Illuminate, and Tough as a Mother.
For more information on Childrenās Colorado, visit: childrenscolorado.org.
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Despite the pervasiveness of child trafficking in the United States, many communities arenāt aware of the scope of the issue. Here in Colorado, the University of Coloradoās Kempe Center is recognized as a leader in the fight against child abuse, and they are important voices in the global conversation around identifying and ending child trafficking. By committing to responding, treating and preventing all forms of child abuse and neglect, medical professionals can make a difference in this crucial effort.
To shed light on these realities and provide insight into how we can all play a part, we are joined by Denise Abdoo, PhD, CPNP., who specializes in child abuse neglect at Childrenās Hospital Colorado. She is an associate professor of pediatrics at the University of Colorado School of Medicine, as well as a member of the Kempe Centerās facility.
Some highlights from this episode include:
The current state of child trafficking nationally and globally The work the Kempe Center is doing to help combat child abuse The reasons why child trafficking is under reported Ways the medical community can provide both physical and mental health careFor more information on Childrenās Colorado, visit: childrenscolorado.org.
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With kids back in school, pediatric viral illnesses are revving their engines. It seems we have returned to normal seasonality for viral disease after the coronavirus pandemic. Top of mind with the arrival of fall is respiratory syncytial virus (RSV). We know how quickly the onset of RSV season can take over our waiting rooms.
Last year, two important developments occurred that could change the course of RSV prevention: the FDA approval of a maternal vaccine and a monoclonal antibody for infants. Far too few mothers and infants benefitted from these treatments during last yearās respiratory season, but now weāve had a year to prepare to do better.
Joining us to discuss this hot topic are two expert pediatricians. Sean OāLeary, MD, is an Infectious Disease Physician at Childrenās Hospital Colorado, a Professor of Pediatrics at the University of Colorado School of Medicine and is the chair of the American Academy of Pediatrics Committee on Infectious Diseases, also known as the Red Book Committee. Matt Dorighi, MD, specializes in pediatrics at Cherry Creek Pediatrics. He is currently chair of the Pediatric Care Network, the largest clinically integrated network for children in the state of Colorado.
Some highlights from this episode include:
Guidelines for Nirsevimab and the maternal vaccine Why availability will not be a barrier this respiratory season How practices can combat vaccine hesitancyFor more information on Childrenās Colorado, visit: childrenscolorado.org.
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Children with autism spectrum disorder (ASD) tend to have more medical complications than the average kid. Among the most common challenges are gastrointestinal (GI) disorders like abdominal pain, constipation and diarrhea. Untreated GI distress in kids with ASD has been linked to many other issues, including sleep, behavioral and psychiatric disorders. Many of these same kids also have selective eating, which impacts their intake of necessary nutrients. Due to these many layers of complexity, it can be challenging to know how to help a child with ASD and GI symptoms.
To understand this intricate issue, we are joined by Christine Waasdorp Hurtado, MD, who specializes in gastroenterology at Childrenās Hospital Colorado. She is the Southern Colorado Executive Faculty Director of the Department of Pediatrics, as well as a Professor of Pediatrics for the University of Colorado School of Medicine.
Some highlights from this episode include:
The most common GI issues in kids with ASD How primary care providers can best treat these kids How certain treatment outcomes can improve quality of lifeFor more information on Childrenās Colorado, visit: childrenscolorado.org.
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Sharing data transparently, whether at a local or a national level, is a foundational contributor to healthcare quality. Atul Gawande wrote about this in his 2004 essay labeled āThe Bell Curveā. Over the last several decades, we have seen many pediatric specialties organize and collaborate around data collection at a national scale to improve care. Weāve seen firsthand how our hospitalās participation in a national cardiac critical care registry has driven quality improvement, better measurable outcomes and improved cardiac arrest rates for patients. Getting the data collection right is the first challenge. In between that first step and actually seeing improvements is a tremendous amount of work. In this episode, we explore the value of data sharing and transparency to improve outcomes for kids.
Our experts for this episode are Carly Scahill, DO, and Kelly OāNeil. Dr. Scahill specializes in pediatric cardiology as a pediatric cardiac intensivist. She is also the Fellowship Director for pediatric cardiology and the cardiac intensive care unit (CICU), as well as an associate professor of pediatrics at the University of Colorado School of Medicine. Kelly OāNeil is a registered nurse and the Manager of the Heart Institute Data Registries and Outcomes. Before her current role, she was a CICU nurse for over ten years.
Some highlights from this episode include:
The purpose and use of clinical registries How data collection improves measurable outcomes The future of data collection in healthcare How to get more entities involvedFor more information on Childrenās Colorado, visit: childrenscolorado.org.āÆāÆāÆ
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Over the last few decades, the roles of nurse practitioners (NPs) and physician assistants (PAs), also known as advanced practice providers (APPs), have greatly expanded to touch even more patient-family lives. They are an essential part of the care we provide, and their roles have evolved over time. In this episode, we explore the crucial part they play in our medical system and how that might continue to evolve in the future.
For this episode, we are joined by two University of Colorado leaders who continue to help keep our APP programs among the top ranked in the country. Jonathan Bowser is the Child Health Associate and Physician Assistant Program Director at the University of Colorado School of Medicine. He is also the Associate Dean of Physician Assistant Studies, the Section Head of Pediatrics, and an associate professor. Jill Marks, NP, is the Specialty Director of the Acute Care Pediatric Nurse Practitioner Program at the University of Colorado College of Nursing. She is also an inpatient nurse practitioner for the section of pediatric neurology at the University of Colorado School of Medicine.
Some highlights from this episode include:
Background on the creation of NPs and PAs The ways these roles have changed over time The impact APPs make on patient care The role APPs will play in healthcare in the futureFor more information on Childrenās Colorado, visit: childrenscolorado.org.āÆāÆāÆ
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Our medical community is committed to providing excellent patient care, and itās also our duty for that care to extend to our planet. Climate change is an increasingly important global health issue where children are the most vulnerable to adverse health outcomes. One major contributing factor to climate change in medicine is the use of nitrous oxide in spaces like the operating room and outpatient clinics. Efforts are underway in hospitals across the country to decrease our environmental impact, including at Childrenās Hospital Colorado.
To explore the exciting new project happening at Childrenās Colorado and to discuss the environmental impacts on a global scale, we are joined by two experts. Tom Majcher, DO, is the Chief of Anesthesiology at Childrenās Colorado, as well as a professor of pediatrics and clinical practice for anesthesiology at the University of Colorado School of Medicine. Diane Gordon, MD, specializes in anesthesiology at Childrenās Colorado and is an associate professor of pediatric anesthesiology at the University of Colorado School of Medicine.
Some highlights from this episode include:
How nitrous oxide is currently used in medical settings The damage it does on the environment What efforts are underway to reduce its impact How to keep the same standard of care with new alternatives The importance of this transition in the operating roomFor more information on Childrenās Colorado, visit: childrenscolorado.org.āÆāÆāÆ
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Over the last few decades, there have been many incredible medical advances in newborn care. At Childrenās Hospital Colorado, weāre launching an exciting new initiative to take another step forward in care for our tiniest patients.
For newborns who need to be hospitalized, getting home as soon as possible is critical for their successful development. A common barrier for discharge that can keep babies in the neonatal intensive care unit (NICU) for additional days or weeks is the need for a nasogastric (NG) tube. Ensuring an infant is receiving proper nutrition is essential to securing a safe discharge. What if we could deliver NG tube feeds at home and provide all the necessary support? Thatās the game changing idea we explore in this episode with our neonatology experts.
To dive into this topic, we are joined by three neonatologists practicing at Childrenās Colorado. Stephanie Bourque, MD, Kathleen Hannan, MD, and Danielle Smith, MD, tell us about a new at-home NG tube feed program that the team at Childrenās Colorado is currently developing. Dr. Smith is the Medical Director of the NICU, Dr. Bourque is the Associate Medical Director of the NICU, and all three of our guests are faculty at the University of Colorado School of Medicine.
Some highlights from this episode include:
What the need has been historically for NG tubes Model for this at-home program Whatās required to make this at-home model a reality The role of the primary care provider in this partnership The impact a change like this could have on patient outcomes and family satisfactionFor more information on Childrenās Colorado, visit: childrenscolorado.org.āÆāÆāÆ
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Join us for another insightful season of Charting Pediatrics! The same hosts you know and love will continue to bring the latest and greatest information about pediatric medicine to your ears. Joined by renowned experts, we will explore prominent topics while being moved by their personal stories. This is a season you won't want to miss!
For more information on Childrenās Colorado, visit: childrenscolorado.org.āÆāÆāÆ
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We all know what it feels like to have a headache, but each person can experience that intensity for dozens of different reasons. Globally, headache disorders affect approximately 40% of the population, which is about 3.1 billion people. Headaches are also among the three most common neurological conditions for most age groups starting at age 5.
As such a ubiquitous issue, itās important for providers to understand, diagnose and treat headaches. What are the most common reasons for headaches in children? How should pediatricians know when a headache is more than surface-level discomfort?
To learn about the latest in pediatric headaches, we are joined by two headache experts, Marcy Yonker, MD, and Angelina Koehler, NP. Dr. Yonker is the Director of the Headache Program at Childrenās Colorado and the Dale, Cindy and Kristin Francescon Endowed Chair for Headache Treatment with the University of Colorado Department of Pediatrics. Angelina Koehler is a certified pediatric nurse practitioner in the Neuroscience Institute at Childrenās Colorado.
Some highlights from this episode include:āÆ
What PCPs should take into account about migraines How to approach headache treatment options What to consider with hesitation around certain medications When to look for signs of a more serious illnessFor more information on Childrenās Colorado, visit: childrenscolorado.org.āÆāÆāÆ
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For almost 50 years, Dr. Fritz Karrer has been wearing a surgeonās cap, growing as a surgeon alongside the evolution of his specialty. For 40 of those 50 years, heās been at Childrenās Hospital Colorado, making an everlasting impact on kids and their families. On the brink of retirement, we look at his exemplary career and discuss how heās watched firsthand the progression of pediatric surgery. His half century of perspective makes him the perfect expert to dive into the growth of pediatric surgery.
Dr. Karrer specializes in pediatric surgery and surgical critical care at Childrenās Colorado and is a Professor of Pediatric Surgery at the University of Colorado School of Medicine. Heās also a colonel in the U.S. Army Reserve, he was recognized as a top doctor in 2023 by 5280 Magazine and heās been awarded the James Strain Award and the Military Medical Merit from the U.S. Army.
Some highlights from this episode include:āÆāÆ
The incredible journey of Dr. Karrerās career The ways pediatric surgery has evolved over the last 50 years The influence of technology on pediatric surgery Advice for young doctors wanting to follow a similar path āÆFor more information on Childrenās Colorado, visit: childrenscolorado.org.āÆāÆāÆ
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More than 50% of rural counties in the United States do not have a pediatrician, and more than 80% of counties lack access to healthcare services that are simply needed to maintain the health of their population. The medical experts in those areas are lifelines to their communities. They are providing essential care, approaching resource and access challenges with creativity and innovation, and connecting kids to specialists when needed. Area codes can determine as much about health and life expectancy as issues like genetic predisposition and lifestyle.
Our two guests are doing this work in rural communities every day. Kelly Miller, MD, is a general pediatrician with Pediatric Partners of the Southwest in Durango, CO. Anna Mack, DNP, FNP, is a family nurse practitioner with Peak Vista Community Health Centers in Colorado Springs. She is also faculty at a post-graduate training advanced practice registered nurse fellowship program.
Some highlights from this episode include:āÆāÆ
What are the primary challenges for providers in rural pediatrics How experts are overcoming rural mental health hurdles for kids Ways providers are using innovative solutions for issues they face in rural areas How more urban and rural organizations can work toward stronger partnershipsFor more information on Childrenās Colorado, visit: childrenscolorado.org.āÆāÆāÆ
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Running is an increasingly popular sport, with high school track and field programs seeing booming participation rates. With rising interest comes more cases of injury, however, incredible sports medicine advancements and programs are helping young runners manage and prevent injuries.
To break down the most common running-related injuries in youth and discuss comprehensive approaches to prevention and recovery, we are joined by three Childrenās Hospital Colorado experts. Aubrey Armento, MD is a sports medicine physician, Medical Director of the Runners Clinic for Young Athletes, and an assistant professor of Orthopedics at the University of Colorado School of Medicine. Amanda McCarthy is a program coordinator of sports nutrition and a registered sports dietician. Cameron (Cody) Yeaman, DPT, is a sports physical therapist and a certified specialist in orthopedic sports and strength and conditioning.
Some highlights from this episode include:āÆāÆ
What to know about new diagnoses in young runners What there is to be learned from dissecting a case study How patients and families benefit from a variety of specialists at the Runners Clinic How pediatricians can understand and tap into an athlete mentality to gain buy-in from their patients. āÆFor more information on Childrenās Colorado, visit: childrenscolorado.org.āÆāÆāÆ
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For some, COVID-19 may seem like a thing of the past, but for medical professionals, the data regarding post-acute sequalae of COVID infection is only just emerging. Four years ago, the start of the pandemic left doctors puzzled by certain symptoms. Today, we are learning more about the long-term impacts of SARS-CoV-2 in children, often called long COVID or PASC. As the population continues to struggle with persistent and debilitating after-effects and symptoms, we are looking for answers.
To provide insight into this important diagnosis, we are joined by Suchitra Rao, MD. She is an infectious disease specialist at Childrenās Hospital Colorado, as well as the Associate Medical Director of Infection Prevention and Control. She is also an associate professor of Pediatrics within the sections of Infectious Diseases, Epidemiology, and Hospital Medicine at the University of Colorado School of Medicine.
Some highlights from this episode include:āÆāÆ
The epidemiology of long COVID in kids The difference between the data in adults and children A discussion of how to diagnose asymptomatic patients A closer look at Dr. Raoās groundbreaking researchFor more information on Childrenās Colorado, visit: childrenscolorado.org.āÆāÆāÆ
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Inflammatory bowel disease, otherwise known as IBD, is an illness pediatric providers need to consider when they see kids with abdominal pain, diarrhea or weight loss. IBD can present in a fairly straightforward way, or it can be incredibly challenging to diagnose. Weāve seen improvements in IBD diagnosis and care recently, including new screening tools and medications, as well as future treatments currently under investigation. Getting these medications to kids can be a challenge since pharmaceutical companies focus on adult indications and pediatric clinical research can sometimes lag. That delays access to some of the best therapies.
One of our experts in IBD at Childrenās Hospital Colorado is our guest for this episode, Edwin De Zoeten, MD. He is the director of the Pediatric Inflammatory Bowel Disease Center, and is the Hoover Family Endowed Chair for Digestive Health and Nutrition. He is a professor of Pediatrics at the University of Colorado school of Medicine and has a basic science research lab focused on better understanding the pathophysiology of IBD and looking at new treatment opportunities.
Some highlights from this episode include:āÆāÆ
Understanding what symptoms look like and how early they can begin Looking at the underlying pathophysiology that triggers IBD Sharing tools pediatricians can use for diagnosing and treating IBD Discussing the durability of treatments and benefits over time āÆFor more information on Childrenās Colorado, visit: childrenscolorado.org.āÆāÆāÆ
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In simple terms, bioethics is the study of ethical, social and legal issues that arise in biomedicine and biomedical research. It provides guidelines for clinical decision-making and is vital to policy change. Despite standards set by medical entities, significant gaps and variabilities exist within bioethics education for pediatric residents. Every resident will face ethical challenges in their career, so it's important that programs prepare learners to navigate these dilemmas. To address these inconsistencies, a chief resident at the University of Colorado School of Medicine has created a new curriculum that could significantly improve our bioethics education.
Joining us for this episode is Ella Sorscher, MD, Brian Jackson, MD, and Brady Slater. Dr. Sorscher is a pediatrics chief resident at the University of Colorado School of Medicine and is one of the brains behind this new bioethics curriculum. Dr. Jackson is the Medical Director of Clinical Ethics and specializes in critical care as a pediatric intensivist at Childrenās Hospital Colorado. He is also an associate professor at the University of Colorado School of Medicine. Dr. Slater is a pediatrics and medical genetics resident at the CU School of Medicine.
Some highlights from this episode include:āÆāÆ
Details about this curriculum The significance of bioethics in a physicianās career Information on assessing learners and evaluating the curriculum Opportunities for other institutions to learn from this modelFor more information on Childrenās Colorado, visit: childrenscolorado.org.āÆāÆāÆ
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Earlier this year, new guidelines were released to improve the diagnosis of pediatric sepsis and septic shock. For the first time, the novel Phoenix Sepsis Criteria provides an objective and data-driven approach to aid in the identification of these life-threatening conditions, including prediction of mortality in children with suspected or confirmed infection. Sepsis is one of the leading causes of death among children worldwide, and these guidelines could be a major step in changing outcomes.
To help us understand these guidelines and apply them to your practice, we are joined by two experts who have been at the forefront of this new research. Tell Bennett, MD, specializes in pediatric critical care at Childrenās Hospital Colorado. He is the Vice Chair of Clinical Informatics, as well as a professor of biomedical informatics and pediatrics at the University of Colorado School of Medicine. Halden Scott, MD, is the Director of Research for the section of emergency medicine at Childrenās Colorado. She is also an associate professor of pediatrics at the University of Colorado School of Medicine.
Some highlights from this episode include:āÆāÆ
How to diagnosis sepsis under the new guidelines How these criteria can be applied to primary care practices What treatment options are and why time is of the essence āÆFor more information on Childrenās Colorado, visit: childrenscolorado.org.āÆāÆāÆ
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