Browse All Episodes — The Peds NP

Browse All Show Notes and References

Read an overview of each episode, review references, and click the link to listen.

Season 1: The Basics (Ep. 1-9)

S1 Ep. 1
When a global pandemic threatens my NP students' ability to complete clinical hours in person, faculty all over the country scrambled to figure out how to reach the academic goals for their students. Join me as I journey through an attempt at conveying my finest clinical pearls using a novel medium. A podcast!
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S1 Ep. 2
When constipation enters the acute care setting or is difficult to manage in primary care, use this podcast to consider the evidence-based practice guidelines and a few pearls of wisdom to assess a child’s presentation, diagnose constipation, and manage the cleanout at home with two essential medications.
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References:
Chumpitazi, C.E., Rees, C.A., Camp, E.A., Henkel, E.B, Valdez, K.L., & Chumpitazi, B.P. (2017). Diagnostic approach to constipation impacts pediatric emergency department disposition. American Journal of Emergency Medicine, 35(10), 1490-1493.
Drossman, D.A., Hasler, W.L. (2016) Rome IV-functional GI disorders: disorders of gut-brain interaction. Gastroenterology, 150(6):1257–1261. doi: 10.1053/j.gastro.2016.03.035.
Ferguson, C.C., Gray, M.P., Diaz, M., & Boyd, K.P. (2017). Reducing unnecessary imaging for patients with constipation in the pediatric emergency department. Pediatrics, 140(1), e1-e7.
Freedman SB, Thull-Freedman J, Manson D, et al. Pediatric abdominal radiograph use, constipation, and significant misdiagnoses. The Journal of pediatrics. 2014;164(1):83-88.e82.
North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. (2014). Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of Pediatric Gastroenterology and Nutrition, 58(2), 258-274.
Varni, J.W., Burwinkle, T.M., Katz, E.R., Meeske, K., & Dickinson, P. (2002). The PedsQL™ in pediatric cancer. Cancer, 94(7), 2090-2106.
Youssef, N.N., Langseder, A.L., Verga, B.J., Mones, R.L., & Rosh, J.R. (2005). Chronic childhood constipation is associated with impaired quality of life: A case-controlled study. Journal of Pediatric Gastroenterology and Nutrition, 41(1), 56-60.
S1 Ep. 3
Today we talk through the tough decision on what to do when a patient presents at the most inconvenient time with Fever Without Source. Why is this a hard decision? What are the things that you should be thinking about? We review the literature, the rationale, and the options of how to manage these patients using evidence-based practice to guide us.
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References:
AAP. (2011). Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics, 128(3), 595-610.
Baraff, L.J. (2000). Management of fever without source in infants and children. Annals of Emergency Medicine, 36(6), 602-614.
Simon, A.E., Lukacs, S.L., & Mendola, P. (2011). Emergency department laboratory evaluations of fever without source in children aged 3 to 36 months. Pediatrics, 128(6), e1368-e1375.
S1 Ep. 4
Rabies is one of those scary words associated with animal bites. But not every situation requires post-exposure prophylaxis. Join us today as we talk about rabies exposure, risk, and post-exposure management in the pediatric patient.
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References:
American Academy of Pediatrics. (2018). Red Book: 31st Ed. American Academy of Pediatrics: Itasca, IL.
Bula-Rusas, F.J., & Olcott, J.L. (2018). Human and animal bites. Pediatrics in Review, 39(10), p. 490-500.
Centers for Disease Control and Prevention. (2019). Wildlife reservoirs for rabies. Retrieved online at https://www.cdc.gov/rabies/exposure/animals/wildlife_reservoirs.html
Mani, C.S., & Murray, D.L. (2006). Rabies. Pediatrics in Review, 27(4), 129-136.
S1 Ep. 5
When a marital argument seeks to justify the use of a seemingly antiquated healthcare learning exercise, we find ourselves at the center of an existential question: Is the keyboard mightier than the mouse click?
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S1 Ep. 6
Vaccine hesitancy has become a controversial and highly politicized topic in healthcare today. Join us as we discuss the history on how we got here, the current literature and obstacles facing the perpetuation of the issue, and how to talk with vaccine hesitant parents.
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References:
AAP Committee on Community Health Services. (2006). Periodic survey #6: Pediatricians’ attitudes and practices surrounding the delivery of immunizations. Retrieved online from https://www.aap.org/en-us/professional-resources/Research/Pages/PS66_Executive_Summary_PediatriciansAttitudesandPracticesSurroundingtheDeliveryofImmunizationsPart2.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR:+No+local+token.
AAP Committee on Practice and Ambulatory Medicine, Committee on Infectious Diseases, Committee on State Government Affairs, Council on School Health and Section on Administration and Practice Management. (2016). Medical versus nonmedical immunization exemptions for child care and school attendance. Pediatrics, e20162145. DOI: https://doi.org/10.1542/peds.2016-2145
Edwards, K.M., Hackell, J.M., The Committee on Infectious Diseases, & The Committee on Practice and Ambulatory Medicine. (2016). Countering vaccine hesitancy. Pediatrics, 138 (3), e20162146. DOI: https://doi.org/10.1542/peds.2016-214.
McCauley, M.M., Kennedy, A., Basket, M., & Sheedy, K. (2012). Exploring the choice to refuse or delay vaccines: A national survey of parents of 6- through 23-month-olds. Academic Pediatrics, 12(5),375–383.
Meissner, H.C. (2020). Ask the Expert: Why is vaccine development against COVID-19 disease so difficult? AAP News. Retrieved from https://www.aappublications.org/news/2020/06/17/covid19vaccines061720
Opel, D.J., Heritage, J., Taylor, J.A., Mangione-Smith, R., Salas, H.S., DeVere, V.,… & Robinson, J.D. (2013) The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics, 132(6), p. 1037-1046. Doi: DOI: https://doi.org/10.1542/peds.2013-2037
Reiland, R. (2018). Searching for a vaccine against mistrust. Johns Hopkins Magazine, online. Retrieved from https://hub.jhu.edu/magazine/2018/winter/vaccines-mistrust-and-misinformation/.
CDC. (2020). Africa kicks out wild polio. Retrieved from https://www.cdc.gov/polio/why-it-matters/africa-kicks-out-wild-polio.htm#:~:text=On%20August%2025%2C%202020%2C%20the,certified%20as%20wild%20poliovirus%2Dfree.
S1 Ep. 7
Practical tips for the APRN student on selecting the article, reading it, then writing a literature review for discussion with classmates or colleagues.
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S1 Ep. 8
Get started on documentation with pearls of wisdom on the different pieces of an outpatient note.
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Reference:
The Joint Commission. (2017). Inadequate hand-off communication. Sintenel Event Alert(58), p. 1-6.
S1 Ep. 9
In this episode of The Peds NP we use a bad example of calling a consult to demonstrate "what not to do" before discussing some good examples and help to develop the critical skill of asking a clinical question.
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Season 2: Primary Care (Ep. 10-21)

S2 Ep. 10
As my primary care pediatrics students finish their first week of class, we review some questions on the newborn and discuss some key principles of clinical notes to get ready for next week.
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S2 Ep. 11
Join us as we pick apart the pieces of a well child check and discuss the ideal head-to-toe exam.
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References:
Leske, D., Hatt, S., Castaneda, Y. (2019) Eye-related quality of life and functional vision in children wearing glasses. Journal of American Association for Pediatric Ophthalmology and Strabismus,24(2). https://doi.org/10.1016/j.jaapos.2019.12.010.
Zabbidi-Hussin, Z.A. (2016). Practical way of creating differential diagnoses through expanded VITAMINS ABCDEK mnemonic. Advances in Medical Education and Practice, 7, 247-248.
S2 Ep. 12
Join us as we unpack the ddx and discuss common and severe problems of the eye in pediatric patients. Later, we talk about journal club reviews of the literature and note one of my favorite ways to appraise an article.
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S2 Ep. 13
Prick up your ears for this week's discussion on some favorite principles at The Peds NP. We use acute otitis media as an example of taking it back to the patho and spending an extra 5 minutes teaching the parents.
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References:
American Academy of Pediatrics (2013). Ten things physicians and patients should question. Released February 21, 2013 (1-5) and March 17, 2014 (6-10); #1, 3, 9 updated July 13, 2016; #1, 2, 4, 5 and 10 updated June 12, 2018. Retrieved online https://www.choosingwisely.org/wp-content/uploads/2015/02/AAP-Choosing-Wisely-List.pdf
FDA. (2017). Use of cough suppressants in children. Retrieved online at https://www.fda.gov/files/drugs/published/Use-of-Cough-Suppressants-in-Children--April-27--2017-Meeting-Summary.pdf
Green JL, Wang GS, Reynolds KM, et al. Safety Profile of Cough and Cold Medication Use in Pediatrics. Pediatrics. 2017;139(6):e20163070
Rosa-Olivares, J., Porro, A., Rodriguez-Varela, M., Riefkohl, G., & Niroomand-Rad, I. (2015). Otitis media: To treat, to refer, to do nothing: A review for the practitioner. Pediatrics in Review, 36(11), 480–488. https://doi.org/10.1542/pir.36-11-480
S2 Ep. 14
Join us today as we discuss how to identify acute disease by recognizing illness scripts written in test questions or in the medical record, then apply these concepts beyond the classroom.
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S2 Ep. 15
Diagnosis is the easy part. Deciding whether to send the comfortably tachypneic bronchiolitic is the hard part. Join us today as we unpack how to make that very decision and hear some pearls on supportive care.
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References:
Cloutier, M.M., Dixon, A.E., Krishnan, J.A., Lemanske, R.F., Pace, W., Schatz, M. (2020) Managing asthma in adolescents and adults: 2020 asthma guideline update from the National Asthma Education and Prevention Program. JAMA, 324(22):2301–2317. doi:10.1001/jama.2020.21974NHLBI asthma guidelines 2007
National Heart, Lung, Blood Institute’s National Asthma Education and Prevention Program. (2012). Guidelines for the diagnosis and management of asthma 2007 (EPR-3). The Journal of Allergy and Clinical Immunology, 120(5), S94-138. Doi: DOI: 10.1016/j.jaci.2007.09.043
S2 Ep. 16
What is one of the unique features of pediatric health care? Monitoring their growth! Join us today as we discuss important primary and acute care issues surrounding pediatric growth.
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References:
CDC. (2010). Use of the World Health Organization and CDC growth charts for children aged 0-59 months in the United States. MMWR Recomm Rep. 2010;59(RR-9);1-15.
S2 Ep. 17
What's the difference between a pediatric patient who needs an LP and one that goes home? Find out on today's episode as we pick apart the presentation of fever without source.
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Reference:
Nadeem, S., Badawy, M., Oke, O.K., Filkins, L.M., Park, J.Y., & Hennes, H.M. (2021). Pyuria and urine concentration for identifying urinary tract infection in young children. Pediatrics, 147(2), e2020014068. doi: 10.1542/peds.2020-014068. PMID: 33514634.
S2 Ep. 18
Patients with acute diagnoses often start, and always end, in primary care. Today we discuss primary care implications of cardiac disease in children.
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References:
AAP. (2017). Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics, 140(3), e20171904.
McCrindle, B.W., Rowley, A.H., Newburger, J.W., Burns, J.C., Bolger, A.F., Gewitz, M., … & Pahl, E. (2017). Diagnosis, treatment, and long-term management of Kawasaki Disease: A scientific statement for health professionals from the American Heart Association. Circulation, 135, e927-e999.
S2 Ep. 19
A novel is to the clinical note what a summary statement is to Cliff's Notes. A summary statement is a concise phrase of synthesized patient information that transforms your assessment, and formulating one is a critical skill for any provider to learn. Understand the essential components of a summary statement and hear a few good and bad examples on this episode.
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References:
Siegel, M. (2017). Concise summaries only, please. Yale School of Medicine News. Retrieved online at https://medicine.yale.edu/news-article/15646/
University of Florida Department of Medicine. (2021). Instructions for write-ups. Retrieved online at https://clerkship.medicine.ufl.edu/clerkship-requirements/write-ups/instructions-for-write-ups/
S2 Ep. 20
Whatever your social life looks like when you go home, I want you to know how important your work in pediatrics is to so many children! Fever is common, the presentation is simple, and this episode reinforces the management of simple febrile seizures according to the 2011 AAP guidelines.
Catgories: guidelines discussion, medical decision making, Family interaction/education, system-based diseases (neuro), primary and acute care
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References:
(AAP), Subcommittee on Febrile Seizures, American Academy of Pediatrics. (2011). Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics, 127(2), 389-394.
Abolfazl, N.-Z., Francois, D., Valerie, H., Pruvost, I., Bennour, A., & Martinot, A. (2013). Risk of bacterial meningitis in young children with a first seizure in the context of fever: a systematic review and meta-analysis. PloS one, 8(1), 55270. doi:10.1371/journal.pone.0055270
Natsume, J., Hamano, S.-I., Iyoda, K., Kanemura, H., Kubota, M., Mimaki, M., . . . Sugie, H. (2017). New guidelines for management of febrile seizures in Japan. Brain & development, 39(1), 2-9. doi:https://dx.doi.org/10.1016/j.braindev.2016.06.003
Seattle Children’s Hospital. (2019). Febrile seizure: Acute presentation v2.0. Retrieved online from https://www.seattlechildrens.org/pdf/febrile-seizures-pathway.pdf.
S2 Ep. 21
Once the exams are all taken, the papers submitted, and the grades are in... you've still got work to do. Healthcare professions require career-long learning, so join me as I discuss some options for staying current and engaged in pediatric learning after you walk off the stage and into clinical practice.
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Season 3: Primary Care (Ep. 22-29)

S3 Ep. 22
On this Mother's Day edition of The Peds NP podcast, we consider the perfect baby shower present for an expecting mother. By using your knowledge of pediatric physiology, growth, and development, you can turn that baby registry into an opportunity to promote health and wellness for a new family.
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S3 Ep. 23
Thank you preceptors for your tireless support of students who cannot learn the art of pediatric healthcare without your bedside teaching. This relationship born out of duty, generosity, and mutual respect can create lifelong collegial friendships. But what should students do if they notice problems in clinical? Today we explore how you should think, do, and say when evidence-based practice gets put in a corner.
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References:
American Academy of Pediatrics. (2020). Tips for successful clerkships. Retrieved online from https://services.aap.org/en/career-resources/medical-students/tips-for-successful-clerkships/
Grenny, J., Patterson, K., Switzler, A., & McMillan, R. (2011). Crucial Conversations: Tools for talking when stakes are high (2nd ed.). McGraw Hill Professional.
Maaks, D., Starr, N.B., Brady, M.A., Gaylord, N.M., Driessnack, M., & Duderstadt, K.G. (2020). Burn’s Pediatric Primary Care (7th ed.). Elsevier.
ThriveAP. (2018). How do you deal with a bad clinical placement. Retrieved from https://thriveap.com/blog/how-do-you-deal-bad-clinical-placement.
S3 Ep. 24
As summer approaches and kids spend more time playing outside, pediatric providers need to be ready to recognize heat-related illness and offer savvy perspectives on how to protect kids from the sun's harmful rays.
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References:
American Academy of Pediatrics. (2011). Ultraviolet radiation: A hazard to children and adolescents. Pediatrics, 127(3), 588-597. doi:10.1542/peds.2010-3501
Center for Biological Diversity. (2021, March 9). Hawai’I senate bill bans harmful sunscreen chemicals. https://biologicaldiversity.org/w/news/press-releases/hawaii-senate-bill-bans-harmful-sunscreen-chemicals-2021-03-09/
Mangus, C.W., & Canares, T.L. (2019). Heat-related illness in children in an era of extreme temperatures. Pediatrics in Review, 40(3), 97-107. doi: 10.1542/pir.2017-0322
U.S. Food & Drug Administration. (2017). Sun protective factor (SPF). Retrieved online from https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/sun-protection-factor-spf
S3 Ep. 25
Having a sense of fashion and listening to what the style gurus tell us "what not to wear" is similar to provider practice and the clinical practice guidelines published by our national authorities. Yet, somehow jorts came back into fashion and albuterol trials remain common practice for bronchiolitis. What will you wear and do?
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References
Condella, A., Mansbach, J.M., Hasegawa, K., Dayan, P.S., Sullivan, A.F., Espinola, J.A., & Camargo, C.A. (2018). Multicenter study of albuterol use among infants hospitalized with bronchiolitis. Western Journal of Emergency Medicine, 19(3), 475-483. doi: 10.5811/westjem.2018.3.35837
Ralston, S.L., Lieberthal, A.S., Meissner, H.C., Alverson, B.K., Baley, J.E., Gadomski, A.M… & Hernandez-Cancio, S. (2014). Clinical practice guideline: The diagnosis, management, and prevention of bronchiolitis. Pediatrics, 134(5), e1474-e1502. doi: 10.1542/peds.2014-2742
S3 Ep. 26
When patients (or parents!) use unique phrasing of a phenomenon, we must interpret their description of the experience in laymen's terms using clarifying questions while being attentive to inaccurate use of medical terms. Let a kid tell you their story and you'll learn everything you need to know. Hear what I mean with a couple of real GI examples from my week.
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References
Tate, J.E., & Bresee, J.S. (2012). Principles and Practice of Pediatric Infectious Diseases (Fourth ed.). Elsevier: China.
S3 Ep. 27
I've got incredible burrito-eating skills like you've never seen. These epic Tex-Mex talents translate to test-taking strategies that are a sure-fire way to effectively implement critical thinking.
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References:
Fernandez-Plaza, A., Saiz-Mendiguren, R., Garcia-Lallana, A., Viteri-Ramirez, G., Etxano, J., & Bondia Garcia, J.M. (2012). Ileo-ileal intussusceptions in a child complainting of abdomnial pain. Eurorad, Case 10092. doi: 10.1594/EURORAD/CASE.10092
Maaks, D.L.G., Starr, N.B., Brady, M.A., Gaylord, N.M., Driessnack, M., & Duderstadt, K.G. (2019). Pediatric Primary Care (7th ed). St Louis: Saunders Elsevier.
PNCB. (2019). PNCB announces unprecedented action for CPNP-AC exam integrity. Retrieved online from https://www.pncb.org/sites/default/files/resources/CPNP-AC_Exam_Press_Release_FINAL_3-4-2019.pdf
Wiersma, F., Allema, J.H., & Holscher, H.C. (2006). Ileoileal intussusception in children: ultrasonographic differentiation from ileocolic intussusception. Paediatric Radiology, 36(11), 1177-1181. doi: 10.1007/s00247-006-0311-2
S3 Ep. 28
Ten percent of Americans report an allergy to amoxicillin, yet most of these don't represent a true allergy. Today we discuss the types of drug allergies, how to determine if the allergy can be removed, and second line drugs for true PCN allergy with the goal of being outstanding stewards of antimicrobial stewardship.
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References
American Academy of Pediatrics. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), p. e964-e999. doi:10.1542/peds.2012-3488
Chaudry, S.B., Veve, M.P., & Wagner, J.L. (2019). Cephalosporins: A focus on side chains and beta-lactam cross reactivity. Pharmacy, 7(3), p. 103. doi: 10.3390/pharmacy7030103
Mill, C., Primeau, M.N., Medoff, E., Lejtenyi, C., O’Keffe, A., Netchiporouk, E., … & Ben-Shoshan, M. (2016). Assessing the diagnostic properties of a graded oral provocation challenge for the diagnosis of immediate and nonimmediate reactions to amoxicillin in children. JAMA Pediatrics, 170(6), e160033. doi:10.1001/jamapediatrics.2016.0033
Shenoy, E.S., Macy, E., Rowe, T., & Blumenthal, K.G. (2019). Evaluation and management of penicillin allergy: A review. JAMA, 321(2), p. 188-199. doi:10.1001/jama.2018.19283
Shulman, S.T., Bisno, A.L., Clegg, H.W., Gerber, M.A., Kaplan, E.L., Lee, G., … & Van Beneden, C. (2012) Clinical practice guideline for the diagnosis and management of Group A Streptococcal pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 55(10), p. e86-102. DOI: 10.1093/cid/cis629
Vyles, D., Chiu, A., Routes, J., Castells, M., Phillips, E.J., Kibicho, J., & Brousseau, D.C. (2018). Antibiotic use after removal of penicillin allergy label. Pediatrics, 141(5), e20173466. doi: 10.1542/peds.2017-3466.
S3 Ep. 29
"What's wrong with your legs?' 'Nothin' at all, thank you. My legs are just fine and dandy.'" This episode takes a line from Forrest Gump and RUNS with it. It's important for providers to know normal MSK development from an intrauterine fetus to the running child so that you can give parents reassurance for normal, expected defects while referring true deformities.
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References:
Espandar, R., Mortazavi, S.M.J., & Baghdadi, T. (2010). Angular deformities of the lower limb in children. Asian Journal of Sports Medicine, 1(1), p. 46-53. doi: 10.5812/asjsm.34871
Gupta, P., Gupta, V., Patil, B., & Verma, V. (2020). Angular deformities of lower limb in children: Correction for whom, when and how? Journal of Clinical Orthopedics and Trauma, 11(2020), p. 196-201. https://doi.org/10.1016/j.jcot.2020.01.008
Scherl, S.A. (2004). Common lower extremity problems in children. Pediatrics in Review, 25(2), p. 52-62. doi: 10.1542/pir.25-2-52

Season 4: Acute Care (Ep. 30-38)

S4 Ep. 30
Whether you're presenting in class, for colleagues, or on a national stage, it's important to have the tools and skills to disseminate your work in a scholarly way. This week's show focuses on helping you with presentation format, PowerPoint visuals, and presentation skills to help you stand out and confidently demonstrate your expertise.
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References:
Cuddy, A. (2012). Your body language may shape who you are. Retrieved online from https://www.ted.com/talks/amy_cuddy_your_body_language_may_shape_who_you_are?language=en#t-603306
Morgan, N. (2011). Why we fear public speaking and how to overcome it. Retrieved online from https://www.forbes.com/sites/nickmorgan/2011/03/30/why-we-fear-public-speaking-and-how-to-overcome-it/?sh=5a85243f460b
S4 Ep. 31
Nutrition is arguably the most important component of care in children with critical illness, yet its importance often falls down the list of priorities. Many questions remain on how best to manage nutrition in pediatric critical care, but this episode addresses many best practices from the SCCM and ASPEN's Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient.
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References
Mehta NM, Bechard LJ, Zurakowski D et al. Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a multicenter, prospective, cohort study. Am J Clin Nutr. 2015;102:199-206.
Mehta NM, Skillman HE, Irving SY, Coss-Bu JA, Vermilyea S, Farrington EA, McKeever L, Hall AM, Goday PS, Braunschweig C. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Pediatr Crit Care Med. 2017 Jul;18(7):675-715. doi: 10.1097/PCC.0000000000001134. PMID: 28691958.
S4 Ep. 32
The 2014 AAP guidelines on the treatment of bronchiolitis are a provider's medical decision-making and management compass, but how can we interpret the vague or absent recommendations involving advanced care of patients requiring hospitalization? This episode covers the recent evidence published since the 2014 guidelines and helps to provide some direction on key issues for patients in need of greater respiratory support.
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References:
Coletti, KD, Bagdure DN, Walker LK, Remy KE, Custer JW. High flow nasal cannula utilization in pediatric critical care: an observational study. Respir Care 2017;62(8):1023-1029.
Elliott, S.A., Gaudet, L.A., Fernandes, R.M., Vandermeer, B., Freedman, S.B., Johnson, D.W., &… Hartling, L. (2021) Comparative efficacy of bronchiolitis interventions in acute care: A network meta-analysis. Pediatrics, 147(5), e2020040816. doi: 10.1542/peds.2020-040816.
Kalburgi, S., & Halley, T. (2020). High-flow nasal cannula use outside of the ICU setting. Pediatrics, 146(5), e20194083. doi: 10.1542/peds.2019-4083.
Leyenaar, J.K., & Ralston, S.L. (2020). Widespread adoption of low-value therapy: The case of bronchiolitis and high-flow oxygen. Pediatrics, 146(5), e2020021188. doi: 10.1542/peds.2020-021188.
Mahant, S., Wahi, G., Bayliss, A., Giglia, L., Kanani, R., Pound, C.M., & … Canadian Paediatric Inpatient Research Network (PIRN). (2021). Intermittent vs continuous pulse oximetry in hospitalized infants with stabilized bronchiolitis: A randomized clinical trial. JAMA Pediatrics, 175(5), p. 466-474. doi: 10.1001/jamapediatrics.2020.6141.
Mallory, M.D., Shay, D.K., Garrett, J., & Bordley, W.C. (2003) Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit. Pediatrics, 111(1), e45-51. doi: 10.1542/peds.111.1.e45.
S4 Ep. 33
Cardiogenic shock occurs in children for a variety of reasons, and there are a variety of vasoactive drugs available to treat the critical condition. But first we need to understand the pathophysiology and pharmacology to best select the drug for the job, which is no easy task.
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References
Bolick, B.N., Reuter-Rice, K., Madden, M.A., Severin, P.N. (2020). Pediatric Acute Care: A guide for Interprofessional Practice (2nd ed.). Jones & Barlett Learning. Burlington, MA.
CDC. (2020). Data and statistics on congenital heart defects. Retrieved online from https://www.cdc.gov/ncbddd/heartdefects/data.html
Hughes, H.K., & Kahl, L.K. (2021). Harriet Lane Handbook. Manual for Pediatric House Officers (22nd ed.). Philadelphia, PA: Mosby.
Manaker, S., Parsons, P.E., & Finlay, G. (2020). Use of vasopressors and inotropes. Retrieved online from https://www.uptodate.com/contents/use-of-vasopressors-and-inotropes?csi=40383b7b-fb7e-48d4-a09d-2d8706878bb1&source=contentShare
Pringle, C.L. (2017). PICU Essentials (1.4.0.305) [Mobile application software]. Retrieved from https://apps.apple.com/us/app/picu-essentials/id1207366521.
S4 Ep. 34
In the first ever guest interview on The Peds NP, pediatric gastroenterologist John Lyles talks with us about pathologic hyperbilirubinemia and inflammatory bowel disease.
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S4 Ep. 35
Infections in the central nervous system can be very dangerous in children, so prompt recognition and treatment is important to avoid morbidity and mortality. A review of various etiologies of CNS infections and their workup yields a valuable discussion on a pearl of wisdom that any provider needs to understand.
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References
American Academy of Pediatrics. (2018). Meningococcal infections. In Kimberlin, D.W., Brady, M.T., Jackson, M.A., & Long, S.S. Red Book (31st ed., pp. 550-561). American Academy of Pediatrics.
Centers for Disease Control and Prevention. (2021). Immunization schedules. Retrieved online from https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
Pantell, R.H., Roberts, K.B., Adams, W.G., Dreyer, B.P., Kupperman, N., O’Leary, S.T., Okechukwu, K… & The Subcommittee on Febrile Infants. (2021). Evaluation and management of well-appearing febrile infants 8-60 days old. Pediatrics, 148(2), p. 1-40. doi: https://doi.org/10.1542/peds.2021-052228
Roy, A.G., Panicker, J., & Kumar, A. (2014). Acute CNS infections. Amrita Journal of Medicine, 10(2), p. 1-44.
Swanson, D. (2015). Meningitis. Pediatrics in Review, 36(12), p. 514-526. doi: 10.1542/pir.36-12-514
S4 Ep. 36
Recognition of anaphylaxis can be difficult for some providers, and the courage to give epinephrine for treatment can be even more so. Johns Hopkins Allergy & Immunology fellow, Dr. Mansi Kotwal, discusses the anaphylaxis presentation and diagnosis in ways you may not have considered. And she reviews adjunct drugs for management in a way that might just change your practice.
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References:
Sampson, H.A., Muñoz-Furlong, A., Campbell, R.L., Adkinson, N.F., Bock, S.A., Branum, A., et al. (2006). Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Journal of Allergy and Clinical Immunology, 117, p. 391–397.
S4 Ep. 37
Human trafficking, specifically sex trafficking, is a worrisome reality that pediatric providers need to recognize and manage with speed and grace. With tools to better understand the at risk populations that may present as hidden victims of this terrible human rights violation, we can better protect our vulnerable child and youth populations.
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References:
Greenbaum, J., & Bodrick, N. (2017). Global human trafficking and child victimization. Policy statement. American Academy of Pediatrics, 140, e20173138.
National Association of Pediatric Nurse Practitioners (Executive Producer). (2021). Child trafficking: Case studies and tools on identifying warning signs [Audio podcast]. TeamPeds Talks. https://anchor.fm/teampeds-talks/episodes/Child-Trafficking-Case-Studies-and-Tools-on-Identifying-Warning-Signs-S3-E3-e1833t0
Peck, J.L., Meadows-Oliver, M., Hays, S.M., & Maaks, D.G. (2020). White paper: Recognizing child trafficking as a critical emerging health threat. Journal of Pediatric Health Care, 35(3), p. 260-269. DOI:https://doi.org/10.1016/j.pedhc.2020.01.005
Philips, A. (2021). 8 terms you should know about human trafficking. Retrieved from https://restorationhousekc.org/6-human-trafficking-terms-you-should-know/
Shared Hope. (2019). Report trafficking. Retrieved from https:// sharedhope.org/join-thecause/report-trafficking/
U.S. Department of Justice. (2020). Child sex trafficking. Retrieved online from https://www.justice.gov/criminal-ceos/child-sex-trafficking
S4 Ep. 38
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 this population. Follow along with full guideline available at https://doi.org/10.1542/peds.2021-052228
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References:
Pantell, R.H., Roberts, K.B., Adams, W.G., Dreyer, B.P., Kupperman, N., O’Leary, S.T., … & Subcommittee on Febrile Infants. (2021). Evaluation and management of well-appearing febrile infants 8 to 60 days old. Pediatrics, 148(2), p. 1-38. https://doi.org/10.1542/peds.2021-052228

Season 5: Primary Care (Ep. 39-43)

S5 Ep. 39
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.
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References:
Chiocca, E. (2019). Advanced pediatric assessment (3rd ed.). Springer Publishing Company.
Hagan, J.F., Shaw, J.S., & Duncan, P. (2017). Bright futures: Guidelines for health supervision of infants, children, and adolescents (4th ed.). American Academy of Pediatrics.
Maaks, D.L.G., Starr, N.B., Brady, M.A., Gaylor, N.M., Driessnack, M., & Duderststadt, K.G. (2019). Burn’s Pediatric Primary Care (7th ed.). Saunders Elsevier.
S5 Ep. 40
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.
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S5 Ep. 41
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.
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References:
Boruta, M.K.R., Lyles, J., Mavis, A.M., & Morgan, S. (in press). Pediatric gastrointestinal and liver disorders. In Encyclopedia of Child and Adolescent Health.
Kerzner, B., Milano, K., MacLean, W.C., Berall, G., Stuart, S., & Chatoor, I. (2015). A practical approach to classifying and managing feeding difficulties. Pediatrics, 135(2), p. 344-353. doi: 10.1542/peds.2014-1630
Menella, J.A., & Bobowski, N.K. (2015). The sweetness and bitterness of childhood: Insights from basic research on taste preferences. Physiology & Behavior, 152(0), p. 502-507. doi: 10.1016/j.physbeh.2015.05.015
S5 Ep. 42
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.
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References:
Carson, R.A., Mudd, S.S., & Madati, P.J. (2016). Clinical practice guideline for the treatment of pediatric acute gastroenteritis in the outpatient setting. Journal of Pediatric Health Care, 30(6), p. 610-616. http://dx.doi.org/10.1016/j.pedhc.2016.04.012
Carson, R.A., Mudd, S.S., & Madati, P.J. (2017). Evaluation of a nurse-initiated acute gastroenteritis pathway in the pediatric emergency department. Journal of Emergency Nursing, 43(5), p. 406-412. doi: 10.1016/j.jen.2017.01.001
Fedorowicz, Z., Jagannath, V. A., & Carter, B. (2011). Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. The Cochrane Collaboration, 9. doi: 10.1002/144651858.CD005506.pub5.
Freedman, S.B., Ali, S., Oleszczuk, M., Gouin, S., & Hartling, L. (2013). Treatment of acute gastroenteritis in children: An overview of systematic reviews of interventions commonly used in developed countries. Evidence-Based Child Health: A Cochrane Review Journal, 8, 1123-1137. doi: 10.1002/ebch.1932
Freedman, S. B., Gouin, S., Bhatt, M., Black, K. J., Johnson, D., Guimont, C.,…Plint, A. (2011). Prospective assessment of practice pattern variations in the treatment of pediatric gastroenteritis. Pediatrics, 127(2), e287-95. doi: 10.1542/peds.2010-2214
Freedman SB, Willan AR, Boutis K, Schuh S. Effect of dilute apple juice and preferred fluids vs electrolyte maintenance solution on treatment failure among children with mild gastroenteritis: a randomized clinical trial. JAMA. 2016;315(18):1966–1974.
Hartman, S., Brown, E., Loomis, E., & Russell, H.A. (2019). Gastroenteritis in children. American Family Physician, 99(3), p. 159-165. PMID: 30702253.
Nir, V., Nadir, E., Schechter, Y., & Kline-Kremer, A. (2013). Parents’ attitudes toward oral rehydration therapy in children with mild-to-moderate dehydration. The Scientific World Journal, 2013, 1-3. http://dx.doi.org/10.1155/2013/828157
Schnadower, D., Tarr, P.I., Casper, T.C., Gorelick, M.H., Dean, J.M., O’Connell, K.J., Mahajan, P., Levine, A.C., Bhatt, S.R., Roskind, C.G., Powell, E.C., Rogers, A.J., & The PECARN Probiotics Study Group. (2018). Lactobacillus rhamnosus GG versus placebo for acute gastroenteritis in children. New England Journal of Medicine, 379(21), p. 2002-2014. doi: 10.1056/NEJMoa1802598
World Health Organization. (2005). The treatment of diarrhoea: A manual for physicians and other senior health workers. 2005. http://apps.who.int/iris/bitstream/10665/43209/1/9241593180.pdf. Accessed March 3, 2022.
S5 Ep. 43
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.
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References:
Clark, E., Plint, A.C., Correll, R., Gaboury, I., & Passi, B. (2007). A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma. Pediatrics , 119 (3): 460–467. doi: 10.1542/peds.2006-1347
Jones, K., Engler, L., Fonte, E., et al. (2021). Opioid reduction through postoperative pain management in pediatric orthopedic surgery. Pediatrics, 148(6):e2020001487
Kleinman, K., McDaniel, L., & Molloy, M. (2021). The Harriet Lane handbook (the Johns Hopkins Hospital) (22nd ed.). Elsevier.
Miller, T.C. & Gerth, J. (2013). Dose of confusion. Propublica. https://www.propublica.org/article/tylenol-mcneil-fda-kids-dose-of-confusion
National Capital Poison Center. (2020). Poison statistics. https://www.poison.org/poison-statistics-national.
Sullivan, J.E., Farrar, H.C., & the Section on Clinical Pharmacology and Therapeutics, Committee on Drugs. (2011). Fever and antipyretic use in children. Pediatrics , 127(3): 580–587. doi: 10.1542/peds.2010-3852
Trippella, G., Ciarcià, M., de Martino, M., & Chiappini, E. (2019). Prescribing controversies: An updated review and meta-analysis on combined/alternating use of ibuprofen and paracetamol in febrile children. Frontiers in Pediatrics, 7:217. doi: 10.3389/fped.2019.00217.
Yin, H.S., Neuspiel, D.R., Paul, I.M., et al. (2021). Preventing home medication administration errors. Pediatrics,148(6): e2021054666

Season 6: Babies (Primary Care) (Ep. 44-48)

S6 Ep. 44
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 and advising the pair when the process isn't as easy as it seems.
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References:
American Academy of Pediatrics. (2021). Breastfeeding overview. Retrieved from https://www.aap.org/en/patient-care/breastfeeding/breastfeeding-overview/
La Lache League. (2022). Breastfeeding info A to Z. Retrieved from https://www.llli.org/breastfeeding-info/
Laura R. Kair, Daniel Kenron, Konnette Etheredge, Arthur C. Jaffe, Carrie A. Phillipi (2013). Pacifier restriction and exclusive breastfeeding. Pediatrics, 131 (4): e1101–e1107. 10.1542/peds.2012-2203
Nice, F.J., & Francell, M. (2020). Selection and use of galactogogues. Leader Today. Retrieved from https://www.llli.org/selection-and-use-of-galactagogues-2/
Pisani, J. (2022). Why is there a baby formula shortage? What to know and what is being done about it. The Wall Street Journal. https://www.wsj.com/articles/why-baby-formula-shortage-11652188230
Thompson, D. (2022). What’s behind America’s shocking baby-formula shortage? The Atlantic. https://www.theatlantic.com/ideas/archive/2022/05/baby-formula-shortage-abbott-recall/629828
S6 Ep. 45
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 know how to complete an age-appropriate vision screening in an infant.
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References:
American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. (2012). Preferred practice pattern guidelines. Pediatric eye evaluations. American Academy of Ophthalmology.
Bell, A.L., Rodes, M.E., & Collier Kellar, L. (2013). Childhood eye examination. American Family Physician, 88(4), p. 241-248.
Brookman K. E. (1983). Ocular accommodation in human infants. American journal of optometry and physiological optics, 60(2), 91–99. https://doi.org/10.1097/00006324-198302000-00001
Loh, A.R., & Chiang, M.F. (2018). Pediatric vision screening. Pediatrics in Review, 39(5), 225-234.
Rosenfield, M. Development of accommodation in human infants. Retrieved from https://entokey.com/development-of-accommodation-in-human-infants/
Wang, J., & Candy, T. R. (2010). The sensitivity of the 2- to 4-month-old human infant accommodation system. Investigative ophthalmology & visual science, 51(6), 3309–3317. https://doi.org/10.1167/iovs.09-4667
S6 Ep. 46
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 discussed.
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References:
Children’s Wisconsin. (2020). Infants straining to move bowels. https://childrenswi.org/-/media/chwlibrary/publication-media-library/2020/03/30/20/48/2144en.pdf
LeLeiko, N. S., Mayer-Brown, S., Cerezo, C., & Plante, W. (2020). Constipation. Pediatrics in review, 41(8), 379–392. https://doi.org/10.1542/pir.2018-0334
Tabbers, M. M., DiLorenzo, C., Berger, M. Y., Faure, C., Langendam, M. W., Nurko, S., Staiano, A., Vandenplas, Y., Benninga, M. A., European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, & North American Society for Pediatric Gastroenterology (2014). Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of pediatric gastroenterology and nutrition, 58(2), 258–274. https://doi.org/10.1097/MPG.0000000000000266
Zeevenhooven, J., Koppen, I. J., & Benninga, M. A. (2017). The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers. Pediatric gastroenterology, hepatology & nutrition, 20(1), 1–13. https://doi.org/10.5223/pghn.2017.20.1.1
S6 Ep. 47
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 suggest critical congenital heart disease and screen appropriately. This episode has helpful perspectives for both the nurse and advanced practice provider.
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References:
Abdurrahman, L., Bockoven, J. R., Pickoff, A. S., Ralston, M. A., & Ross, J. E. (2003). Pediatric cardiology update: Office-based practice of pediatric cardiology for the primary care provider. Current problems in pediatric and adolescent health care, 33(10), 318–347. https://doi.org/10.1016/s1538-5442(03)00137-8
CDC. (2022). Critical congenital heart defects. Retrieved from https://www.cdc.gov/ncbddd/heartdefects/cchd-facts.html.
Cleveland Clinic. (2022). Cyanotic heart disease. Retrieved from https://my.clevelandclinic.org/health/diseases/22441-cyanotic-heart-disease
Glidewell, J., Grosse, S.D., Riehle-Colarusso, T., Pinto, N., Hudson, J., Daskalov, R., Gaviglio, A., Darby, E., Singh, S., & Sontag, M. (2019) Actions in support of newborn screening for critical congenital heart disease — United States, 2011–2018. Morbity and Mortality Weekly Report, 68:107–111. DOI: http://dx.doi.org/10.15585/mmwr.mm6805a3external icon
Mahle, W. T., Martin, G. R., Beekman, R. H., 3rd, Morrow, W. R., & Section on Cardiology and Cardiac Surgery Executive Committee (2012). Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics, 129(1), 190–192. https://doi.org/10.1542/peds.2011-3211
Martin, G. R., Ewer, A. K., Gaviglio, A., Hom, L. A., Saarinen, A., Sontag, M., Burns, K. M., Kemper, A. R., & Oster, M. E. (2020). Updated Strategies for Pulse Oximetry Screening for Critical Congenital Heart Disease. Pediatrics, 146(1), e20191650. https://doi.org/10.1542/peds.2019-1650
Puri, K., Allen, H. D., & Qureshi, A. M. (2017). Congenital Heart Disease. Pediatrics in review, 38(10), 471–486. https://doi.org/10.1542/pir.2017-0032
Strobel, A. M., & Lu, l. (2015). The Critically Ill Infant with Congenital Heart Disease. Emergency medicine clinics of North America, 33(3), 501–518. https://doi.org/10.1016/j.emc.2015.04.002
S6 Ep. 48
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.
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References:
CDC. (2022). Developmental surveillance resources for healthcare providers. Retrieved from https://www.cdc.gov/ncbddd/actearly/hcp/index.html.
Zubler JM, Wiggins LD, Macias MM, et al. Evidence-InformedMilestones for Developmental Surveillance Tools. Pediatrics. 2022;149(3):e2021052138

Season 7: Cognitive Bias in Healthcare (Ep. 49-53)

S7 Ep. 49
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.
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References:
Balogh, E. P., Miller, B. T., Ball, J. R., Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine, & The National Academies of Sciences, Engineering, and Medicine (Eds.). (2015). Improving Diagnosis in Health Care. National Academies Press (US).
Berkwitt, A., & Grossman, M. (2014). Cognitive bias in inpatient pediatrics. Hospital pediatrics, 4(3), 190–193. https://doi.org/10.1542/hpeds.2014-0002
Bordini, B. J., Stephany, A., & Kliegman, R. (2017). Overcoming Diagnostic Errors in Medical Practice. The Journal of pediatrics, 185, 19–25.e1. https://doi.org/10.1016/j.jpeds.2017.02.065
Carberry, A. R., Hanson, K., Flannery, A., Fischer, M., Gehlbach, J., Diamond, C., & Wald, E. R. (2018). Diagnostic Error in Pediatric Cancer. Clinical pediatrics, 57(1), 11–18. https://doi.org/10.1177/0009922816687325
CRICO. (2014). Malpractice risks in the diagnostic process. Retrieved from
https://www.rmf.harvard.edu/Malpractice-Data/Annual-Benchmark-Reports/Risks-in-the-Diagnostic-Process
Institute of Medicine (US) Committee on Quality of Health Care in America. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press (US).
Institute of Medicine (US) Committee on Quality of Health Care in America, Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To Err is Human: Building a Safer Health System. National Academies Press (US).
National Geographic Kids. (No date). 10 facts about great white sharks! Retrieved from https://www.natgeokids.com/uk/discover/animals/sea-life/great-white-sharks/
Royce, C.S., Hayes, M.M., & Schwartzstein, R.M. (2019). Teaching critical thinking: A case for instruction in cogntitive biases to reduce diagnostic errors and improve patient safety.
S7 Ep. 50
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.
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References:
Arokszallasi, T., Balogh, E., Csiba, L., Fekete, I., Fekete, K., & Olah, L.. (2019). Acute alcohol intoxication may cause delay in stroke treatment – case reports. BMC Neurology, 19, 14. https://doi.org/10.1186/s12883-019-1241-6
Berkwitt, A., & Grossman, M. (2014). Cognitive bias in inpatient pediatrics. Hospital pediatrics, 4(3), 190–193. https://doi.org/10.1542/hpeds.2014-0002
Clark, B. W., Derakhshan, A., & Desai, S. V. (2018). Diagnostic Errors and the Bedside Clinical Examination. The Medical clinics of North America, 102(3), 453–464. https://doi.org/10.1016/j.mcna.2017.12.007
Croskerry, P., Singhal, G., & Mamede, S. (2013). Cognitive debiasing 2: impediments to and strategies for change. BMJ quality & safety, 22 Suppl 2(Suppl 2), ii65–ii72. https://doi.org/10.1136/bmjqs-2012-001713
Galvani, A. P., Parpia, A. S., Foster, E. M., Singer, B. H., & Fitzpatrick, M. C. (2020). Improving the prognosis of health care in the USA. Lancet (London, England), 395(10223), 524–533. https://doi.org/10.1016/S0140-6736(19)33019-3
Mamede, S., Splinter, T.A.W., Gog, T., Rikers, R., & Schmidt, H.G. (2012). Exploring the role of salient distracting clinical features in the emergence of diagnostic errors and the mechanisms through which reflection counteracts mistakes. BMJ Quality & Safety, 21, p. 295-300. doi:10.1136/bmjqs-2011-000518
Marshall, T.L., Rinke, M.L., Olson, A.P.J., Brady, P.W. (2022). Diagnostic error in pediatrics: A narrative review. Pediatrics, 149 (Supplement 3): e2020045948D. 10.1542/peds.2020-045948D
S7 Ep. 51
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. Lastly, we explore 4 best practice techniques to help you avoid bias in the first place.
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References
Abimanyi-Ochom, J., Bohingamu Mudiyanselage, S., Catchpool, M., Firipis, M., Wanni Arachchige Dona, S., & Watts, J. J. (2019). Strategies to reduce diagnostic errors: a systematic review. BMC medical informatics and decision making, 19(1), 174. https://doi.org/10.1186/s12911-019-0901-1
Benninga, M. A., Faure, C., Hyman, P. E., St James Roberts, I., Schechter, N. L., & Nurko, S. (2016). Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology, S0016-5085(16)00182-7. https://doi.org/10.1053/j.gastro.2016.02.016
Bolick, B.N., Reuter-Rice, K., Madden, M.A., & Severin, P.A. (2021). Pediatric Acute Care: A Guide for Interprofessional Practice (2nd ed). Elsevier.
Centers for Disease Control and Prevention. (2021). Botulism: Diagnosis and treatment. https://www.cdc.gov/botulism/testing-treatment.html
Committee on Diagnostic Error in Health Care; Board on Health Care Services; Institute of Medicine; The National Academies of Sciences, Engineering, and Medicine; Balogh EP, Miller BT, Ball JR, editors. Improving Diagnosis in Health Care. Washington (DC): National Academies Press (US); 2015 Dec 29. 3, Overview of Diagnostic Error in Health Care. Available from: https://www.ncbi.nlm.nih.gov/books/NBK338594/
Ely, J. W., & Graber, M. A. (2015). Checklists to prevent diagnostic errors: a pilot randomized controlled trial. Diagnosis (Berlin, Germany), 2(3), 163–169. https://doi.org/10.1515/dx-2015-0008
Graber, M. L., Sorensen, A. V., Biswas, J., Modi, V., Wackett, A., Johnson, S., Lenfestey, N., Meyer, A. N., & Singh, H. (2014). Developing checklists to prevent diagnostic error in Emergency Room settings. Diagnosis (Berlin, Germany), 1(3), 223–231. https://doi.org/10.1515/dx-2014-0019
Marshall, T.L., Rinke, M.L., Olson, A.P.J., Brady, P.W. (2022). Diagnostic error in pediatrics: A narrative review. Pediatrics, 149 (Supplement 3): e2020045948D. 10.1542/peds.2020-045948D
O’Hagan, T., Fennell, J., Tan, K., Ding, D., & Thomas-Jones, I. (2019). Cognitive bias in the clinical decision making of doctors. Future Healthcare Journal, 6(1), s113.
Tabbers, M. M., DiLorenzo, C., Berger, M. Y., Faure, C., Langendam, M. W., Nurko, S., Staiano, A., Vandenplas, Y., Benninga, M. A., European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, & North American Society for Pediatric Gastroenterology. (2014). Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of Pediatric Gastroenterology and Nutrition, 58(2), 258–274. https://doi.org/10.1097/MPG.0000000000000266
The Canadian Medical Protection Authority. Common cognitive biases: Influences on decision making. Good Practices Guide. https://www.cmpa-acpm.ca/serve/docs/ela/goodpracticesguide/pages/human_factors/Cognitive_biases/common_cognitive_biases-e.html
Zabidi-Hussin Z. A. (2016). Practical way of creating differential diagnoses through an expanded VITAMINSABCDEK mnemonic. Advances in medical education and practice, 7, 247–248. https://doi.org/10.2147/AMEP.S106507
S7 Ep. 52
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 practices for avoiding diagnostic error in the clinical setting.
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References:
Hulens, M., Rasschaert, R., Vansant, G., Stalmans, I., Bruyninckx, F., & Dankaerts, W. (2018). The link between idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome: exploration of a shared pathophysiology. Journal of pain research, 11, 3129–3140. https://doi.org/10.2147/JPR.S186878
Mondragon J, Klovenski V. Pseudotumor Cerebri. [Updated 2022 Sep 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536924/
Norris, D., Clark, M. S., & Shipley, S. (2016). The Mental Status Examination. American family physician, 94(8), 635–641.
Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity reviews : an official journal of the International Association for the Study of Obesity, 16(4), 319–326. https://doi.org/10.1111/obr.12266
The Canadian Medical Protection Authority. Common cognitive biases: Influences on decision making. Good Practices Guide. https://www.cmpa-acpm.ca/serve/docs/ela/goodpracticesguide/pages/human_factors/Cognitive_biases/common_cognitive_biases-e.html
Villines, Z. (2021). What to know about obesity discrimination in health care. Medical News Today. https://www.medicalnewstoday.com/articles/obesity-discrimination-in-healthcare
S7 Ep. 53
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.
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References:
Marshall, T.L., Rinke, M.L., Olson, A.P.J., Brady, P.W. (2022). Diagnostic error in pediatrics: A narrative review. Pediatrics, 149 (Supplement 3): e2020045948D. 10.1542/peds.2020-045948D
The Canadian Medical Protection Authority. Common cognitive biases: Influences on decision making. Good Practices Guide. https://www.cmpa-acpm.ca/serve/docs/ela/goodpracticesguide/pages/human_factors/Cognitive_biases/common_cognitive_biases-e.html
Yale, S. C., Cohen, S. S., Kliegman, R. M., & Bordini, B. J. (2022). A pause in pediatrics: implementation of a pediatric diagnostic time-out. Diagnosis (Berlin, Germany), 9(3), 348–351. https://doi.org/10.1515/dx-2022-0010

Season 8: Primary Care (Ep. 54-57)

S8 Ep. 54
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 prescribing practice in 2023.
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References:
Bachur RG, Monuteaux MC, Neuman MI. A comparison of acute treatment regimens for migraine in the emergency department. Pediatrics 2015;135:232-238.
Brady, K.B. (2020). 'Benadryl challenge": What pediatricians need to know. AAP News. Retrieved from https://publications.aap.org/aapnews/news/6210/Benadryl-Challenge-What-pediatricians-need-to-know
Chehab, H., Fischer, P. R., & Christenson, J. C. (2021). Preparing Children for International Travel. Pediatrics in Review, 42(4), 189–202. https://doi.org/10.1542/pir.2018-0353
Ghossein N, Kang M, Lakhkar AD. Anticholinergic Medications. [Updated 2022 May 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555893/
Green, J.L., Wang, G.S., Reynolds, K.M., Banner, W., Bond, G.R., Kauffman, R.E., Palmer, R.B., Paul, I.M., Dart, R.C. (2017). Safety profile of cough and cold medication use in pediatrics. Pediatrics, 139(6), e20163070. doi: 10.1542/peds.2016-3070
Guthrie, C.C., & Nathani, Y. (2019). Acute treatment of pediatric migraine. Pediatric Emergency Medicine Reports. Relias Media. Retrieved https://www.reliasmedia.com/articles/144150-acute-treatment-of-pediatric-migraine
Palmer, R. B., Reynolds, K. M., Banner, W., Bond, G. R., Kauffman, R. E., Paul, I. M., Green, J. L., & Dart, R. C. (2020). Adverse events associated with diphenhydramine in children, 2008-2015. Clinical toxicology (Philadelphia, Pa.), 58(2), 99–106. https://doi.org/10.1080/15563650.2019.1609683
Paul, I.M., Yoder, K.E., Crowell, K.R., Shaffer, M.L., McMillan, H.S., Carlson, L.C., Dilworth, D.A., Berlin, C.M. (2004). Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents. Pediatrics, 114(1), e85-e90. doi: 10.1542/peds.114.1.e85
Shaker, M. S., Wallace, D. V., Golden, D. B. K., Oppenheimer, J., Bernstein, J. A., Campbell, R. L., Dinakar, C., Ellis, A., Greenhawt, M., Khan, D. A., Lang, D. M., Lang, E. S., Lieberman, J. A., Portnoy, J., Rank, M. A., Stukus, D. R., Wang, J., Collaborators, Riblet, N., Bobrownicki, A. M. P., … Wang, J. (2020). Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. The Journal of allergy and clinical immunology, 145(4), 1082–1123. https://doi.org/10.1016/j.jaci.2020.01.017
Stern J, Pozun A. Pediatric Procedural Sedation. [Updated 2022 Sep 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572100/
Trottier ED, Bailey B, Lucas N, Lortie A. Prochlorperazine in children with migraine: A look at its effectiveness and rate of akathisia. Am J Emerg Med 2012;30:456-463
S8 Ep. 55
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 haven't. This episode is a great guideline refresher and microbiology update while learning how to talk parents into partnership on watchful waiting.
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References:
American Academy of Pediatrics. (2019). Chapter quality network improving antibiotic prescribing for children: Change package. Retrieved from https://downloads.aap.org/DOCCSA/CQN%20ABX%20Change%20Package%20Final%20October%202019.pdf
Frost, H. M., & Hersh, A. L. (2022). Rethinking Our Approach to Management of Acute Otitis Media. JAMA pediatrics, 176(5), 439–440. https://doi.org/10.1001/jamapediatrics.2021.6575
Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., Joffe, M. D., Miller, D. T., Rosenfeld, R. M., Sevilla, X. D., Schwartz, R. H., Thomas, P. A., & Tunkel, D. E. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964–e999. https://doi.org/10.1542/peds.2012-3488
Sanchez, G.V., Fleming-Dutra, K.E., Roberts, R.M., & Hicks, L.A. (2016). Core elements of outpatient antibiotic stewardship. MMRW Recomm Rep., 65(6), p. 1-12. doi: 10.15585/mmrw.rr.6506a1
Smolinski, N. E., Antonelli, P. J., & Winterstein, A. G. (2022). Watchful Waiting for Acute Otitis Media. Pediatrics, 150(1), e2021055613. https://doi.org/10.1542/peds.2021-055613
Sun, D., McCarthy, T. J., & Liberman, D. B. (2017). Cost-Effectiveness of Watchful Waiting in Acute Otitis Media. Pediatrics, 139(4), e20163086. https://doi.org/10.1542/peds.2016-3086
Venekamp, R. P., Sanders, S. L., Glasziou, P. P., Del Mar, C. B., & Rovers, M. M. (2015). Antibiotics for acute otitis media in children. The Cochrane database of systematic reviews, 2015(6), CD000219. https://doi.org/10.1002/14651858.CD000219.pub4
S8 Ep. 56
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.
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References:
Centers for Disease Control and Prevention (2022). Influenza antiviral medications: Summary for clinicians. Retrieved from https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#Table1
Frost, H. M., & Hersh, A. L. (2022). Rethinking Our Approach to Management of Acute Otitis Media. JAMA pediatrics, 176(5), 439–440. https://doi.org/10.1001/jamapediatrics.2021.6575
Giovanni Piedimonte, Miriam K. Perez; Respiratory Syncytial Virus Infection and Bronchiolitis. Pediatr Rev December 2014; 35 (12): 519–530. https://doi.org/10.1542/pir.35-12-519
Liu, J. W., Lin, S. H., Wang, L. C., Chiu, H. Y., & Lee, J. A. (2021). Comparison of Antiviral Agents for Seasonal Influenza Outcomes in Healthy Adults and Children: A Systematic Review and Network Meta-analysis. JAMA network open, 4(8), e2119151. https://doi.org/10.1001/jamanetworkopen.2021.19151
Parikh R, Mathai A, Parikh S, Chandra Sekhar G, Thomas R. Understanding and using sensitivity, specificity and predictive values. Indian J Ophthalmol. 2008 Jan-Feb;56(1):45-50. doi: 10.4103/0301-4738.37595. PMID: 18158403; PMCID: PMC2636062.
Spencer D. Johnson, Jennifer S. Harthan, Tammy Than, Mary K. Migneco, Ellen Shorter, Meredith M. Whiteside, Christina E. Morettin, Christian K. Olson, Crystal A. Rosemann, Mathew S. Margolis, Leonard W. Haertter, Julia B. Huecker, Bojana Rodic-Polic, Richard S. Buller, Gregory A. Storch, Mae O. Gordon, Andrew T. E. Hartwick; Predictive Accuracy and Densitometric Analysis of Point-of-Care Immunoassay for Adenoviral Conjunctivitis. Trans. Vis. Sci. Tech. 2021;10(9):30. doi: https://doi.org/10.1167/tvst.10.9.30.
Stanford T. Shulman, Alan L. Bisno, Herbert W. Clegg, Michael A. Gerber, Edward L. Kaplan, Grace Lee, Judith M. Martin, Chris Van Beneden, Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 55, Issue 10, 15 November 2012, Pages e86–e102, https://doi.org/10.1093/cid/cis629
Stanford Medicine. (2022). Common cold in children. Retrieved from https://www.stanfordchildrens.org/en/topic/default?id=upper-respiratory-infection-uri-or-common-cold-90-P02966
Walsh, P. S., Schnadower, D., Zhang, Y., Ramgopal, S., Shah, S. S., & Wilson, P. M. (2022). Association of Early Oseltamivir With Improved Outcomes in Hospitalized Children With Influenza, 2007-2020. JAMA pediatrics, 176(11), e223261. https://doi.org/10.1001/jamapediatrics.2022.3261
World Health Organization. (2019). WHO launches new global influenza strategy. https://www.who.int/news-room/detail/11-03-2019-who-launches-new-global-influenza-strategy
S8 Ep. 57
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 parents on what beverages their infants and toddlers should be drinking.
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Season 9: Health Equity in Pediatrics (Ep. 58-66)

S9 Ep. 58
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 tangible best practices that can be implemented immediately to provide more equitable care in your workplace. As you learn to view every patient encounter through a lens of health equity, you’ll be able to apply these concepts to the evaluation and management of the diverse children for whom you care and improve their journey toward health. When you become a partner in the health equity care plan, rather than just an authority in health care, you bring practicality to your recommendations and interventions that augment the expert knowledge you share. Apply these concepts to a challenging example with a historical precedent that shapes how you understand the approach to overcoming obstacles on the journey to health equity.
Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant. For more information, please community.napnap.org/northcarolinachapter.
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References:
American Psychological Association. (2022). Racial and ethnic identity. https://apastyle.apa.org/style-grammar-guidelines/bias-free-language/racial-ethnic-minorities
Braveman, P., Arkin, E., Orleans, T., Proctor, D., & Plough, A. (2017). What is health equity? Achieving health equity. The Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html
Centers for Disease Control and Prevention. (2022, August 2). Health equity guiding principles for inclusive communication. https://www.cdc.gov/healthcommunication/Health_Equity.html
Duke Health. (2020). Weight management for children and teens. Duke Health. https://www.dukehealth.org/pediatric-treatments/childhood-obesity
Jindal, M., Trent, M., & Mistry, K. B. (2022). The Intersection of Race, Racism, and Child and Adolescent Health. Pediatrics in review, 43(8), 415–425. https://doi.org/10.1542/pir.2020-004366
Pediatric Nursing Certification Board. (2022). Pediatric Nursing Workforce Report 2022: A Demographic Profile of 53,000 PNCB-Certified Nursing Professionals. https://pncb.org/ sites/default/files/resources/PNCB_2022_Pediatric_Nursing_Workforce_Demographic_ Report.pdf
Zippia. (2022, September 9). Family nurse practitioner demographics and statistics in the US. https://www.zippia.com/family-nurse-practitioner-jobs/demographics/
S9 Ep. 59
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 notions. In this episode, we discuss examples of how implicit bias can impact health care in children and the skills that provider’s can hone to combat its influence.
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References:
FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC medical ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8
Gonzalez, C. M., Lypson, M. L., & Sukhera, J. (2021). Twelve tips for teaching implicit bias recognition and management. Medical teacher, 43(12), 1368–1373. https://doi.org/10.1080/0142159X.2021.1879378
Goyal, M. K., Johnson, T. J., Chamberlain, J. M., Cook, L., Webb, M., Drendel, A. L., Alessandrini, E., Bajaj, L., Lorch, S., Grundmeier, R. W., Alpern, E. R., & PEDIATRIC EMERGENCY CARE APPLIED RESEARCH NETWORK (PECARN) (2020). Racial and Ethnic Differences in Emergency Department Pain Management of Children With Fractures. Pediatrics, 145(5), e20193370. https://doi.org/10.1542/peds.2019-3370
Greenwald, A. G., Dasgupta, N., Dovidio, J. F., Kang, J., Moss-Racusin, C. A., & Teachman, B. A. (2022). Implicit-Bias Remedies: Treating Discriminatory Bias as a Public-Health Problem. Psychological science in the public interest : a journal of the American Psychological Society, 23(1), 7–40. https://doi.org/10.1177/15291006211070781
Jindal, M., Trent, M., & Mistry, K. B. (2022). The Intersection of Race, Racism, and Child and Adolescent Health. Pediatrics in review, 43(8), 415–425. https://doi.org/10.1542/pir.2020-004366
Mossey J. M. (2011). Defining racial and ethnic disparities in pain management. Clinical orthopaedics and related research, 469(7), 1859–1870. https://doi.org/10.1007/s11999-011-1770-9
Pediatric Nursing Certification Board. (2022). Pediatric Nursing Workforce Report 2022: A Demographic Profile of 53,000 PNCB-Certified Nursing Professionals. https://pncb.org/ sites/default/files/resources/PNCB_2022_Pediatric_Nursing_Workforce_Demographic_ Report.pdf
Project Implicit. (2011). Take a test. https://implicit.harvard.edu/implicit/takeatest.html
Raphael, J. L., & Oyeku, S. O. (2020). Implicit Bias in Pediatrics: An Emerging Focus in Health Equity Research. Pediatrics, 145(5), e20200512. https://doi.org/10.1542/peds.2020-0512
Sabin J. A. (2022). Tackling Implicit Bias in Health Care. The New England journal of medicine, 387(2), 105–107. https://doi.org/10.1056/NEJMp2201180
Smiley, R. A., Ruttinger, C., Oliveira, C. M., Hudson, L. R., Allgeyer, R., Reneau, K. A., Silvestre, J. H., & Alexander, M. (2021). The 2020 National Nursing Workforce Survey. Journal of Nursing Regulation, 12(1). https://doi.org/10.1016/s2155-8256(21)00027-2.
U.S. Equal Employment Opportunity Commission. (2023). Religious garb and grooming in the workplace: Rights and responsibilities. https://www.eeoc.gov/laws/guidance/religious-garb-and-grooming-workplace-rights-and-responsibilities#_ftn17
S9 Ep. 60
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 naive 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 unconsciously embedded into language and behavior. As an ally, interrupting microaggressions can be a challenge that requires curiosity to confront. The decision to interrupt is individual and complex, but this episode will provide allies with the skills to intervene through role play in several scenarios.
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References:
Acholonu, R. G., Cook, T. E., Roswell, R. O., & Greene, R. E. (2020). Interrupting Microaggressions in Health Care Settings: A Guide for Teaching Medical Students. MedEdPORTAL : The journal of teaching and learning resources, 16, 10969. https://doi.org/10.15766/mep_2374-8265.10969
FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC medical ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8
Kanter, J. (2020). Microaggressions aren’t just innocent blunders– research links them with racial bias. The Conversation. https://theconversation.com/microaggressions-arent-just-innocent-blunders-research-links-them-with-racial-bias-145894
Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: implications for clinical practice. The American psychologist, 62(4), 271–286. https://doi.org/10.1037/0003-066X.62.4.271
Sue, D. W., Alsaidi, S., Awad, M. N., Glaeser, E., Calle, C. Z., & Mendez, N. (2019). Disarming racial microaggressions: Microintervention strategies for targets, White allies, and bystanders. The American psychologist, 74(1), 128–142. https://doi.org/10.1037/amp0000296
Turner, J., Higgins, R., & Childs, E. (2021). Microaggression and Implicit Bias. The American Surgeon, 87(11), 1727–1731. https://doi.org/10.1177/00031348211023418
S9 Ep 61
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. 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 tools to correctly pronounce and address their patients in a way that honors the patient and their caregivers. Together we can prove that a rose by another name would smell just as sweet.
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References
Dali, S., Atasuntseva, A., Shankar, M., Ayeroff, E., Holmes, M., Johnson, C., Terkawi, A. S., Beadle, B., Chang, J., Boyd, K., & Dunn, T. (2022). Say My Name: Understanding the Power of Names, Correct Pronunciation, and Personal Narratives. MedEdPORTAL : the journal of teaching and learning resources, 18, 11284. https://doi.org/10.15766/mep_2374-8265.11284
Keister, A. (2022). Can I still use sir and ma’am? When should I use Mr., Mrs., Ms., and Mx? What to do when you don’t know someone’s gender. The Diversity Movement. Retreived from https://thediversitymovement.com/sir-maam-mr-mrs-ms-mx-what-to-do-when-you-dont-know-someones-gender/
Lebensohn-Chialvo F. (2021). That's not my name. Families, systems & health : the journal of collaborative family healthcare, 39(1), 163–164. https://doi.org/10.1037/fsh0000588
S9 Ep. 62
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 miniseries on Health Equity in Children. The best practices for providers 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 with obesity are people first.
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References
Bell, C. N., Kerr, J., & Young, J. L. (2019). Associations between Obesity, Obesogenic Environments, and Structural Racism Vary by County-Level Racial Composition. International journal of environmental research and public health, 16(5), 861. https://doi.org/10.3390/ijerph16050861
Centers for Disease Control and Prevention. (2022). Inclusive communication principles. Gateway to Health Communication. https://www.cdc.gov/healthcommunication/Key_Principles.html
Gmeiner, M. S., & Warschburger, P. (2020). Intrapersonal predictors of weight bias internalization among elementary school children: a prospective analysis. BMC pediatrics, 20(1), 408. https://doi.org/10.1186/s12887-020-02264-w
Hadjiyannakis, S., Ibrahim, Q., Li, J., Ball, G. D. C., Buchholz, A., Hamilton, J. K., Zenlea, I., Ho, J., Legault, L., Laberge, A. M., Thabane, L., Tremblay, M., & Morrison, K. M. (2019). Obesity class versus the Edmonton Obesity Staging System for Pediatrics to define health risk in childhood obesity: results from the CANPWR cross-sectional study. The Lancet. Child & adolescent health, 3(6), 398–407. https://doi.org/10.1016/S2352-4642(19)30056-2
Hampl, S. E., Hassink, S. G., Skinner, A. C., Armstrong, S. C., Barlow, S. E., Bolling, C. F., Avila Edwards, K. C., Eneli, I., Hamre, R., Joseph, M. M., Lunsford, D., Mendonca, E., Michalsky, M. P., Mirza, N., Ochoa, E. R., Sharifi, M., Staiano, A. E., Weedn, A. E., Flinn, S. K., Lindros, J., … Okechukwu, K. (2023). Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics, 151(2), e2022060640. https://doi.org/10.1542/peds.2022-060640
Haqq, A. M., Kebbe, M., Tan, Q., Manco, M., & Salas, X. R. (2021). Complexity and Stigma of Pediatric Obesity. Childhood obesity (Print), 17(4), 229–240. https://doi.org/10.1089/chi.2021.0003
Puhl, R. M., & Himmelstein, M. S. (2018). Adolescent preferences for weight terminology used by health care providers. Pediatric obesity, 13(9), 533–540. https://doi.org/10.1111/ijpo.12275
Puhl, R. M., Peterson, J. L., & Luedicke, J. (2011). Parental perceptions of weight terminology that providers use with youth. Pediatrics, 128(4), e786–e793. https://doi.org/10.1542/peds.2010-3841
Yan J, Liu L, Zhu Y, Huang G, Wang PP. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health. 2014 Dec 13;14:1267. doi: 10.1186/1471-2458-14-1267. PMID: 25495402; PMCID: PMC4301835.
S9 Ep. 63
It’s good advice for any pediatric provider to not assume anything. In the sixth episode of the miniseries on Health Equity in Children, we understand how not making assumptions is a best practice for pediatric providers from the evaluation and management of LGBTQ patients, to communicating with diverse families, and serving as an ally in health promotion.
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References
Brown, C., Frohard-Dourlent, H., Wood, B. A., Saewyc, E., Eisenberg, M. E., & Porta, C. M. (2020). "It makes such a difference": An examination of how LGBTQ youth talk about personal gender pronouns. Journal of the American Association of Nurse Practitioners, 32(1), 70–80. https://doi.org/10.1097/JXX.0000000000000217
Centers for Disease Control and Prevention. (2019). Health disparities among LTGBQ youth. Adolescent and School Health. https://www.cdc.gov/healthyyouth/disparities/health-disparities-among-lgbtq-youth.htm
Coulter-Thompson, E. I., Matthews, D. D., Applegate, J., Broder-Fingert, S., & Dubé, K. (2023). Health Care Bias and Discrimination Experienced by Lesbian, Gay, Bisexual, Transgender, and Queer Parents of Children With Developmental Disabilities: A Qualitative Inquiry in the United States. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 37(1), 5–16. https://doi.org/10.1016/j.pedhc.2022.09.004
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., Lowry, R., Chyen, D., Whittle, L., Thornton, J., Lim, C., Bradford, D., Yamakawa, Y., Leon, M., Brener, N., & Ethier, K. A. (2018). Youth Risk Behavior Surveillance - United States, 2017. Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), 67(8), 1–114. https://doi.org/10.15585/mmwr.ss6708a1
Kyriakou, A., Nicolaides, N. C., & Skordis, N. (2020). Current approach to the clinical care of adolescents with gender dysphoria. Acta bio-medica : Atenei Parmensis, 91(1), 165–175. https://doi.org/10.23750/abm.v91i1.9244
National Association of Pediatric Nurse Practitioners, Evans, S.C., Derouin, A.L., Fuller, M.G., Heighway, S., & Schapiro, N.A. (2018). NAPNAP position statement on health risks and needs of lesbian, gay, bisexual, transgender, and questioning youth. The Journal of Pediatric Health Care, 33(2), p. A12-A14. doi: https://doi.org/10.1016/j.pedhc.2018.12.005
Roth, L. T., Friedman, S., Gordon, R., & Catallozzi, M. (2020). Rainbows and "Ready for Residency": Integrating LGBTQ Health Into Medical Education. MedEdPORTAL : the journal of teaching and learning resources, 16, 11013. https://doi.org/10.15766/mep_2374-8265.11013
Simons, L. K., Leibowitz, S. F., & Hidalgo, M. A. (2014). Understanding gender variance in children and adolescents. Pediatric annals, 43(6), e126–e131. https://doi.org/10.3928/00904481-20140522-07
S9 Ep. 64
Mental health is one of the greatest health risks encountered by children and adolescents in today’s world. Stigma can be one of the biggest barriers to diagnosis, access to care, and treatment for children, particularly in communities that are marginalized. In the final episode of the miniseries on Health Equity in Children, we bring mental health into your everyday conversations to diminish stigma and give mental health the time it deserves to help your patients grow up happy and healthy.
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References
Bureau of Health Workforce, Health Resources and Services Administration, U. S. Department of Health & Human Services. (2019). Designated health professional shortage areas statistics. Retrieved from https://bhw.hrsa.gov/shortage-designa tion/hpsa-criteria
Cotton, N. K., & Shim, R. S. (2022). Social Determinants of Health, Structural Racism, and the Impact on Child and Adolescent Mental Health. Journal of the American Academy of Child and Adolescent Psychiatry, 61(11), 1385–1389. https://doi.org/10.1016/j.jaac.2022.04.020
Harris, T. B., Udoetuk, S. C., Webb, S., Tatem, A., Nutile, L. M., & Al-Mateen, C. S. (2020). Achieving Mental Health Equity: Children and Adolescents. The Psychiatric clinics of North America, 43(3), 471–485. https://doi.org/10.1016/j.psc.2020.06.001
National Association of Pediatric Nurse Practitioners, Developmental and Behavioral Health Special Interest Group, Frye, L., Van Cleve, S., Heighway, S., & Johnson-Smith, A. (2020). NAPNAP position statement on the integration of mental health care in pediatric primary care settings. Journal of Pediatric Health Care, 34(5), p. 514-517, https://doi.org/10.1016/j.pedhc.2020.04.013
Pumariega, A. J., Rothe, E., Mian, A., Carlisle, L., Toppelberg, C., Harris, T., Gogineni, R. R., Webb, S., Smith, J., & American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI) (2013). Practice parameter for cultural competence in child and adolescent psychiatric practice. Journal of the American Academy of Child and Adolescent Psychiatry, 52(10), 1101–1115. https://doi.org/10.1016/j.jaac.2013.06.019
Song, J., Mailick, M. R., & Greenberg, J. S. (2018). Health of parents of individuals with developmental disorders or mental health problems: Impacts of stigma. Social science & medicine (1982), 217, 152–158. https://doi.org/10.1016/j.socscimed.2018.09.044
Telesia, L., Kaushik, A., & Kyriakopoulos, M. (2020). The role of stigma in children and adolescents with mental health difficulties. Current opinion in psychiatry, 33(6), 571–576. https://doi.org/10.1097/YCO.0000000000000644
Waid, J., & Kelly, M. (2020). Supporting family engagement with child and adolescent mental health services: A scoping review. Health & social care in the community, 28(5), 1333–1342. https://doi.org/10.1111/hsc.12947
Walter, H. J., Vernacchio, L., Trudell, E. K., Bromberg, J., Goodman, E., Barton, J., Young, G. J., DeMaso, D. R., & Focht, G. (2019). Five-Year Outcomes of Behavioral Health Integration in Pediatric
S9 Ep. 66
In the eighth and final episode of the Health Equity in Pediatrics podcast series, the epilogue begins with my inspiration for the series, shares some parting sentiments, and discusses the results and conclusions of the cross-sectional study published in the special DEIB edition of Journal of Pediatric Health Care (March/April 2024). I’ll rewind to my childhood and walk you down the cobblestone brick paths of my hometown, the book that changed my perspective, and the words that helped a podcast create allies. I’ll share the results of the international series and post-survey cross-sectional study. The conclusions will fuel your soul about the series’ impact on listeners and implications for DEI education standardization. Now that you’ve listened, you can be confident that you can make a difference in the equitable care experienced by your patients. After touring the country talking about podcasting and health equity in pediatrics, I’m headed for one last stop in Denver. You’re invited to join me on March 13 at the NAPNAP national conference session 117 for “Scholarly Podcasting 101” where you can learn about quality standards and technology in podcasting, help decide the future of The Peds NP, and envision your own podcast.
Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP)Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant. For more information, please community.napnap.org/northcarolinachapter
References
Carson, R.A., Sobolewski, B., & Bowen, F. (2024). Evaluating a health equity podcast for provider practice change: A cross-sectional study. Journal of Pediatric Health Care, in press.
Kapur, G. (2021). To drink from the well: The struggle for equality at the nation’s oldest public university. Blair/Carolina Wren Press.
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Season 10: Primary Care (Ep. 65, 67)

S10 Ep. 65
Nirsevimab is the new FDA-approved monoclonal antibody RSV vaccine for the prevention of severe lower respiratory illness in infants. In this episode, we discuss the current recommendations on who gets the vaccine and when, how to use a lens of health equity to approach the current vaccine shortages, and how to discuss safety and efficacy with vaccine hesitant parents. Now that nirsevimab is on the routine infant immunization schedule, it’s extremely important and pediatric providers understand the recommendations and science behind the monoclonal antibody.
Listen here
References:
CDC Health Alert Network. (2023). Limited availability of nirsevimab in the United States—Interim CDC recommendations to protect infants from Respiratory Syncytial Virus (RSV) during the 2023–2024 respiratory virus season. Emergency Preparedness and Response. https://emergency.cdc.gov/han/2023/han00499.asp?c
Centers for Disease Control and Prevention. (2023). Frequently asked questions about RSV immunization with monoclonal antibody for children 19 months and younger. Vaccines and Preventable Diseases. https://www.cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html
Centers for Disease Control and Prevention. (2022). Vaccines for Children Program. https://www.cdc.gov/vaccines/programs/vfc/index.html
Centers for Disease Control and Prevention. (2023). General best practice guidelines for immunization. Vaccine Recommendations and the Guidelines of the ACIP. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html
Jones, J. M., Fleming-Dutra, K. E., Prill, M. M., Roper, L. E., Brooks, O., Sánchez, P. J., Kotton, C. N., Mahon, B. E., Meyer, S., Long, S. S., & McMorrow, M. L. (2023). Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR. Morbidity and mortality weekly report, 72(34), 920–925. https://doi.org/10.15585/mmwr.mm7234a4
Hill, D., & Parga-Belinkie, J. (Host). (2023, August 29). Immunizations special: RSV, Covid, pneumococcal disease, influenza (No. 170) [Audio podcast episode]. In Pediatrics on call. American Academy of Pediatrics. www.aap.org/podcast
Rha, B., Curns, A. T., Lively, J. Y., Campbell, A. P., Englund, J. A., Boom, J. A., Azimi, P. H., Weinberg, G. A., Staat, M. A., Selvarangan, R., Halasa, N. B., McNeal, M. M., Klein, E. J., Harrison, C. J., Williams, J. V., Szilagyi, P. G., Singer, M. N., Sahni, L. C., Figueroa-Downing, D., McDaniel, D., … Gerber, S. I. (2020). Respiratory Syncytial Virus-Associated Hospitalizations Among Young Children: 2015-2016. Pediatrics, 146(1), e20193611. https://doi.org/10.1542/peds.2019-3611
Suh, M., Movva, N., Jiang, X., Bylsma, L. C., Reichert, H., Fryzek, J. P., & Nelson, C. B. (2022). Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009-2019: A Study of the National (Nationwide) Inpatient Sample. The Journal of infectious diseases, 226(Suppl 2), S154–S163. https://doi.org/10.1093/infdis/jiac120
S10 Ep. 67
At the peak of respiratory virus season, bronchiolitis is one of the most common presentations in infants and young toddlers. The characteristic wheeze and prolonged duration of illness can be distressing for parents, who may lack the practical knowledge of how to effectively implement supportive care. When the mainstay of treatment is supportive care without any single curative intervention, you need to be able to discuss the etiology, management, and anticipatory guidance on a level that the parents can understand. This episode introduces the idea of capacity-building family-centered care and takes a granular, detailed approach to improving family understanding and home care education so that you can facilitate better evidence-based care in the unrestricted environment of the home. By arming parents with the knowledge and skills needed to care for their infant at home and the clear, objective return criteria, you’re providing family-centered care and reducing unnecessary visits.
Listen here
References
Justice NA, Le JK. Bronchiolitis. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441959/
Rha, B., Curns, A. T., Lively, J. Y., Campbell, A. P., Englund, J. A., Boom, J. A., Azimi, P. H., Weinberg, G. A., Staat, M. A., Selvarangan, R., Halasa, N. B., McNeal, M. M., Klein, E. J., Harrison, C. J., Williams, J. V., Szilagyi, P. G., Singer, M. N., Sahni, L. C., Figueroa-Downing, D., McDaniel, D., … Gerber, S. I. (2020). Respiratory Syncytial Virus-Associated Hospitalizations Among Young Children: 2015-2016. Pediatrics, 146(1), e20193611. https://doi.org/10.1542/peds.2019-3611
Suh, M., Movva, N., Jiang, X., Bylsma, L. C., Reichert, H., Fryzek, J. P., & Nelson, C. B. (2022). Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009-2019: A Study of the National (Nationwide) Inpatient Sample. The Journal of infectious diseases, 226(Suppl 2), S154–S163. https://doi.org/10.1093/infdis/jiac120

Season 11: Acute Care PNP Faculty Series (Ep. 68-78)

S11 Ep. 68
Welcome to The Peds NP Acute Care Faculty series! This collaborative series was created and peer-reviewed by national experts and leaders in acute care PNP education to meet the needs of our current and future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a conversational approach so that you can learn nuances of clinical skills before you reach the bedside.
This episode welcomes the acute care PNP student to clinical, where you’ll learn important bedside lessons that apply your knowledge to practical situations. Our faculty offered advice on preparation, clinical rotation best practices, and how to finish the rotation successfully. There are key pearls and pitfalls to guide the student toward gaining competency in their newfound skills. We acknowledge those pesky doubts that cause imposter syndrome, and encourage the role of the learner. Through it all, your clinical is what you make of it, and you can be confident that you have the skills to competently enter a new role.
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Authors (alphabetical): Becky Carson, DNP, APRN, CPNP-PC/AC, Brittany Christiansen, PhD, DNP, APRN, CPNP-PC/AC, FNP-C, AE-C, CNE, Julie Kuzin, DNP, APRN, CPNP-PC/AC, Priscila Reid, DNP, FNP-C, CPNP-AC, Dani Sebbens, DNP, CPNP-AC/PC
References:
Carley, A., & Garrett, L. (2022). Supporting Role Knowledge and Role Transition in Neonatal APRN Students. Neonatal network : NN, 41(3), 168–171. https://doi.org/10.1891/11-T-75
Clance, P. R., & Imes, S. A. (1978). The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research & Practice, 15(3), 241–247. https://doi.org/10.1037/h0086006
Edwards-Maddox S. Burnout and impostor phenomenon in nursing and newly licensed registered nurses: A scoping review. J Clin Nurs. 2023 Mar;32(5-6):653-665. doi: 10.1111/jocn.16475. Epub 2022 Aug 2. PMID: 35918887.
Lee, T., Lee, S. J., Yoon, Y. S., Ji, H., Yoon, S., Lee, S., & Ji, Y. (2023). Personal Factors and Clinical Learning Environment as Predictors of Nursing Students' Readiness for Practice: A Structural Equation Modeling Analysis. Asian nursing research, 17(1), 44–52. https://doi.org/10.1016/j.anr.2023.01.003
Scanlan JM, Laurencelle F, Plohman J. Understanding the impostor phenomenon in graduate nursing students. Int J Nurs Educ Scholarsh. 2023 Dec 7;20(1). doi: 10.1515/ijnes-2022-0058. PMID: 38053510.
White, A., & Rivera, L. (2023). Increasing Student Confidence Prior to an Obstetric Clinical Practicum. Nurse educator, 48(6), E195. https://doi.org/10.1097/NNE.0000000000001381
S11 Ep. 69
This episode guides the novice pediatric provider on creations of an acute care differential diagnosis. It starts with a story about a Southerner in a snow storm and the unfortunate car problem that resulted from an unexpected guest in the engine. A clear parallel ties the mechanic’s diagnosis with a few amateur onomatopoeias (“clunk, clunk, clunk”) with the skills needed to form illness scripts and develop differentials. A brief case study on an adolescent with acidosis introduces the idea of broad differential formation and the importance of a complete evaluation before diagnoses are eliminated. Medical decision-making is difficult, and a systematic approach to differential diagnosis formation is essential. The episode uses simple examples to help listeners apply the concepts and form a differential in real time. The discussion covers the importance of careful accrual of information, initial differential creation using a systematic approach, how to narrow your differential based on key findings of the assessment, and how to approach an open-ended differential honestly with families while avoiding cognitive bias. With the understanding that, “disease exists on a continuum that evolves and we see the patient at a snapshot in time,” the episode offers a step by step guide on how to build a differential. Classic mantras of The Peds NP are finally explained and tied to the development of your acute care differential. Every novice needs to listen to this episode before ever stepping foot in the clinical setting to be prepared for diagnostic reasoning and the process of narrowing your differential.
Authors (alphabetical): Aimee Bucci DNP, APRN, CPNP-AC, Becky Carson, DNP, APRN, CPNP-PC/AC, & Dani Sebbens, DNP, CPNP-PC/AC
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References:
Balogh, E. P., Miller, B. T., Ball, J. R., Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine, & The National Academies of Sciences, Engineering, and Medicine (Eds.). (2015). Improving Diagnosis in Health Care. National Academies Press (US).
Brennan, M.M (2020). Teaching strategy 1: cultivating diagnostic decision-making with problem based learning: from most likely to least likely. Innovative Strategies in Teaching Nursing. doi: 10.1891/9780826161215
Carson, R. A., & Lyles, J. L. (2024). Cognitive Bias in an Infant with Constipation. The Journal of pediatrics, 113996. Advance online publication. https://doi.org/10.1016/j.jpeds.2024.113996
Hammond, M. E. H., Stehlik, J., Drakos, S. G., & Kfoury, A. G. (2021). Bias in Medicine: Lessons Learned and Mitigation Strategies. JACC. Basic to translational science, 6(1), 78–85. https://doi.org/10.1016/j.jacbts.2020.07.012Marshall, T. L., Rinke, M. L., Olson, A. P. J., & Brady, P. W. (2022). Diagnostic Error in Pediatrics: A Narrative Review. Pediatrics, 149(Suppl 3), e2020045948D.https://doi.org/10.1542/peds.2020-045948D
Marshall, T. L., Rinke, M. L., Olson, A. P. J., & Brady, P. W. (2022). Diagnostic Error in Pediatrics: A Narrative Review. Pediatrics, 149(Suppl 3), e2020045948D. https://doi.org/10.1542/peds.2020-045948D
Smith, S.K., Benbenek, M.M., Bakker, C.J., & Bockwoldt, D. (2022). Scoping review: diagnostic reasoning as a component of clinical reasoning in the U.S. primary care nurse practitioner education. Journal of Advanced Nursing, 78:3869-3896. doi: 10.1111/jan.15414
S11 Ep. 70
For many scholars, the poster and its prerequisite abstract are the first product of dissemination of their work. This episode guides the new scholar through the entire process– from selecting a conference destination, writing the abstract in a concise manner, creation of the poster, and the poster session at the conference. Key pearls and pitfalls of abstract submission, the use of artificial intelligence, and your final poster presentation complete the beginner’s guide to dissemination.
Authors: (alphabetical) Becky Carson, DNP, APRN, CPNP-PC/AC and Mike Maymi, DNP, APRN, CPNP-AC, CCRN, CNE
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References:
Barker, E., & Phillips, V.. (2021). Creating conference posters: Structure, form and content. Journal of Perioperative Practice, 31(7-8), 296–299. https://doi.org/10.1177/1750458921996254
Dave, T., Athaluri, S. A., & Singh, S. (2023). ChatGPT in medicine: an overview of its applications, advantages, limitations, future prospects, and ethical considerations. Frontiers in artificial intelligence, 6, 1169595. https://doi.org/10.3389/frai.2023.1169595
Drury, A., Pape, E., Dowling, M., Miguel, S., Fernández-Ortega, P., Papadopoulou, C., & Kotronoulas, G. (2023). How to Write a Comprehensive and Informative Research Abstract. Seminars in oncology nursing, 39(2), 151395. https://doi.org/10.1016/j.soncn.2023.151395
Freysteinson, W. M., & Stankus, J. A. (2019). The Language of Scholarship: How to Write an Abstract That Tells a Compelling Story. Journal of continuing education in nursing, 50(3), 107–108. https://doi.org/10.3928/00220124-20190218-04
S11 Ep. 71
This episode discusses a standardized approach to delivering bad news, founded in the literature. The SPIKES protocol is the most well recognized approach to create an environment, assess patient and family knowledge and preferences, deliver the news compassionately, and empathize prior to a summary. With examples of phrasing you can offer at each step, you’ll gain the skills necessary to deliver bad news.

Authors (alphabetical): Becky Carson, DNP, APRN, CPNP-PC/AC, Ann Felauer, DNP, APRN, CPNP-PC/AC, Belinda Large, DNP, APRN, CPNP-PC/AC, and Robyn Stamm, DNP, APRN, CPNP-PC/AC
Listen here
References:
Brouwer, M. A., Maeckelberghe, E. L. M., van der Heide, A., Hein, I. M., & Verhagen, E. A. A. E. (2021). Breaking bad news: what parents would like you to know. Archives of disease in childhood, 106(3), 276–281. https://doi.org/10.1136/archdischild-2019-318398
Buckman R. (1984). Breaking bad news: why is it still so difficult?. British medical journal (Clinical research ed.), 288(6430), 1597–1599. https://doi.org/10.1136/bmj.288.6430.1597
Buckman R. (2001). Communication skills in palliative care: a practical guide. Neurologic clinics, 19(4), 989–1004. https://doi.org/10.1016/s0733-8619(05)70057-8
Institute of Medicine (US) Committee on Palliative and End-of-Life Care for Children and Their Families, Field, M. J., & Behrman, R. E. (Eds.). (2003). When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. Chapter 4 communication, goal setting, and care planning. National Academies Press (US).
Kaplan M. (2010). SPIKES: a framework for breaking bad news to patients with cancer. Clinical journal of oncology nursing, 14(4), 514–516. https://doi.org/10.1188/10.CJON.514-516
Ptacek, J. T., & Eberhardt, T. L. (1996). Breaking bad news. A review of the literature. JAMA, 276(6), 496–502.
Sisk, B., Frankel, R., Kodish, E., & Harry Isaacson, J. (2016). The Truth about Truth-Telling in American Medicine: A Brief History. The Permanente journal, 20(3), 15–219. https://doi.org/10.7812/TPP/15-219
Varkey B. (2021). Principles of Clinical Ethics and Their Application to Practice. Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 30(1), 17–28. https://doi.org/10.1159/000509119
S11 Ep. 72
This episode applies the concepts from the prior episode on “Delivering Bad News” (S11 Ep. 71) to a few examples where HIV status was disclosed to a pediatric patient. After reflection and discussion of a few ethical principles important to consent/assent, it’s time to practice delivering bad news in a case study. An unfolding case poses questions to get you thinking about what you might say. Make it interactive by pausing your podcast and answer the question yourself. The case walks you step-by-step through the process of delivering bad news to a child and their family using the SPIKES protocol. There's no perfect answer, but this example helps to prepare you for competency-based learning, so that you’re ready to deliver bad news in practice.

Authors (alphabetical): Becky Carson, DNP, APRN, CPNP-PC/AC, Ann Felauer, DNP, APRN, CPNP-PC/AC, Belinda Large, DNP, APRN, CPNP-PC/AC, and Robyn Stamm, DNP, APRN, CPNP-PC/AC
Listen here
References
Brouwer, M. A., Maeckelberghe, E. L. M., van der Heide, A., Hein, I. M., & Verhagen, E. A. A. E. (2021). Breaking bad news: what parents would like you to know. Archives of disease in childhood, 106(3), 276–281. https://doi.org/10.1136/archdischild-2019-318398
Cassim, S., Kidd, J., Keenan, R., Middleton, K., Rolleston, A., Hokowhitu, B., Firth, M., Aitken, D., Wong, J., & Lawrenson, R. (2021). Indigenous perspectives on breaking bad news: ethical considerations for healthcare providers. Journal of medical ethics, medethics-2020-106916. Advance online publication. https://doi.org/10.1136/medethics-2020-106916
Field, M.J. & Behrman, R.E. (2003). When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. Chapter 4 communication, goal setting, and care planning. Committee on Palliative and End-of-Life Care for Children and Their Families. Institute of Medicine (US)
Holmes, S. N., & Illing, J. (2021). Breaking bad news: tackling cultural dilemmas. BMJ supportive & palliative care, 11(2), 128–132. https://doi.org/10.1136/bmjspcare-2020-002700
Kaplan, M. (2010). SPIKES: A framework for breaking bad news to patients with cancer. Clinical Journal of Oncology Nursing, 14(4), 514-516. https://cjon.ons.org/cjon/14/4/spikes-framework-breaking-bad-news-patients-cancer
Kumar, V., & Sarkhel, S. (2023). Clinical Practice Guidelines on Breaking Bad News. Indian journal of psychiatry, 65(2), 238–244. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_498_22
Labaf, A., Jahanshir, A., Baradaran, H., & Shahvaraninasab, A. (2015). Is it appropriate to use Western guidelines for breaking bad news in non-Western emergency departments? A patients’ perspective. Clinical Ethics, 10(1–2), 13–21. https://doi.org/10.1177/1477750915581797
Monden, K. R., Gentry, L., & Cox, T. R. (2016). Delivering bad news to patients. Proceedings (Baylor University. Medical Center), 29(1), 101–102. https://doi.org/10.1080/08998280.2016.11929380
Mostafavian, Z., Shaye, Z. A., & Farajpour, A. (2018). Mothers' preferences toward breaking bad news about their children cancer. Journal of family medicine and primary care, 7(3), 596–600. https://doi.org/10.4103/jfmpc.jfmpc_342_17
S11 Ep. 73
This episode explores wellness for the pediatric nurse practitioner. We first discuss burnout in terms of its physical and mental impact on the provider as well as poorer patient outcomes and healthcare systems burdens. After we identify symptoms of burnout and compassion fatigue, we’ll discuss what wellness looks like in various systems at work from organizational culture of wellness to ease of daily work and finally personal resilience. We end with a discussion on self-compassion and introduce the evidence in support of meditation as a strategy to promote mind-body wellness. For some, this concept is new, so the technical aspects of meditation are unpacked to facilitate your own path to daily wellness. This episode pairs well with the 5-minute meditation for pediatric providers.
Authors: Becky Carson, DNP, APRN, CPNP-PC/AC, Bridget Sullivan Garmisa, MSN, MS, CRNP, RD
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References:
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: care, health, and cost. Health affairs (Project Hope), 27(3), 759–769. https://doi.org/10.1377/hlthaff.27.3.759
Chan, G. K., Kuriakose, C., Blacker, A., Harshman, J., Kim, S., Jordan, L., & Shanafelt, T. D. (2021). An organizational initiative to assess and improve well-being in advanced practice providers. Journal of Interprofessional Education & Practice, 25, 100469-. https://doi.org/10.1016/j.xjep.2021.100469
Green, A. A., & Kinchen, E. V. (2021). The Effects of Mindfulness Meditation on Stress and Burnout in Nurses. Journal of holistic nursing : official journal of the American Holistic Nurses' Association, 39(4), 356–368. https://doi.org/10.1177/08980101211015818
Kabat-Zinn, J. (2005). Wherever You Go There You are (10th ed.). Hyperion
Kriakous, S. A., Elliott, K. A., Lamers, C., & Owen, R. (2021). The Effectiveness of Mindfulness-Based Stress Reduction on the Psychological Functioning of Healthcare Professionals: a Systematic Review. Mindfulness, 12(1), 1–28. https://doi.org/10.1007/s12671-020-01500-9
Leiter, M. P., & Maslach, C. (2004). Areas of worklife: A structured approach to organizational predictors of job burnout. In P. L. Perrewé & D. C. Ganster (Eds.), Emotional and physiological processes and positive intervention strategies (pp. 91–134). Elsevier Science/JAI Press.
Lennon, Y. (2023). The quintuple aim: What it is and why does it matter? Chess Health Solutions. https://www.chesshealthsolutions.com/2023/08/01/the-quintuple-aim-what-is-it-and-why-does-it-matter/#:~:text=The%20Quintuple%20Aim%20is%20an,system%20to%20establish%20health%20equity.
Makary, M. A., & Daniel, M. (2016). Medical error-the third leading cause of death in the US. BMJ (Clinical research ed.), 353, i2139. https://doi.org/10.1136/bmj.i2139
Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual review of psychology, 52, 397–422. https://doi.org/10.1146/annurev.psych.52.1.397
National Wellness Institute. (2024). NWI’s six dimensions of wellness. https://nationalwellness.org/resources/six-dimensions-of-wellness/#:~:text=Wellness%20is%20a%20conscious%2C%20self,a%20long%20and%20healthy%20life.
Neff, K. D. (2023). Self-Compassion: Theory, Method, Research, and Intervention. Annual Review of Psychology, 74(1), 193–218. https://doi.org/10.1146/annurev-psych-032420-031047
Panagioti, M., Khan, K., Keers, R. N., Abuzour, A., Phipps, D., Kontopantelis, E., Bower, P., Campbell, S., Haneef, R., Avery, A. J., & Ashcroft, D. M. (2019). Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. BMJ (Clinical research ed.), 366, l4185. https://doi.org/10.1136/bmj.l4185
Peters E. (2018). Compassion fatigue in nursing: A concept analysis. Nursing forum, 53(4), 466–480. https://doi.org/10.1111/nuf.12274
Shanafelt, T. D., & Noseworthy, J. H. (2017). Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clinic Proceedings, 92(1), 129–146. https://doi.org/10.1016/j.mayocp.2016.10.004
Shanafelt, T. D., Larson, D., Bohman, B., Roberts, R., Trockel, M., Weinlander, E., Springer, J., Wang, H., Stolz, S., & Murphy, D. (2023). Organization-Wide Approaches to Foster Effective Unit-Level Efforts to Improve Clinician Well-Being. Mayo Clinic Proceedings, 98(1), 163–180. https://doi.org/10.1016/j.mayocp.2022.10.031
S11 Ep. 74
Meditation begins at 2:00.
This 5-minute meditation for pediatric providers is designed to help you center your day before your work to boost your wellness, improve resilience, and connect better with yourself, your patients, and your colleagues.
First we’ll create a peaceful environment and establish the ground rules of meditation, then get your body into position. The guided meditation takes you through 5 minutes of breath to help you calm your mind and body while making room for empathy and patience. No judgment, but lots of kindness and compassion for your thoughts and feelings. The session ends by bringing body and mind back into your space and showing gratitude for the practice. Use this meditation every day before you go to work with infants, children, adolescents, and young adults to improve your wellness and their outcomes.
Listen here
References:
The Meditation Initiative. (nd). 5 minute guided meditation script. https://meditationinitiative.org/5-minute-meditation-script
Mindful. (2024). How to start your day with meditation. https://www.mindful.org/how-to-start-your-day-with-meditation/
S11 Ep. 75
This episode begins with a brief review of malnutrition and pediatric nutritional assessment in acute care settings. Next we begin a choose-your-own-nutrition adventure by asking a series of questions that aid in medical decision-making for which nutrition route is appropriate, and, if enteral feeding is best, then determines the type of tube indicated. A case-based discussion with examples helps you to apply the concepts to a complex scenario. Our next episode will focus on formula selection, the initiation of feeds, and assessment of tolerance.
Authors: Becky Carson, DNP, APRN, CPNP-PC/AC, Jessica D. Murphy, DNP, CPNP-AC, CPHON, CNE, & Marian Malone, DNP, APRN, CPNP-AC/PC
Listen here
References:
Bechtold, M. L., Brown, P. M., Escuro, A., Grenda, B., Johnston, T., Kozeniecki, M., Limketkai, B. N., Nelson, K. K., Powers, J., Ronan, A., Schober, N., Strang, B. J., Swartz, C., Turner, J., Tweel, L., Walker, R., Epp, L., & Malone, A. (2022). When is enteral nutrition indicated? Journal of Parenteral and Enteral Nutrition, 46(7), 1470–1496. https://doi.org/10.1002/jpen.2364
Becker, P., Carney, L. N., Corkins, M. R., Monczka, J., Smith, E., Smith, S. E., Spear, B. A., & White, J. V. (2014). Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition. Nutrition in Clinical Practice, 30(1), 147–161. https://doi.org/10.1177/0884533614557642
Green Corkins, K. (2015). Nutrition‐focused physical examination in pediatric patients. Nutrition in Clinical Practice, 30(2), 203–209. https://doi.org/10.1177/0884533615572654
Hess, L., & Crossen, J. (2008). Pediatric Nutrition Handbook (3rd ed.). Cincinnati Children’s.
Mehta, N. M., Skillman, H. E., Irving, S. Y., Coss-Bu, J. A., Vermilyea, S., Farrington, E. A., McKeever, L., Hall, A. M., Goday, P. S., & Braunschweig, C. (2017). Guidelines for the provision and assessment of Nutrition Support Therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Pediatric Critical Care Medicine, 18(7), 675–715. https://doi.org/10.1097/pcc.0000000000001134
Panchal, A. K., Manzi, J., Connolly, S., Christensen, M., Wakeham, M., Goday, P. S., & Mikhailov, T. A. (2014). Safety of enteral feedings in critically ill children receiving vasoactive agents. Journal of Parenteral and Enteral Nutrition, 40(2), 236–241. https://doi.org/10.1177/0148607114546533
Yi, Dae Young. (2018). Enteral nutrition in pediatric patients. Pediatric Gastroenterology, Hepatology & Nutrition, 21(1), 12-19. http://doi.org/10.5223/pghn.2018.21.1.12
S11 Ep. 76
*This is the second episode in a 2 part series on enteral feeding. Listen to Episode 75: Malnutrition and Feeding Tube Selection first.

This episode walks through the decision-making for which enteral formula to select based on the patient's age, protein needs, and GI function. A list of commercially available examples is listed for each age group and protein type. Fluid and caloric goals are discussed to determine if concentrated formulas are appropriate. Lastly, the process of starting continuous feeds and advancing to bolus feeds while assessing for tolerance is reviewed. Build functional skills by following along with a case study that is continued from the prior episode. It's proof that there's more than just formula that goes into tube feedings.
Authors: Becky Carson, DNP, APRN, CPNP-PC/AC, Jessica D. Murphy, DNP, CPNP-AC, CPHON, CNE, & Marian Malone, DNP, APRN, CPNP-AC/PC
Listen here
References:
Bechtold, M. L., Brown, P. M., Escuro, A., Grenda, B., Johnston, T., Kozeniecki, M., Limketkai, B. N., Nelson, K. K., Powers, J., Ronan, A., Schober, N., Strang, B. J., Swartz, C., Turner, J., Tweel, L., Walker, R., Epp, L., & Malone, A. (2022). When is enteral nutrition indicated? Journal of Parenteral and Enteral Nutrition, 46(7), 1470–1496. https://doi.org/10.1002/jpen.2364
Becker, P., Carney, L. N., Corkins, M. R., Monczka, J., Smith, E., Smith, S. E., Spear, B. A., & White, J. V. (2014). Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition. Nutrition in Clinical Practice, 30(1), 147–161. https://doi.org/10.1177/0884533614557642
Green Corkins, K. (2015). Nutrition‐focused physical examination in pediatric patients. Nutrition in Clinical Practice, 30(2), 203–209. https://doi.org/10.1177/0884533615572654
Hess, L., & Crossen, J. (2008). Pediatric Nutrition Handbook (3rd ed.). Cincinnati Children’s.
Mehta, N. M., Skillman, H. E., Irving, S. Y., Coss-Bu, J. A., Vermilyea, S., Farrington, E. A., McKeever, L., Hall, A. M., Goday, P. S., & Braunschweig, C. (2017). Guidelines for the provision and assessment of Nutrition Support Therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Pediatric Critical Care Medicine, 18(7), 675–715. https://doi.org/10.1097/pcc.0000000000001134
Panchal, A. K., Manzi, J., Connolly, S., Christensen, M., Wakeham, M., Goday, P. S., & Mikhailov, T. A. (2014). Safety of enteral feedings in critically ill children receiving vasoactive agents. Journal of Parenteral and Enteral Nutrition, 40(2), 236–241. https://doi.org/10.1177/0148607114546533
Yi, Dae Young. (2018). Enteral nutrition in pediatric patients. Pediatric Gastroenterology, Hepatology & Nutrition, 21(1), 12-19. http://doi.org/10.5223/pghn.2018.21.1.12
S11 Ep. 77
This episode reviews the features of a patient presentation in the pediatric intensive care unit (PICU) and goes in depth on how learners can incorporate trends, new findings, and summaries into a succinct discussion in family-centered rounds. After an introduction with some general best practices, the guide begins with effective pre-rounding and progresses to the step-by-step components of a PICU patient presentation. The template describes each component’s contents in detail, followed immediately by an example to demonstrate the practical application of each concept… “It might sound something like this:”... This episode is a valuable tool for any pediatric provider seeking to increase their skills in succinct synthesis and patient presentations, regardless of clinical setting.

This episode was peer reviewed by The Peds NP faculty series peer review team. You can read about our novel and scholarly approach to peer review, review our faculty lineup, and learn more about the series, competency mapping, references, and show notes at www.thepedsnp.com. There was no financial support or conflicts of interest to report. Follow me on Instagram @thepedsnppodcast. Email me at thepedsnp@gmail.com. Remember that this isn’t just a podcast, you’re listening for the kids.

Authors (alphabetical): Jackie Calhoun, DNP, CRNP, CPNP-AC, CCRN, Becky Carson, DNP, APRN, CPNP-PC/AC, Lena Oliveros, MSN, CPNP-AC, Priscila Reid, DNP, APRN, FNP-C, CPNP-AC
Listen here
References:
Bolick, B.N., Reuter-Rice, K., Madden, M.A., Severin, P.N. (2020). Pediatric Acute Care: A guide for Interprofessional Practice (2nd ed.). Jones & Barlett Learning. Burlington, MA.

Oubre, R. (2024). Systems versus problem-based notes. Dr. Oubre’s Digest. https://droubredigest.beehiiv.com/p/systems-versus-problems-based-notes

Stanford Medicine. (nd). Coaching best practices– Presenting a patient. https://med.stanford.edu/content/dam/sm/peds/documents/Program%20Information/coaching/Coaching%20Feedback%20Summary_Presenting%20a%20Patient.pdf

UC San Diego School of Medicine. (2018). Overview and general information about oral presentation. Practical Guide to Clinical Medicine. https://meded.ucsd.edu/clinicalmed/oral.html
This is the final episode of The Peds NP Acute Care PNP Faculty series. The series was created and peer-reviewed by national leaders in acute care PNP education in collaboration to meet the needs of our current and future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach so that you can learn nuances of clinical skills before you reach the bedside.
As I come to an end of my time as a faculty member at the Catholic University of America and our Acute Care PNP Faculty series, I remember my graduation from Johns Hopkins. These terminal moments are likened to a graduation, and serve as a wonderful time for reflection. The episode recollects the student speaker commencement address given at my graduation, filled with vehicular metaphors and acknowledgements of failure. A common theme of “Onward” is woven throughout to remind listeners that, at whatever graduation you find yourself celebrating right now, be hopeful and excited at the good that is left to do in the world.
The Peds NP will return in 2025 from Duke University…
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Season 12: Coming soon

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