How do you know when a head injury can be observed or if more work-up needs to be done? Find out in this episode!

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Julia Magana (pediatric emergency medicine). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.com

Key Points:

• Low risk head injuries do not need head imaging. The criteria for low risk head injuries are those where the patient’s GCS is 15 without altered mental status and do not have signs of skull fracture. If any of these signs are present, head imaging with a head CT is recommended
• If the head injury includes history of loss of consciousness or vomiting, a non-frontal scalp hematoma (ie parietal, temporal, or occipital), a severe mechanism of injury, or a severe headache, then generally observation is still recommended but a head CT can be obtained based on clinical decision making.

Sources:

• Stat Pearls. Pediatric Head Trauma. Micelle J, et al. February 2024: https://www.ncbi.nlm.nih.gov/books/NBK537029/
• Pediatrics. Abusive Head Trauma in Infants and Children: Technical Report. Sandeep Narang, et all. February 2025: https://publications.aap.org/pediatrics/article/155/3/e2024070457/201049/Abusive-Head-Trauma-in-Infants-and-Children

Opioid use disorders affect babies and children in all ways. In newborns, it can present as neonatal opioid withdrawal syndrome (also known as NOWS). Learn how hospital systems are managing infants with NOWS with the Eat, Sleep, Console protocol in our episdoe today!

Key Points:

• Eat Sleep Console (ESC) focuses on non-pharmacological intervention first before initiating medication. This includes limiting excessive stimulation, keeping the room dark and quiet, swaddling, rocking, swaying, and giving babies a pacifier or feeding.
• Compared to using the Finnegan scoring system, ESC results in shorter or equal length of hospital stay for infants with NOWS. However, some critics of ESC raise the concern for undertreating infants with NOWS.
• Morphine, clonidine, and phenobarbital are common agents used to treat infant with NOWS

Sources:

• Neoreviews (2025) 26 (4): e223–e232. https://doi.org/10.1542/neo.26-4-010
• Hosp Pediatr (2025) 15 (3): e121–e125. https://doi.org/10.1542/hpeds.2024-008094
• Hosp Pediatr (2025) 15 (3): e99–e101. https://doi.org/10.1542/hpeds.2025-008332
• Kaltenbach K, O'Grady KE, Heil SH, et al. Prenatal exposure to methadone or buprenorphine: Early childhood developmental outcomes. Drug Alcohol Depend. 2018;185:40-49. https://doi.org/10.1016/j.drugalcdep.2017.11.030
• Rees P, Stilwell PA, Bolton C, et al. Childhood Health and Educational Outcomes After Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysis. J Pediatr. 2020;226:149-156.e16. https://doi.org/10.1016/j.jpeds.2020.07.013

Learn about language and speech development, potential etiologies of speech delay, and early interventions for speech delay.

Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.com

This episode was written by pediatricians Lidia Park and Tammy Yau as well as UCD pediatrics resident Elaine Ho, with content support from Anisha Srinivasan (UCD child development and behavioral pediatrician). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points

• CDC and AAP have created updated 2022 developmental guidelines that includes changes in speech and language milestones for childrens and have added guidelines forage ages 15 months and 30 months
• Differential for speech delay is broad and includes hearing loss, global developmental delay, autism, and isolated language disorders
• Interventions include speech therapy services and exercises at home
• Pediatricians play critical role in surveillance, evaluation, and management of speech delays to allow for earlier intervention and improved outcomes

Sources

• Jennifer M. Zubler, Lisa D. Wiggins, Michelle M. Macias, Toni M. Whitaker, Judith S. Shaw, Jane K. Squires, Julie A. Pajek, Rebecca B. Wolf, Karnesha S. Slaughter, Amber S. Broughton, Krysta L. Gerndt, Bethany J. Mlodoch, Paul H. Lipkin; Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics March 2022; 149 (3): e2021052138. 10.1542/peds.2021-052138
• Maris Rosenberg, MD, Nancy Tarshis, MA, MS, 2016. "Speech and Language Concerns (Chapter 195)", American Academy of Pediatrics Textbook of Pediatric Care, Thomas K. McInerny, MD, FAAP, Henry M. Adam, MD, FAAP, Deborah E. Campbell, MD, FAAP, Thomas G. DeWitt, MD, FAAP, Jane Meschan Foy, MD, FAAP, Deepak M. Kamat, MD, PhD, FAAP, Rebecca Baum, MD, FAAP, Kelly J. Kelleher, MD, MPH, FAAP
• Heidi M. Feldman; Evaluation and Management of Language and Speech Disorders in Preschool Children. Pediatr Rev April 2005; 26 (4): 131–142. https://doi.org/10.1542/pir.26-4-131
• Henry Adam; Speech and Language Concerns. Quick References 2022; 10.1542/aap.ppcqr.396455
• ASHA Communication Milestones and Age Ranges https://www.asha.org/public/developmental-milestones/communication-milestones/

Audio Clips: From Youtube Channel “Pathways”

The 4 to 6 Month Baby Communication Milestones to Look For: https://www.youtube.com/watch?v=d0FGHFrMRXI

10-12 month Old Communication Milestones https://www.youtube.com/watch?v=zYHpjZC2qCA

19-24 Month Communication Milestones: https://www.youtube.com/watch?v=-2C--4gay2c