Have patients asking you about aluminum in vaccines? Listen to this episode to learn about important facts so that you can answer their questions appropriately.

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Anh Nguyen (allergy and immunology). 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:

• Alumium is an immune adjuvant, it helps the body's innate immune cells recognize vaccine antigen and enhances the ability of the vaccine antigen to activate innate immune cells. Your body has a better response to vaccines with aluminum than without. This is especially important for infants
• Aluminum toxicity is mostly only seen in adult dialysis patients or chronic kidney disease patients due to aluminum in dialysis and total parenteral nutrition. There are no credible reports of aluminum toxicity linked to vaccines
• There are higher levels of serum aluminum after taking over the counter antacids used to treat GERD than after giving an intramuscular vaccine.

Sources:

• “The Role and Safety of Aluminum Adjuvants in Childhood Vaccines”. Pediatrics (2025)
• https://doi.org/10.1542/peds.2025-074874

We're back with journal club to review a study evaluating the PECARN guidelines on febrile infants under 28 days of age and serious bacterial infections like meningitis.

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:

• Urinalysis, absolute neutrophil count, and procalcitonin are useful predictors of serious bacterial infection
• In this study, using urine studies, absolute neutrophil count, and procalcitonin were able to risk stratify patients into risk for meningitis and no cases of meningitis were missed

Sources:

• Burstein B, Waterfield T, Umana E, Xie J, Kuppermann N. Prediction of Bacteremia and
• Bacterial Meningitis Among Febrile Infants Aged 28 Days or Younger. JAMA. Published
• online December 8, 2025. doi:10.1001/jama.2025.21454
• Kuppermann N, Dayan PS, Levine DA, et al. A Clinical Prediction Rule to Identify
• Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA
• Pediatr. 2019;173(4):342-351. doi:10.1001/jamapediatrics.2018.5501

Dealing with a crying and moving child who needs sedation for a laceration repair? Intranasal midazolam is a good sedative option but what dose do you choose? Learn more in this journal club episode where we talk about a recent study that evaluated the most effective dosing of intranasal midazolam.

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Julia Marlow (pediatric hospitalist). 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.comKey Points:

• Intranasal midazolam is a good non-invasive sedative option. It has similar plasma concentrations as intravenous administration because it bypasses first pass metabolism unlike oral administration. Onset of action is 20-30 minutes and can last 30-60 minutes.
• Dosing of intranasal midazalam for children is 0.2 - 0.5 mg/kg
• Based on the results of this study, 0.4 - 0.5 mg/kg of midazolam was found to provide more effective sedation without increased adverse events for the studied patient population (6 months - 7 years old with simple laceration)
• Always critically think through studies! This study had limitations including the narrow patient population (did not include children with autism or developmental delay, did not include children less than 6 months old, and had a small study sample size with n = 101)

Sources:

• Tsze DS, Woodward HA, McLaren SH, et al. Optimal Dose of Intranasal Midazolam for Procedural Sedation in Children: A Randomized Clinical Trial. JAMA Pediatr. Published online July 28, 2025. doi:10.1001/jamapediatrics.2025.2181
• UpToDate “Pediatric procedural sedation: pharmacological agents”