Tripoding and a thumb print sign on X-ray are your buzz words for epiglottitis that you don't want to miss as it can cause very rapid respiratory compromise requiring ICU care. We'll go over what to look out for and how to treat epiglottitis in this week's episode

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Zachary Chaffin (pediatric critical care). 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:

• Epiglottitis can present with rapid onset fever, sore throat, difficulty breathing, and drooling. On exam, you might see stridor, retractions, and tripoding which is when the patient is leaning forward with their head tilted upward.
• Epiglottitis can lead to respiratory failure and may require intubation
• The most common causes of epiglottitis are Staph aureus, Streptococcus pneumonoiae, and Haemophilus influenzae though the latter has decreased due to vaccination with the Hib vaccine
• Treatment for epiglottitis includes antibiotics like ceftriaxone and vancomycin for 7-10 days. Steroids and racemic epinephrine have not been shown to improve outcomes for epiglottitis.

Sources:

• Croup and Epiglottitis. Mark Shlomovich, et al. Pediatr Rev (2025) 46 (7): 366–372. https://doi.org/10.1542/pir.2024-006420
• Epiglottitis Associated With Intermittent E-cigarette Use: The Vagaries of Vaping Toxicity. Pediatrics (2020) 145 (3): e20192399. https://doi.org/10.1542/peds.2019-2399
• Croup (laryngitis, laryngotracheitis, spasmodic croup, laryngotracheobronchitis, bacterial tracheitis, and laryngotracheobronchopneumonitis) and epiglottitis (supraglottitis). In: Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 8th edition, Tovar Padua LJ, Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ (Eds), Elsevier, Philadelphia 2019. Vol 1, p.175.
• Up to Date: Epiglottitis: Management, Clinical Features and Diagnosis

Wondering how to best protect your patients or your own baby this winter from RSV? We'll go over the different preventative options against RSV in today's episode!

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Kenneth Yau (general pediatrics). 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:

• RSV immunizations can stimulate an immune response to create antibodies against RSV or can directly give antibodies to an individual
• The RSV vaccine (Abrysvo) for adults can be given to pregnant individuals to provide passive immunity to infants after birth. It should be given at 32-36 weeks of gestational and 2 weeks prior to delivery
• After birth, infants can be given an RSV immunization, either nirsevimab (Beyfortus) or clesrovimab (Enflonsia), which are RSV antibodies. These can be given to all infants less than 8 months old if the pregnant parent did not receive Abrysvo. High risk infants 8-19 months should also receive RSV immunization.

Sources:

• CDC: https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/pregnant-people.html
• AAP Oct 2025: https://doi.org/10.1542/peds.2025-073923
• AAP Patient Care: https://www.aap.org/en/patient-care/respiratory-syncytial-virus-rsv-prevention/rsv-frequently-asked-questions/?srsltid=AfmBOopMfpneGvJVfI8lZGHlZg5gtqU7AtrR2NbqYzVh9OINyVnrXqT-

Measles cases are rising world-wide so now's the time to brush up on this previously rare life threatening and vaccine preventable illness.

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Ritu Cheema (pediatric infectious disease). 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:

• Measles is a highly contagious vaccine preventable viral infection. From 1 single person infected with measles, an average of 18 people can be infected compared to an average of 10 for Ebola and an average of 6 for COVID.
• 2 doses of the live attenuated measles vaccine is 97% effective at preventing measles infection
• Herd immunity prevents wide-spread measles outbreaks. The threshold needed to prevent large scale measles outbreaks is 95%. Only 92.7% of kindergarteners in the US received both MMR shots for the 2023-2024.
• Symptoms of measles includes cough, conjunctivitis, coryza (rhinorrhea), Koplik spots (white spots in the mouth), and rash spreading from the face down, Serious complications include death (1-3 deaths per 1000 cases), encephalitis (20% mortality), and subacute sclerosing panencephalitis (SSPE) which is almost universally fatal.

Sources:

• “What’s Old is New Again: Measles”. Pediatrics (2025) 155 (6): e2025071332.
• https://doi.org/10.1542/peds.2025-071332
• “CDC Confirms Worst Year for Measles since 1992”. AAP News. Sean Stangland. Jul 9 2025.
• “Vaccines Matter: Measles and Its Complications”. Pediatrics (2025) 156 (1): e2025071622. https://doi.org/10.1542/peds.2025-071622
• Mina MJ, Metcalf CJE, de Swart RL, Osterhaus ADME, Grenfell BT. Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality. Science. 2015;348(6235):694–699. PubMed doi: 10.1126/science.aaa3662
• Mina MJ, Kula T, Leng Y, et al. Measles virus infection diminishes preexisting antibodies that offer protection from other pathogens. Science. 2019;366(6465):599–606. PubMed doi: 10.1126/science.aay6485
• Lin WH, Kouyos RD, Adams RJ, Grenfell BT, Griffin DE. Prolonged persistence of measles virus RNA is characteristic of primary infection dynamics. Proc Natl Acad Sci U S A. 2012;109(37):14989-14994. doi:10.1073/pnas.1211138109
• AAP Red Book: Measles
• Medical vs Nonmedical Immunization Exemptions for Child Care and School Attendance: Policy Statement. Pediatrics (2025) 156 (2): e2025072714. https://doi.org/10.1542/peds.2025-072714

Ever wonder what if the cafe au lait macule on your patient might be something more than just a benign birth mark? Learn more about neurofibromatosis 1 and other genetic disorders associated with cafe au lait macules in today’s episode.

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Suma Shankar (pediatric genomic 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:

• Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder with complete penetrance but variable expression.
• NF1 can be diagnosed clinically if a patient has the following features and meets the specific clinical criteria: cafe au lait macules, neurofibromas, freckling, optic gliomas, iris hamartomas, an osseous lesion, and/or a first degree relative with NF1

Sources:

Pediatrics, Miller et al (2019) 143 (5): e20190660. https://doi.org/10.1542/peds.2019-0660

Have you ever wondered if your patient pausing to breathe in their sleep is concerning or not? Learn about the signs of central sleep apnea and which medical conditions it is often associated with in pediatric patients in this episode.

This episode was written by pediatricians Tammy Yau, Lidia Park, and Jessica Ahn, with content support from Ambika Chidambaram (UCD pediatric pulmonology). 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

• Central sleep apnea (CSA) occurs when the brain’s central respiratory drive can’t send proper signals to the muscles that are part of breathing.
• CSA is diagnosed by a polysomnogram if there are apneic episodes that last 20 seconds or longer or if they are associated with oxygen desaturations, arousals, or heart rate changes (specific criteria in footnote).
• Central apneas are considered normal during certain stages of sleep (onset, during REM, after arousal), in premature infants less than 37 weeks corrected gestational age, and when ascending to altitudes greater than 3500 m above sea level.
• Common pediatric conditions associated with CSA include congenital central hypoventilation syndrome, achondroplasia, and Arnold-Chiari malformations.

Diagnostic Criteria for CSA

• Apneic episodes last 20 seconds or longer OR
• The apnea lasts at least the duration of two breaths during baseline breathing and is associated with an arousal or at least a 3% oxygen desaturation OR
• If the event occurs in an infant younger than 1 years old, it has to last at least the duration of two breaths during baseline breathing AND be associated with a decrease in heart rate to less than 50 beats per minute for at least 5 seconds OR less than 60 beats per minute for 15 seconds

Diagnostic Criteria for Periodic Breathing

• At least three episodes of central pauses lasting for at least 3 seconds interspersed by less than 20 seconds of normal breathing.

References

• Gipson K, Lu M, Kinane TB. Sleep-Disordered breathing in children. Pediatrics in Review. 2019;40(1):3-13. doi:10.1542/pir.2018-0142
• McLaren AT, Bin-Hasan S, Narang I. Diagnosis, management and pathophysiology of central sleep apnea in children. Paediatric Respiratory Reviews. 2018;30:49-57. doi:10.1016/j.prrv.2018.07.005
• Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Journal of Clinical Sleep Medicine. 2012;08(05):597-619. doi:10.5664/jcsm.2172
• Javaheri S, Dempsey JA. Central sleep apnea. Comprehensive Physiology. Published online December 10, 2012:141-163. doi:10.1002/cphy.c110057
• Selim BJ, Somers V, Caples SM. Central sleep apnea, hypoventilation syndrome, and sleep in high altitude. In: Springer eBooks. ; 2017:597-618. doi:10.1007/978-1-4939-6578-6_33
• Fauroux B, AlSayed M, Ben-Omran T, et al. Management of sleep-disordered breathing in achondroplasia: guiding principles of the European Achondroplasia Forum. Orphanet Journal of Rare Diseases. 2025;20(1). doi:10.1186/s13023-025-03717-0

Wondering how you describe the rash of measles, molluscum contagiosum, hand foot mouth, or chickenpox? Learn how in today’s episode!

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Aruna Venkatesan and Gabriel Molina (dermatologists at Santa Clara Valley Medical Center). 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:

• When describing a rash, include the basic morphology, size, color, location, distribution and configuration, and any secondary morphology
• When taking photos, try to have natural light and make sure the rash is in focus. If taking a close up photo, make sure to have a photo further away so that the location of the rash is clear.

Sources:

• Stanford Medicine: https://stanfordmedicine25.stanford.edu/the25/dermatology.html
• Allmon A, Deane K, Martin KL. Common skin rashes in children. American family physician. 2015 Aug 1;92(3):211-6.
• CDC Measles: https://www.cdc.gov/measles/data-research/index.html

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