The Peds NP: Pearls of Pediatric Evidence-Based Practice

Practical Prescribing for Acetaminophen and Ibuprofen (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.

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

Discharge Education for Acute Gastroenteritis (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.  

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.

Picky Eating in Primary Care (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. 

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

When Derm Met Allergy (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.  

The Newborn Exam (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.

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.

2021 AAP Guidelines on Febrile Infants (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

 

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

Human Trafficking (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.

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

Anaphylaxis with Mansi Kotwal, MD (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.  

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.

CNS Infections (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.

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

Pediatric GI with John Lyles, MD (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.