The Challenging Realities of Rural Pediatrics

As a child, a nosebleed can be painful and embarrassing. Surprisingly, it’s also something primary care providers run into often in their practices. While the great majority of nosebleeds, also called epistaxis, are limited in severity and duration, about 6% of people who experience them will seek medical attention. Interventions range from self-treatment and home remedies to more intensive procedural options and medications. Why are we seeing so many cases of epistaxis in our offices? What is causing the onset of these nosebleeds, and are environmental changes a culprit? To explore the intricacies of epistaxis, we are joined by Jeremy Prager, MD. Dr. Prager specializes in otolaryngology at Children’s Hospital Colorado and is a Professor of Otolaryngology at the University of Colorado School of Medicine. Some highlights from this episode include:  How to differentiate between a nosebleed and a more severe epistaxis diagnosis.  The importance of partnership between the specialist and the primary care provider to properly care for a nosebleed.  The most common causes of a nose bleed  in children by age.  How to support patients when outpatient management isn’t working.  For more information on Children’s Colorado, visit: childrenscolorado.org. 

One of the great medical accomplishments of our time is the evolution of precision medicine. The ability to understand a patient’s unique genetic profile has become more accessible to our patients, and now, there are multiple mechanisms for using that information to overcome disease. One of the specialties leading the way in precision medicine is pediatric neurology. According to the World Health Organization, more than one in three people are affected by some type of neurological condition. They are a leading cause of ill health and disability worldwide. This subset of precision medicine will not only help us decrease those numbers but also allow us to treat some of these conditions in ways we have never done before. To detail this exciting work, we’re joined by two experts. Scott Demarest, MD, and Julie Parsons, MD, are both pediatric neurologists at Children’s Hospital Colorado and faculty at the University of Colorado School of Medicine. Dr. Demarest focuses on rare epilepsy conditions, and Dr. Parsons specializes in neuromuscular disease. Dr. Demarest is the Clinical Director of the Precision Medicine Institute at Children’s Colorado. Some highlights from this episode include:  Understanding precision neurology within the context of precision medicine  Why precision neurology positively impacts diagnosis and treatment options  How families are more easily accessing important genetic testing  The role primary care providers play with caring for these rare diseases  For more information on Children’s Colorado, visit: childrenscolorado.org.    

Many of us avoid talking about suicide, not only because it’s a difficult conversation, but also because we don’t know how to. And avoiding that conversation can be a barrier to helping those most at risk. One family from Colorado is at the forefront of changing the stigma and creating opportunities for fearless conversations. They courageously shared their story in a powerful documentary released earlier this year called “My Sister Liv.” In this special episode, we honor Liv Kunik’s life and learn about how her story is spurring hundreds of courageous discussions around suicide. The guests for this episode are family members at the heart and soul of the documentary, as well as mental health advocates. Honey Beuf is Liv’s mom, and she is the co-founder and Executive Director of The Liv Project. Tess Kunik is Liv’s sister and the co-founder of The Liv Project. Her voice also narrates the film, taking us through Liv’s story. Jessica Hawks, PhD, is the Clinical Director of the Pediatric Mental Health Institute at Children’s Hospital Colorado and a child and adolescent psychologist. She is also an Associate Professor at the University of Colorado School of Medicine. Some highlights from this episode include:  An overview of how the “My Sister Liv” documentary came together and the impact it’s having in the community   Ways for friends, family and providers to have “fearless conversations”  A discussion of how providers can best care for suicidal patients and their families, such as asking direct questions  A look at advocacy efforts underway and tools created to support courageous conversations  A youth suicide prevention resource from the American Academy of Pediatrics and the American Foundation for Suicide Prevention providers can use in their daily practice  Visit The Liv Project website to learn more about their work, how you can access the film and details about the game mentioned in the episode, The Game that Goes There. For more information on Children’s Colorado, visit: childrenscolorado.org.    

In the state of Colorado, cases of Neonatal Abstinence Syndrome (NAS) and Neonatal Opioid Withdrawal Syndrome (NOWS) increased by 120% from 2011 to 2016. Clinicians provide critical support to improve outcomes for these newborns, and there’s been impressive collaboration among healthcare providers around this issue. Two important examples are the Colorado Hospitals Substance Exposed Newborn Quality Improvement Collaborative, otherwise known as CHoSEN QIC, and Kids in Care Setting Clinic (KICKS). In this episode, we learn about these initiatives and how they benefit hospitals like Children’s Hospital Colorado to provide the best care for our patients. Joining us for this discussion are two experts. Bird Gilmartin, MD, is the Medical Director for Kids in Care Settings Clinic (KICS) at Children’s Colorado, as well as an associate professor of clinical pediatrics at the University of Colorado School of Medicine. Sunah (Susan) Hwang, MD, specializes in neonatal and perinatal medicine at Children’s Colorado and is an associate professor of pediatric neonatology at the University of Colorado School of Medicine. This episode looks at:  The epidemic of perinatal opioid use, as well as illicit and legally prescribed substance abuse  Suggestions on shifting your perspective as a provider about families with substance use issues  The ways these substance abuse programs intertwine with our legal system   Some resources our experts recommend utilizing are the Colorado Perinatal Care Quality Collaborative (CPCQC), Illuminate, and Tough as a Mother.  For more information on Children’s Colorado, visit: childrenscolorado.org. 

Despite the pervasiveness of child trafficking in the United States, many communities aren’t aware of the scope of the issue. Here in Colorado, the University of Colorado’s Kempe Center is recognized as a leader in the fight against child abuse, and they are important voices in the global conversation around identifying and ending child trafficking. By committing to responding, treating and preventing all forms of child abuse and neglect, medical professionals can make a difference in this crucial effort. To shed light on these realities and provide insight into how we can all play a part, we are joined by Denise Abdoo, PhD, CPNP., who specializes in child abuse neglect at Children’s Hospital Colorado. She is an associate professor of pediatrics at the University of Colorado School of Medicine, as well as a member of the Kempe Center’s facility.    Some highlights from this episode include:  The current state of child trafficking nationally and globally  The work the Kempe Center is doing to help combat child abuse  The reasons why child trafficking is under reported  Ways the medical community can provide both physical and mental health care  For more information on Children’s Colorado, visit: childrenscolorado.org. 

With kids back in school, pediatric viral illnesses are revving their engines. It seems we have returned to normal seasonality for viral disease after the coronavirus pandemic. Top of mind with the arrival of fall is respiratory syncytial virus (RSV). We know how quickly the onset of RSV season can take over our waiting rooms.   Last year, two important developments occurred that could change the course of RSV prevention: the FDA approval of a maternal vaccine and a monoclonal antibody for infants. Far too few mothers and infants benefitted from these treatments during last year’s respiratory season, but now we’ve had a year to prepare to do better. Joining us to discuss this hot topic are two expert pediatricians. Sean O’Leary, MD, is an Infectious Disease Physician at Children’s Hospital Colorado, a Professor of Pediatrics at the University of Colorado School of Medicine and is the chair of the American Academy of Pediatrics Committee on Infectious Diseases, also known as the Red Book Committee. Matt Dorighi, MD, specializes in pediatrics at Cherry Creek Pediatrics. He is currently chair of the Pediatric Care Network, the largest clinically integrated network for children in the state of Colorado.   Some highlights from this episode include:  Guidelines for Nirsevimab and the maternal vaccine  Why availability will not be a barrier this respiratory season  How practices can combat vaccine hesitancy  For more information on Children’s Colorado, visit: childrenscolorado.org. 

Children with autism spectrum disorder (ASD) tend to have more medical complications than the average kid. Among the most common challenges are gastrointestinal (GI) disorders like abdominal pain, constipation and diarrhea. Untreated GI distress in kids with ASD has been linked to many other issues, including sleep, behavioral and psychiatric disorders. Many of these same kids also have selective eating, which impacts their intake of necessary nutrients. Due to these many layers of complexity, it can be challenging to know how to help a child with ASD and GI symptoms.    To understand this intricate issue, we are joined by Christine Waasdorp Hurtado, MD, who specializes in gastroenterology at Children’s Hospital Colorado. She is the Southern Colorado Executive Faculty Director of the Department of Pediatrics, as well as a Professor of Pediatrics for the University of Colorado School of Medicine.  Some highlights from this episode include:  The most common GI issues in kids with ASD  How primary care providers can best treat these kids  How certain treatment outcomes can improve quality of life  For more information on Children’s Colorado, visit: childrenscolorado.org. 

Sharing data transparently, whether at a local or a national level, is a foundational contributor to healthcare quality. Atul Gawande wrote about this in his 2004 essay labeled ‘The Bell Curve’. Over the last several decades, we have seen many pediatric specialties organize and collaborate around data collection at a national scale to improve care. We’ve seen firsthand how our hospital’s participation in a national cardiac critical care registry has driven quality improvement, better measurable outcomes and improved cardiac arrest rates for patients. Getting the data collection right is the first challenge. In between that first step and actually seeing improvements is a tremendous amount of work. In this episode, we explore the value of data sharing and transparency to improve outcomes for kids. Our experts for this episode are Carly Scahill, DO, and Kelly O’Neil. Dr. Scahill specializes in pediatric cardiology as a pediatric cardiac intensivist. She is also the Fellowship Director for pediatric cardiology and the cardiac intensive care unit (CICU), as well as an associate professor of pediatrics at the University of Colorado School of Medicine. Kelly O’Neil is a registered nurse and the Manager of the Heart Institute Data Registries and Outcomes. Before her current role, she was a CICU nurse for over ten years. Some highlights from this episode include:  The purpose and use of clinical registries  How data collection improves measurable outcomes  The future of data collection in healthcare  How to get more entities involved  For more information on Children’s Colorado, visit: childrenscolorado.org.    

Over the last few decades, the roles of nurse practitioners (NPs) and physician assistants (PAs), also known as advanced practice providers (APPs), have greatly expanded to touch even more patient-family lives. They are an essential part of the care we provide, and their roles have evolved over time. In this episode, we explore the crucial part they play in our medical system and how that might continue to evolve in the future. For this episode, we are joined by two University of Colorado leaders who continue to help keep our APP programs among the top ranked in the country. Jonathan Bowser is the Child Health Associate and Physician Assistant Program Director at the University of Colorado School of Medicine. He is also the Associate Dean of Physician Assistant Studies, the Section Head of Pediatrics, and an associate professor. Jill Marks, NP, is the Specialty Director of the Acute Care Pediatric Nurse Practitioner Program at the University of Colorado College of Nursing. She is also an inpatient nurse practitioner for the section of pediatric neurology at the University of Colorado School of Medicine. Some highlights from this episode include:  Background on the creation of NPs and PAs  The ways these roles have changed over time  The impact APPs make on patient care  The role APPs will play in healthcare in the future  For more information on Children’s Colorado, visit: childrenscolorado.org.    

Our medical community is committed to providing excellent patient care, and it’s also our duty for that care to extend to our planet. Climate change is an increasingly important global health issue where children are the most vulnerable to adverse health outcomes. One major contributing factor to climate change in medicine is the use of nitrous oxide in spaces like the operating room and outpatient clinics. Efforts are underway in hospitals across the country to decrease our environmental impact, including at Children’s Hospital Colorado. To explore the exciting new project happening at Children’s Colorado and to discuss the environmental impacts on a global scale, we are joined by two experts. Tom Majcher, DO, is the Chief of Anesthesiology at Children’s Colorado, as well as a professor of pediatrics and clinical practice for anesthesiology at the University of Colorado School of Medicine. Diane Gordon, MD, specializes in anesthesiology at Children’s Colorado and is an associate professor of pediatric anesthesiology at the University of Colorado School of Medicine. Some highlights from this episode include:  How nitrous oxide is currently used in medical settings  The damage it does on the environment  What efforts are underway to reduce its impact  How to keep the same standard of care with new alternatives  The importance of this transition in the operating room  For more information on Children’s Colorado, visit: childrenscolorado.org.