Strep Throat

Yuck! Did someone say kissing bug? Ok we don't mean an actual insect but we are going to talk about mononucleosis or Epstein Barr virus (EBV) and explain where the term "kissing bug" came from.This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Dean Blumberg (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 [email protected] points:EBV is human herpesvirus 4 affecting B-cells and spreads through saliva or blood transfusions. About 90% of US adults are infected with it!Symptoms of EBV are typical mild upper respiratory symptoms including fever, cough, rhinorrhea, and sore throat that can look like palatal petechiae and tonsillar exudate on exam. EBV can appear similar to strep which is why testing is important to differentiateBecause EBV is a virus, treatment is usually supportive but severe disease or immunocompromised patients may be given antivirals, immunomodulators, and/or steroidsSourcesRed Book Epstein-Barr Virus Infections (Infectious Mononucleosis)“Epstein-Barr Virus”. Pediatr Rev (2011) 32 (9): 375–384. https://doi.org/10.1542/pir.32-9-375“Cytomegalovirus and Epstein-Barr Virus Infections”. Pediatr Rev (2016) 37 (6):223–234. https://doi.org/10.1542/pir.2015-0072Luzuriaga K, Sullivan JL. Infectious mononucleosis. N Engl J Med. 2010;362(21):1993-2000. doi:10.1056/NEJMcp1001116

Sore throats can be one of the most difficult symptoms to deal with you have a cold. But what if it's not just from a virus and it's group A strep instead? Learn about this common bacterial throat infection in our episode today!This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Dean Blumberg (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 [email protected] points:Group A streptococcal (GAS) pharyngitis (commonly referred to as "strep throat") is a bacterial infection of the tonsils and pharynx.Scarlet fever refers to GAS infection causing a sandpaper like rash on the body due to exotoxins.Diagnose with a throat swab (rapid antigen, culture, and/or PCR or NAAAT) and treat with penicillin or amoxicillin for a full 10 day course. Use Keflex or clindamycin for those with penicillin allergySources“Group A Streptococcal Infections”. Red Book. https://doi.org/10.1542/9781610027373-S3_018_010“Dr. William Douglas' Description of Scarlet Fever in 1736—An American Medical Classic” Pediatrics (1978) 61 (6): 888. https://doi.org/10.1542/peds.61.6.888“Blindness in Walnut Grove: How did Mary Ingalls Lose her Sight?” Pediatrics (2013) 131 (3): 404–406. https://doi.org/10.1542/peds.2012-1438

Cute baby movements or is it infantile spasms in disguise? Learn what to look out for in today's episode!This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Joanna Galindo (pediatric neurology). 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 [email protected] points:Infantile spasms are characterized by flexion of the trunk or neck and adduction or abduction of the arms, usually bilateral and symmetric in clusters and occuring in babies less than 1 years oldHypsarrhythmia on EEG is classic for infantile spasms and can help differentiate it from benign spasms of infancy or myoclonic epilepsy of infancyTreatment is with ACTH or high dose steroids and/or vigabatrin.Sources:Pavone P, Polizzi A, Marino SD, et al. West syndrome: a comprehensive review. Neurol Sci. 2020;41(12):3547-3562. doi:10.1007/s10072-020-04600-5Go CY, Mackay MT, Weiss SK, et al. Evidence-based guideline update: medical treatment of infantile spasms [RETIRED]. Report of the Guideline Development Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2012;78(24):1974-1980. doi:10.1212/WNL.0b013e318259e2cfRiikonen R. Biochemical mechanisms in pathogenesis of infantile epileptic spasm syndrome. Seizure. 2023;105:1-9. doi:10.1016/j.seizure.2023.01.004

What happens when kids bite off more than they can chew? Today we discuss pediatric foreign body ingestion, specifically focusing on button batteries. This episode was written by pediatric resident Mariama Lei Poquiz and pediatricians Lidia Park and Tammy Yau, with content support from pediatric gastroenterologist Dean Libet. 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 [email protected] Key Points: Children of all ages are at risk for foreign body ingestion, with children ages 6-36 months at the most risk due to their developmental stage. Other vulnerable populations include children and adolescents with behavioral, developmental, and psychiatric conditions. About 98% of all foreign body ingestions in children are found to be both accidental and composed of common items found in the home, including magnets, batteries, coins, toys, jewelry. Button batteries in the esophagus are an emergency and should be endoscopically removed within 2 hours of ingestion. It is important to assess for esophageal injury and aortic involvement because esophageal associated injuries are common and aortoenteric fistulas have a high mortality rate.  Button batteries distal to the esophagus can be managed depending on the child’s age and battery size in conjunction with the clinician’s clinical decision-making skills. If a button battery has not passed the stomach within 14 days of ingestion or if a child develops GI symptoms, the battery must be removed endoscopically. For more information regarding button battery safety, please visit the National Safety Council’s page on button batteries and the US Consumer Product Safety Commission’s page on button, cell, and coin batteries. For button battery ingestion, please call 911 and for immediate triage questions please call the National Battery Ingestion Hotline at 1-800-498-8666.  References Anfang RR, Jatana KR, Linn RL, Rhoades K, Fry J, Jacobs IN. pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. Laryngoscope. 2019;129(1):49-57. doi:10.1002/lary.27312Clinker C, Alvey B, Reynolds E, Wieck M. Post-extraction management of esophageal button battery injuries in children: A scoping review of imaging, ICU admission, and NPO practices. Journal of Pediatric Surgery. 2026;61(7):163066. doi:10.1016/j.jpedsurg.2026.163066Dana E. Stone, Bryan C. Lembo; Foreign Body Ingestion and Aspiration. Pediatr Rev June 2026; 47 (6): 352–355. https://doi.org/10.1542/pir.2025-006817 Foreign Body Ingestion Algorithms: Button Battery, Coin/Blunt Objects, Magnet, Sharp Objects, Esophageal Food Impaction.Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr. 2015;60(4):562-574. doi:10.1097/MPG.0000000000000729 Leinwand K, Brumbaugh DE, Kramer RE. Button Battery Ingestion in Children: A Paradigm for Management of Severe Pediatric Foreign Body Ingestions. Gastrointest Endosc Clin N Am. 2016;26(1):99-118. doi:10.1016/j.giec.2015.08.003 Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging battery-ingestion hazard: clinical implications. Pediatrics. 2010;125(6):1168-1177. doi:10.1542/peds.2009-3037 McMahon K, Conners GP, Mohseni M. Pediatric Foreign Body Ingestion. [Updated 2025 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430915/ National Capital Poison Center’s Button Battery Ingestion triage and treatment guideline | poison control. National Capital Poison Center. 2018. Accessed July 22, 2026. https://www.poison.org/battery/guideline.Sutherland J, Bowen L. Ingestion of foreign bodies and caustic substances in children. BJA Educ. 2023;23(1):2-7. doi:10.1016/j.bjae.2022.09.003

Today we discuss pediatric fractures in the emergency department.  We focus on how to identify fractures that may be indicative of child abuse versus those caused by accidental trauma or other medical conditions.This episode was written by UCD pediatric resident Mariama Lei Poquiz, with content support from pediatric emergency medicine and child abuse specialist Julia Magaña and additional help and guidance from pediatric hospitalist Lidia Park. 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 [email protected] points:·       Pediatric fractures may be the cause of accidental, medical, or non-accidental causes. Evaluation of pediatric fractures caused by non-accidental trauma can be done by taking a thorough history, a meticulous physical exam, and clinical judgement supplemented by imaging and laboratory data.  ·       While there are no pathognomonic fractures indicative of child abuse, there are high risk features that increase the suspicion for child abuse. Additionally, there are fractures with higher specificity for child abuse than others. These high specificity fractures include those in the ribs, pelvis, scapula, sternum, classic metaphyseal lesions, and long bones in non-ambulatory children.  ·       Toddler’s fractures are accidental fractures that may mimic child abuse.  ·       The radiographic skeletal survey is the standard screening tool for evaluating children under 2 years old who are suspected of being abused. It is important to also do a follow up skeletal survey approximately 2 weeks after the initial one if the first skeletal survey was positive, equivocal, or negative, but with persistent clinical suspicion. These specific findings can be found in the American College of Radiology guidelines. Other work-up can include head imaging and laboratory studies.    Sources:   Auerbach, M., Coombs, C., Lindberg, D., Magaña, J., Ornstein, A., Sharma, S., & Tiyyagura, G. (2023, October). Bottom Line Recommendations: Child Abuse. Emergency Medical Services for Children Innovation and Improvement Center and Translating Emergency Medicine for Kids.   Cindy W. Christian, COMMITTEE ON CHILD ABUSE AND NEGLECT, James E. Crawford-Jakubiak, Emalee G. Flaherty, John M. Leventhal, James L. Lukefahr, Robert D. Sege, Harriet MacMillan, Catherine M. Nolan, Linda Anne Valley, Tammy Piazza Hurley; The Evaluation of Suspected Child Physical Abuse. Pediatrics May 2015; 135 (5): e1337–e1354. 10.1542/peds.2015-0356  Cohen H, Miller S, Levin T, et al. ACR–SPR Practice Parameter for the Performance and Interpretation of Skeletal Surveys in Children. Amended 2023 (Resolution 2c, 2d)  Sait S, Havariyoun G, Newman H, Das S, Haque S. Effective radiation dose of skeletal surveys performed for suspected physical abuse. Pediatr Radiol. 2023 Jan;53(1):69-77. doi: 10.1007/s00247-022-05477-6. Epub 2022 Aug 17. PMID: 35974201.   Suzanne Haney, Susan Scherl, Linda DiMeglio, Jeannette Perez-Rossello, Sabah Servaes, Nadia Merchant, and the COUNCIL ON CHILD ABUSE AND NEGLECT, SECTION ON ORTHOPAEDICS, SECTION ON RADIOLOGY, and SECTION ON ENDOCRINOLOGY, and the SOCIETY FOR PEDIATRIC RADIOLOGY; Evaluating Young Children With Fractures for Child Abuse: Clinical Report. Pediatrics February 2025; 155 (2): e2024070074. 10.1542/peds.2024-070074  Tibial shaft fractures - pediatric. Orthobullets. Accessed June 12, 2026. https://www.orthobullets.com/pediatrics/4026/tibial-shaft-fractures--pediatric.  Toddler fracture | Radiology Reference Article. Radiopaedia. Accessed June 12, 2026. https://radiopaedia.org/articles/toddler-fracture?lang=us.  Translating Emergency Knowledge for Kids. (2021, March). Bottom Line Recommendations Pediatric Fractures. 

When do we use inflammatory markers? What do they tell us? Learn how these lab values make a difference in your clinical decision making!This episode was written by pediatricians Lidia Park and Tammy Yau as well as pediatrics resident Anjali Doshi, with content support from Natasha Nakra, pediatric infectious disease physician. 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 [email protected] Points: ESR is a marker of inflammation anywhere in the body. It is non-specific and doesn’t always indicate infection. CRP is an acute phase reactant that can be useful in inflammation or infection, but is also non-specific. This can be useful in trending if an infectious process or inflammation is improving.Recent studies now show that procalcitonin is a non-specific marker for bacterial infections and more clinicians are leaning away from using this marker.It is important before ordering these markers to assess which is needed and if a normal or elevated level will change your clinical plan before ordering unnecessary tests.References:Pihl AF, Balamuth F, Michelson KA. Inflammatory markers in pediatrics. Pediatr Rev. 2025;46(4):231-245. doi:10.1542/pir.2023-006920Bell SG, Goldman RD. Pediatric Sepsis. In: StatPearls. StatPearls Publishing; updated January 2025. Accessed June 27, 2026. https://www.ncbi.nlm.nih.gov/books/NBK557485/Shah S, Bachur R. Pediatric Dehydration. In: StatPearls. StatPearls Publishing; updated 2025. Accessed June 27, 2026. https://www.ncbi.nlm.nih.gov/books/NBK441843/Shane AL, Sánchez PJ, Stoll BJ. Neonatal Sepsis. In: StatPearls. StatPearls Publishing; updated 2025. Accessed June 27, 2026. https://www.ncbi.nlm.nih.gov/books/NBK539794/Yo CH, Hsieh PS, Lee SH, et al. Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source: a systematic review and meta-analysis. Ann Emerg Med. 2012;60(5):591-600. https://pmc.ncbi.nlm.nih.gov/articles/PMC7640940/Woods CR, et al. Clinical practice guideline for the evaluation and management of well-appearing febrile infants 8 to 60 days of age. Clin Infect Dis. 2020;70(3):538-543. doi:10.1093/cid/ciz635Stockmann C, Ampofo K, Killpack J, et al. Procalcitonin accurately identifies hospitalized children with low risk of bacterial community-acquired pneumonia. J Pediatric Infect Dis Soc. 2018;7(1):46-53. doi:10.1093/jpids/pix018

You've heard of ACEs and ABCs, but what about DEF? Here we learn about trauma-informed care.This episode was written by pediatric resident Mallika Iyer-Horiuchi with content support from pediatricians Tammy Yau, Lidia Park, and Jihey Park (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 [email protected] PointsTrauma informed care improves patient interactions and outcomes. Remember the mnemonic DEF which stands for treat Distress, support Emotions, include the Family.”Pain, fear, and uncertainty can amplify trauma responses—treating distress quickly improves both cooperation and recovery.Clear explanations, caregiver presence, and simple coping strategies can significantly reduce pediatric medical traumatic stress.Caregivers’ stress affects the child’s recovery—supporting the family supports the patient.Sources:James Duffee, Moira Szilagyi, Heather Forkey, Erin T. Kelly; COUNCIL ON COMMUNITY PEDIATRICS, COUNCIL ON FOSTER CARE, ADOPTION, AND KINSHIP CARE, COUNCIL ON CHILD ABUSE AND NEGLECT, COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, Trauma-Informed Care in Child Health Systems. Pediatrics August 2021; 148 (2): e2021052579. 10.1542/peds.2021-052579https://www.healthcaretoolbox.org/d-e-f-framework-trauma-informed-carehttps://www.healthcaretoolbox.org/sites/default/files/images/pdf/DEFpocketcards.pdf  https://www.nctsn.org/

Learn all about non-barrier contraceptives including intrauterine devices, implants, injectables, pills, vaginal rings, and transdermal patches.This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Adrienne Hong (family 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 [email protected] points:Intrauterine devices and implants are the most effective contraceptives at preventing pregnancyNon-barrier contraceptives do not protect against sexually transmitted infectionsCombined progestin-estrogen contraceptives are contraindicated in those with migraines, severe hypertension, severe liver disease, sickle cell disease, lupus, history of thromboembolism or stroke, and other diseases that increase the risk for thrombosisEmergency contraception includes oral ulipristal, oral levonorgestrel, and IUDs and should be taken with 72-120 hours after unprotected sexual intercourse. Only oral levonorgestrel is available without a prescription. Source:Pediatrics July 2025: https://publications.aap.org/pediatrics/article/156/1/e2025072218/202151/Contraceptive-Counseling-and-Methods-forPediatrics August 2020: https://publications.aap.org/pediatrics/article/146/2/e2020007252/36888/Long-Acting-Reversible-Contraception-Specific?autologincheck=redirected Pediatrics August 2020: http://doi.org/10.1542/peds.2020-007237 ACOG 2025: https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2015/09/emergency-contraception 

Having “the talk” with your teenage patients? Learn how to navigate discussing sexual intercourse and contraception in this 2 part episode. This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Adrienne Hong (family 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 [email protected] points:Maintain an open dialogue with patients when discussing sexual history. Include the 5 P’s - partners, practices, protection from STIs, past history of STIs, and pregnancy intention. Barrier contraceptives include external condoms, internal condoms, latex sheets or dental dams, diaphragms, cervical caps, sponges, spermicides, and vaginal pH modulators. Condoms can protect against sexually transmitted infections (STIs) and pregnancy while diaphragms, cervical caps, sponges, spermicides, and vaginal pH modulators protect against pregnancy only and not STIsSource:Pediatrics July 2025: https://publications.aap.org/pediatrics/article/156/1/e2025072218/202151/Contraceptive-Counseling-and-Methods-forPediatrics August 2020: https://publications.aap.org/pediatrics/article/146/2/e2020007252/36888/Long-Acting-Reversible-Contraception-Specific?autologincheck=redirected Pediatrics August 2020: http://doi.org/10.1542/peds.2020-007237 ACOG: Barrier Methods of Birth Control: Spermicide, Condom, Diaphragm, and Cervical Cap | ACOG

In this episode we learn how to recognize concerning bruising using the TEN-4-FACESp rule. TEN-4-FACESp is an important rule that teaches us to recognize abnormal bruising and is a clinical tool that helps us decide whether further investigation for child abuse is warranted. This episode was written by pediatric resident Megan Branson, and pediatricians Tammy Yau and Lidia Park with content support from Julia Magana, a pediatric emergency medicine physician and child abuse specialist. 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 [email protected] Points:The TEN-4-FACESp rule highlights high-risk bruising: torso, ears, neck, any bruise in infants ≤4 months, and facial areas (frenulum, angle of jaw, cheeks, eyelids, subconjunctivae), plus patterned bruising Evaluation should include a thorough, neutral history, full skin exam, and consideration of medical causes (e.g., ITP, bleeding disorders), while remembering this is a screening tool—not diagnostic of abuse.This tool can help learners understand more about child abuse and develop their skills for recognizing it in their patients:https://emscimprovement.center/news/introducing-peak-child-abuse-a-free-educational-toolkit/