You’ve probably seen an infantile hemangiomas before but did you they can be associated with PHACE or LUMBAR syndrome? Learn about this and everything else about infantile hemangiomas in this week’s episode.

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Caitlin Peterman (pediatric dermatology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

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Key Points:

• Infantile hemangioma which are the most common benign tumor of infancy. Most will involute on their own after 4 months of age and self-resolve
• Hemangiomas can affect nearby organs causing vision impairment, feeding difficulties, or airway compromise. Other complications include ulceration and disfigurement
• First line treatment includes oral propranolol for thicker lesions and topical timolol for superficial/thin lesions. Surgery or laser is reserved for select hemangiomas

Sources

AAP Jan 2019: https://publications.aap.org/pediatrics/article/143/1/e20183475/37268/Clinical-Practice-Guideline-for-the-Management-of?searchresult=1

Ebstein's anomaly is a congenital heart defect that involves an abnormally developed tricuspid valve. Learn more about its effects on the heart physiology in today's episode.

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Daniel Cortez (pediatric cardiology). 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:

• Ebstein's anomaly is characterized by an abnormally placed tricuspid valve causing atrialization of the right ventricle. This can lead to single ventricle physiology.
• Wolff-Parkinson-White (WPW), right bundle branch blocks (RBBB), mitral valve prolapse, mitral valve dysplasia, bicuspid aortic valve, ventricular septal defect, and coarctation of the aorta can all be associated with Ebstein's anomaly
• Treatment of Ebstein's anomaly requires a patient to be stable enough to tolerate surgical correction like aortopulmonary shunting, PDA stenting, tricuspid valvuloplasty, and/or single ventricle palliation. Some patients will require inhaled nitrous oxide, Prostaglandin E, antiarrhythmics, and/or ECMO as well

Sources:

• Truong et al. “Ebstein Anomaly in the Fetus: Preparing for the Perfect Storm”.
• Neoreviews (2011) 12 (5): e260–e269. https://doi.org/10.1542/neo.12-5-e260

If you've been getting a lot more questions about hepatitis B and vaccination from your patients and families and wondering where to find the answers, look no further than our episode today filled with useful information from evidence based sources.

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 pediagogypod@gmail.com

Key Points:

• As of the time of this podcast publishing, the American Academy of Pediatrics still recommends Hepatitis B vaccination at birth, 1-2 months, and 6-18 months.
• Hepatitis B vaccination introduction decreased the lifetime prevalence of hepatitis B from 33% to 5% between 1988-2004.
• 4 in every 1000 people with hepatitis B will go on to develop chronic hepatitis B which can lead to liver failure or hepatocellular carcinoma.
• Hepatitis B has an average incubation of 90 days meaning you might not have symptoms for the first few months of infection. 20-30% of people with hepatitis B do not have a clear source of infection which is why prevention is crucial

Sources:

• “Hepatitis B in Children”. Pediatr Rev (2008) 29 (4): 111–120.
• https://doi.org/10.1542/pir.29-4-111
• “Hepatitis B” Red Book chapter
• https://www.aap.org/en/patient-care/immunizations/vaccination-recommendations-by-
• the-aap/

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”

Sometimes kids are FOS - full of stool! In today's episode, we talk about how to diagnose and treat functional constipation which is a common cause of abdominal pain in pediatrics and can be a pain in the butt, literally!

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Kelly Haas (pediatric gastroenterology). 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:

• Functional constipation is constipation not due to any other underlying conditions such as Hirschsprungs, spinal cord dysphraphism, or other disease.
• Functional constipation is defined as having at least 1 month of symptoms in kids younger than 4 years old (or) symptoms at least once per week for at least 2 months in kids older than 4 years old who do not meet IBS criteria. Symptoms include 2 or fewer stools per week, at least 1 episode of incontinence per week after toilet training is established, a history of excessive stool retention/retentive posturing/excessive volitional stool retention, a history of hard or painful bowel movements, the presence of large fecal mass in rectum, or a history of large diameter stools that may obstruct the toilet
• Encopresis is liquid stool that goes around large stool balls and is indicative of constipation rather than diarrhea
• Polyethylene glycol (PEG, miralax), lactulose, and enemas are all good treatment options for constipation

Sources:

• Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. Tabbers MM, et al. J Pediatr Gastroenterol Nutr. 2014;58(2):258-274. doi:10.1097/MPG.0000000000000266
• Constipation. Neal S. LeLeiko, et al. Pediatr Rev (2020) 41 (8): 379–392. https://doi.org/10.1542/pir.2018-033

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