Uvula deviation, sore throat, fever? Learn all about peritonsillar abscesses in this episode!

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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Dean Blumberg (UC Davis pediatric infectious disease). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• Peritonsillar abscess (PTA) is a suppurative infection of the tissue between the palatine tonsil capsule and the pharyngeal muscles
• Symptoms include fever, sore throat, uvular deviation, trismus, voice changes, drooling, unilateral tonsillar swelling with deviation of the uvula to the contralateral side
• Diagnosis can be clinical but imaging is often obtained
• Treat with antibiotics (empiric amoxicillin, cephalosporin, or clindamycin but adjust based on cultures) and incision and drainage

Sources:

• A Clinical Approach to Tonsillitis, Tonsillar Hypertrophy, and Peritonsillar and Retropharyngeal Abscesses. R Bochner, et al. Pediatrics in Review (2017) 38 (2): 81–92. https://doi.org/10.1542/pir.2016-0072

Marijuana, cannabis, THC, and CBD are among the many common words and forms of cannabis that pediatric patients are being exposed to in our current day and age. Keep up to date about the official AAP policy and recommendations with today's episode.

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This episode was written by pediatricians Tammy Yau and Lidia Park. Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• At the time of this episode release, marijuana is considered a schedule I drug at the federal level meaning here is high potential for abuse, no medical use, and/or lack of safety with using this drug. The official AAP stance is to avoid cannabinoid use in most children. More studies need to be done to determine the long term effects.
• Cannabis plants generally have both THC and CBD which are types of cannabinoids. THC can cause intoxication, analgesia, and antiemesis. CBD is less intoxicating and anxiolytic.
• Cannabis intoxication can cause tachycardia, hypertension, red eyes, dry mouth, orthostatic hypotension, increased appetite and thirst, drowsiness, insomnia, anxiety, short term memory loss, ataxia, stroke, nystagmus, hypothermia, hypotonia, and rarely respiratory depression. Treatment is supportive.
• THC can be detected in breastmilk. There is not enough information about long term safety and implications of THC exposure in utero or while breastfeeding.
• In children, epidiolex is the only plant derived cannabinoid FDA approved for use of severe seizures in children.

Sources:

• Ammerman S, et al. The impact of marijuana policies on youth: clinical, research, and legal update. Pediatrics. 2015 Mar 1;135(3):e769-85. doi: 10.1542/peds.2014-4146
• Hale’s Medications & Mothers’ Milk 2023: A Manual of Lactational Pharmacology
• Fischedick J, Van Der Kooy F, Verpoorte R. Cannabinoid receptor 1 binding activity and quantitative analysis of Cannabis sativa L. smoke and vapor. Chem Pharm Bull (Tokyo). 2010;58(2):201-207. doi:10.1248/cpb.58.201

Don't miss this cause of anemia in your differential in today’s episode about autoimmune hemolytic anemia!

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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Anjali Pawar (UC Davis pediatric hematology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• Autoimmune hemolytic anemia is an extravascular hemolysis
• Symptoms can include pallor, fatigue, lightheadedness, jaundice, tachycardia, acrocyanosis, dark urine, splenomegaly, and gallstones with labs showing anemia with schistocytes, reticulocytosis, hyperbilirubinemia, elevated LDH, elevated AST, and positive Coombs testing.
• AIHA can be triggered by infections, underlying autoimmune diseases, malignancy, immunosuppression, and medications.
• Treatment is steroids or rituximab for warm AIHA and avoiding the cold for cold AIHA. In refractory cases, splenectomy or stem cell transplant may be needed. Transfusions are generally not recommended due to ongoing hemolysis unless anemia is severe.

Sources:

• Voulgaridou A, Kalfa TA. Autoimmune Hemolytic Anemia in the Pediatric Setting. J Clin Med. 2021;10(2):216. Published 2021 Jan 9. doi:10.3390/jcm10020216
• Noronha, Suzie A. "Acquired and congenital hemolytic anemia." Pediatrics in Review 37.6 (2016): 235-246. doi: 10.1542/pir.2015-0053

Plan ahead for the flu season with our episode today where we talk about how to treat the common flu, also known as influenza.

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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Dean Blumberg (UC Davis pediatric infectious disease). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• The influenza vaccine is important every flu season!
• Anti-viral neuraminidase inhibitors like oseltamivir/Tamiflu (oral), zanamavir (inhaled), and peramavir (IV) prevent the flu virus from fusing with infected cell membranes preventing the release of the virus
• Baloxivir is a endonuclease inhibitor that inhibits mRNA synthesis that can be given as a one time dose to treat influenza infections.
• Otitis media, PNA, retropharyngeal abscesses, Pott puffy tumors, empyema, meningitis, encephalitis, GBS, acute cerebella ataxia, transverse myelitis, myositis, pericarditis, and myocarditis are all serious complications that can occur with influenza infections

Sources:

• O’Leary ST, et al. Recommendations for Prevention and Control of Influenza in Children, 2024–2025: Technical Report. Pediatrics. 2024 Oct 1;154(4). doi: 10.1542/peds.2024-068508
• AAP Red Book, 2023. doi:10.1542/9781610025782-S3_068
• Moscona, A. Neuraminidase Inhibitors for Influenza. N Engl J Med 2005;353:1363-1373. 2025 Sept 9. doi: 10.1056/NEJMra05074

Have you ever wondered if your patient's snoring is concerning or not? Learn about how we screen for obstructive sleep apnea in pediatric patients in this episode.

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This episode was written by pediatricians Lidia Park, Tammy Yau, and Jessica Ahn with content support from Ambika Chidambaram (UCD pediatric pulmonology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points

• Obstructive sleep apnea (OSA) occurs when there is either complete or partial narrowing of the upper airway during sleep that causes an awakening from sleep and/or results in at least 3% drop in oxygen saturation and lasts 2 breath lengths.
• Symptoms of OSA can include episodes of apnea, gasping, choking, frequent awakenings, sleep enuresis, attention difficulties, behavioral problems, daytime sleepiness.
• On physical exam, watch out for enlarged tonsils and/or adenoids, micrognathia, retrognathia, or hypotonia.
• Untreated OSA is an independent comorbid factor for many conditions such as failure to thrive, obesity, and cardiovascular diseases like insulin resistance, fatty liver disease, and hypertension.
• Disorders associated with OSA include Down syndrome, Duchenne Muscular Dystrophy, Prader Willi, achondroplasia, hypothyroidism, and acromegaly.
• The gold standard for diagnosis of OSA is polysomnography and is based off of AHI scores: 1-5 is mild, 6-10 is moderate, and 11 or greater is severe.
• First line treatment for most children is adenotonsillectomy. If this fails, second line treatment is CPAP or BiPAP.

References

• Krishna J, Kalra M, McQuillan ME. Sleep disorders in childhood. Pediatrics in Review. 2023;44(4):189-202. doi:10.1542/pir.2022-005521
• American Academy of Sleep Medicine. Obstructive Sleep Apnea.; 2008. https://aasm.org/resources/factsheets/sleepapnea.pdf. Accessed October 29, 2024.
• Benedek P, Balakrishnan K, Cunningham MJ, et al. International Pediatric Otolaryngology group (IPOG) consensus on the diagnosis and management of pediatric obstructive sleep apnea (OSA). International Journal of Pediatric Otorhinolaryngology. 2020;138:110276. doi:10.1016/j.ijporl.2020.110276
• Basha S, Bialowas C, Ende K, Szeremeta W. Effectiveness of adenotonsillectomy in the resolution of nocturnal enuresis secondary to obstructive sleep apnea. The Laryngoscope. 2005;115(6):1101-1103. doi:10.1097/01.mlg.0000163762.13870.83

Join us for part 2 of our 2 part series on sickle cell disease. In this episode, we’ll go over the acute complications related to sickle cell disease and their management.

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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Anjali Pawar (UC Davis pediatric hematology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• Consider acute chest syndrome in a patient with cough, fever, hypoxemia, and new infiltrate on CXR
• Acute pain episodes should be treated with IV hydration, oxygen as needed, and adequate pain management.
• Chronic complications often result from chronic vascular blockage and inadequate oxygenation such as splenomegaly, avascular necrosis, retinopathy, nephropathy, and ulcers.

Sources:

• Pediatrics 2024, A. Yates. https://doi.org/10.1542/peds.2024-066842

In part 1 of this 2 part series on sickle cell disease, we’re going to discuss the general pediatric management of a patient with sickle cell disease including what special precautions and additional routine health maintenance they need.

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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Anjali Pawar (UC Davis pediatric hematologist). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• Patients with sickle cell disease should receive penicillin prophylaxis from 2 months old til 5 years old or until pneumococcal vaccine series is completed
• For patients with HbSS or sickle beta zero thalassemia, offer hydroxyurea at 9 months of age, even if they don’t have clinical symptoms. They should also receive stroke risk screening with an annual transcranial doppler
• Patients with sickle cell disease should receive annual screening for retinopathy and nephropathy around age 10
• Patients with sickle cell disease should receive an additional pneumococcal (20 or 23) vaccine and the meningococcal ACWY vaccine at age 10 and men B after age 10 if they have functional asplenia or a splenectomy

Sources:

Pediatrics 2024, A. Yates. https://doi.org/10.1542/peds.2024-066842

Wondering how to get pesky eczema under control? Listen up in today’s episode.

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

Key Points:

● Daily moisturization, cotton clothing, avoiding allergens and irritants like dust mites help prevent eczema flares

● For eczema flares, treat with a topical steroid, lower potency on the face and higher potency elsewhere on the body

● Look out for superimposed bacterial infections from Staphloccocus aureus or group A streptococcus and treat with topical or oral antibiotics depending on the spread (local vs extensive)

● Eczema herpeticum is due to HSV and should be treated with acyclovir, sometimes requiring hospitalization if severe or close to the eyes



Sources:

- AAP Patient Care Atopic Dermatitis: https://www.aap.org/en/patient-care/atopic-dermatitis/treatment-of-atopic-dermatitis/

- Pediatrics in Review, April 2018, Waldman et al, https://doi.org/10.1542/pir.2016-0169