Why do we talk about safe sleep for infants? What causes infants to die suddenly and unexpectedly? Goals of safe sleep recommendations are to increase infant arousability and decrease asphyxiating environments Asking about sleep practices ABCs of safe sleep: Alone, Back, Crib Safe sleep recommendations: Infants should be on their backs Infants should sleep on a firm, flat, noninclined sleep surface There should be no bedding, such as pillows, blankets, bumper pads, stuffed toys, or fur-like materials in the infant’s sleep area. The infant should be breastfed as much and for as long as possible. The infant should sleep in the parents’ room, close to the parent’s bed but on a separate surface designed for infants, ideally for at least the first 6 months of life. Couches, sofas, and padded armchairs are extremely dangerous places for infants to sleep. Offer a pacifier at sleep time Parents should stay smoke-free during pregnancy and after the infant is born. Parents should avoid alcohol, marijuana, opioids, and illicit drug use during pregnancy and after birth Infants should be fully immunized. Commercial sleep products are only safe if they are consistent with safe sleep recommendations Tummy time  References: Moon RY, Carlin RF, Hand I, American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics. 2022 Jul 1; 150(1):e2022057990. https://publications.aap.org/pediatrics/article/150/1/e2022057990/188304/Sleep-Related-Infant-Deaths-Updated-2022?autologincheck=redirected Won’t my baby choke if they spit up when placed on their back to sleep? https://safetosleep.nichd.nih.gov/reduce-risk/back-sleeping

Sexual History - why it is important Confidentiality 5 Ps Framework  Partners Practices Protection of STIs Past history of STIs Pregnancy Intention STI Screening and Treatment HIV screening algorithm References: 5 Ps Framework:  https://www.cdc.gov/std/treatment/SexualHistory.htm STI Screening and Treatment:  https://www.cdc.gov/std/treatment-guidelines/provider-resources.htm#MobileApp https://www.cdc.gov/std/treatment-guidelines/default.htm HIV screening algorithm: https://stacks.cdc.gov/view/cdc/50872

How to examine a baby/infant How to examine a toddler/preschool aged child Focused information on the ear exam/otoscopy How to examine a school aged child/teen Engaging older children in your exam Focused information on the genitourinary exam  Presenting your physical exam during oral presentation Resources/Links: Bates' Guide to Physical Examination and History Taking by Lynn Bickley (your pediatric clinics will generally have a copy) https://batesvisualguide.com

List of pediatric vaccines How vaccines work Types of vaccines What you need to do before the visit What you should review with families before ordering the vaccines (including precautions and contraindications) Anticipatory guidance about vaccines How to handle vaccine hesitancy REFERENCES/LINKS: www.cdc.gov/vaccines AAP Child and Adolescent Immunization Schedule by Age: https://publications.aap.org/redbook/pages/Immunization-Schedules?autologincheck=redirected O’Shea P, John J, et al. Reframing the Conversation about Child and Adolescent Vaccines, January 2023, Frameworks Institute. https://www.frameworksinstitute.org/wp-content/uploads/2023/01/reframing-the-conversation-about-child-and-adolescent-vaccinations_Jan272023.pdf

Before the Rotation  Reach out to your team.. Understand what first day expectations are.  Peruse the patient list. Identify what study materials and resources will help you excel. Come ready to learn and have fun!  How to Pre-round Collect information on previous day and overnight events - includes talking with resident or night team, reading all notes from day prior Review all vitals from past day Review and calculate “Ins and Outs” Review all labs Check to see what medications, including PRN meds, your patient got Introduce yourself to patient and family - get their input on how patient is doing  Collect your thoughts, interpret your data, and formulate your assessment and plan for your presentation and note How to Present a Patient on the inpatient wards service Begin with one liner Subjective: interval and overnight events Any patient or caregiver concern or question noted when you prerounded Ins and Outs Vital signs Head-to-toe physical exam Labs, microbiology, and radiology Assessment one-liner Plan How to be an effective team member Touch base with a resident to run through your assessment and plan.  Show initiative Be honest and direct On rounds, listen to all patient presentations, not just your own Follow

The goal of the adolescent well visit is to empower the adolescent in starting to take ownership of their health with the support of their provider and caregiver. Before visit: Review normal psychosocial development of adolescence Review sexual maturity rating (SMR) (previously referred to as Tanner Staging) of adolescence  Review past medical history, medications, vaccines, labs, prior concerns from previous visits, and their last well visit if available.  Vital signs (including BP), height weight, BMI. Any screening questionnaires (e.g., PHQ-9A)   During visit: Introduce yourself; ask how they would like to be addressed Review structure of visit, including genital exam and interviewing adolescent alone; importance of confidentiality Direct questions to adolescent as much as possible Concerns from adolescent/parent or from prior visits that require follow up or updates Psychosocial screening: HEADSS (home, education/employment, activities, drugs, sexuality, suicide/depression/self-image, and safety) or SSHADESS (strength, school, home, activities, drugs/substance use, emotions/eating/depression, sexuality, and safety). NOTE: Some of this will be done during confidential interview.  Nutrition: number of meals/snacks, dairy intake  Sleep: nighttime and naps Screen time: duration, type(s) Dental: frequency of brushing, last seen by dentist Menstrual history: Age of menarche, frequency, length of periods, heaviness of flow, symptoms associated with menses Review medications, allergies, growth chart, vaccines Confidential interview: any additional questions or concerns; Home, Drugs and substance use; Emotions, eating, and depression; Sexuality; Safety   Physical exam Head to toe Discuss acne Need chaperone for breast and genital exam Preparation for oral presentation

Show Notes/Description This episode describes how to prepare for a newborn’s first outpatient visit after being discharged from the birth hospital, including the information that you need to obtain from the medical record before the visit, the topics you need to discuss during the visit, and how to approach the physical examination in a newborn.    Title: Before Your First Newborn Follow up Visit   Host: Augustin Casals,MD  Pediatrics Resident, University of Virginia.    Show Outline: Introduction Socio-emotional state of parents Before the visit, you should review Prenatal history Delivery history, gestational age Physical exam at time of birth Preventative treatments Course in newborn nursery or NICU Type of feeding Concerns for infection Bilirubin Screening tests Newborn visit Parental questions and concerns Feeding history and any problems with feeding Elimination  Sleep and safe sleep Social history and parental support system Review of systems – irritability, fever, rashes.  Normal newborn vital signs Infant growth parameters and weight trajectory Physical exam General Head size and shape Eyes – pupil shape, red light reflex, scleral icterus Cardiovascular – murmurs, capillary refill Respiratory Abdominal Genitourinary – testicles, hernias/hydroceles,

Peds GI clinic covers a host of gastrointestinal, pancreatic, liver and nutrition issues -3yr fellowship after peds residency  Before Clinic  Review what types of patients you will be seeing. It may be a mix of lots of issues, or just a liver transplant clinic. This will tell you what type of prep you should do (conditions to read up on, medications to review, etc) before the day of clinic. On the day of clinic, review expectations with the attending, fellow or resident physician. Do they want you to see patient independently and write notes, just shadow or somewhere inbetween. Review what questions they always want asked, what exams you should do alone vs with your whole team. Setting expectations before you start will set you up for success!  Questions: Pain, the PQRST mnemonic is helpful to better understand the pain Provoked the pain Quality of the pain Radiating Severity  Specific questions to ask in Peds GI:  Does pain wakes the patient at night?  how much school or other activities the Patient has missed because of symptoms?  Does defecation or passage of gas alleviates pain?  Any specific dietary changes already tried? Poop! understand the: Quality of the stool Size and caliber of the bowel movement (Use Bristol stool scale) GERD vs EoE   A complete GI exam– a lot more than the abdomen!