Virtual Curbside

This month, we begin a new series on Polycystic Ovary Syndrome (PCOS), including the discussion surrounding a potential name change to Polycystic Metabolic Ovary Syndrome (PMOS) and evolving diagnostic criteria, particularly for adolescents. Our Paul Wirkus, MD, FAAP, and expert Katherine Hayes, MD, explore how our understanding of the condition continues to change and why diagnosing adolescents requires special consideration.The conversation covers updated diagnostic criteria, the role of hyperandrogenism, and how oral contraceptive pills (OCPs) can affect evaluation and diagnosis. They also discuss the importance of excluding other conditions that may present with similar symptoms and the value of an "at-risk" designation for adolescents who do not yet meet all diagnostic criteria. This approach allows clinicians to monitor symptoms over time without prematurely assigning a potentially lifelong diagnosis.Finally, our guest highlights the importance of getting the diagnosis right, including the long-term imp

In this Q&A episode, we wrap up our series on vitamin K deficiency bleeding by answering common questions about newborn prophylaxis and ongoing protection. Our host Paul Wirkus, MD, FAAP, and Sarah Coggins, MD, MSCE discuss whether infants ever need additional supplementation or a second dose after the initial birth dose, how long protection lasts, and whether there is a point at which it is too late to administer intramuscular (IM) vitamin K.The conversation also explores whether early antibiotic exposure can affect an infant’s risk of bleeding complications and why standardized, FDA-approved alternatives to the IM injection are not available in the United States. These questions provide an opportunity to examine the evidence behind current recommendations and the challenges of ensuring reliable vitamin K protection for newborns.This episode concludes our series with practical insights to help pediatricians answer families’ questions, address concerns about vitamin K prophylaxis, and explain the importan

In Episode 3 of our series on vitamin K deficiency bleeding, we focus on one of the most challenging aspects of newborn care: talking with parents who are hesitant about vitamin K prophylaxis. Our host Paul Wirkus, MD, FAAP, and two experts, Kristan Scott, MD, MSHP, and Sarah Coggins, MD, MSCE, explore three key factors that shape parental decisions: personal beliefs, concerns about infant welfare, and outside influences. Throughout the conversation, they emphasize that parents genuinely want what is best for their babies and that listening with empathy is essential to building trust.The discussion addresses common concerns, including whether vitamin K is synthetic, the ingredients in available formulations, the use of small amounts of alcohol as a stabilizing agent, and fears about a possible link to leukemia. Our guests review the limitations of earlier studies suggesting a link and the lack of consistent findings in subsequent research. They also discuss how concerns about infant pain can be acknowledged a

In Episode 2 of our series on vitamin K deficiency bleeding (VKDB), our host Paul Wirkus, MD, FAAP and two experts, Kristan Scott, MD, MSHP and Sarah Coggins, MD, MSCE explore why intramuscular (IM) vitamin K is recommended for newborns, how current supplementation guidelines were established, and what the evidence tells us about its effectiveness. We compare oral and IM administration, discuss why recommendations vary between countries, and review findings from studies in Denmark, Sweden, and Australia.The conversation also addresses common questions and misinformation families may encounter online, including the risks of unregulated products and the importance of understanding that there is no FDA-approved over-the-counter vitamin K product for newborn prophylaxis. We discuss why some breastfed infants may remain vulnerable to vitamin K deficiency even after receiving the IM injection and why increasing maternal supplementation to boost vitamin K levels in breast milk is not a reliable substitute for newbor

This month, we begin a new series on Vitamin K Deficiency with host Paul Wirkus, MD, FAAP and two experts,  Kristan Scott, MD, MSHP and Sarah Coggins, MD, MSCE joining us to explore why newborns are particularly vulnerable to vitamin K deficiency and how our approach to prevention has evolved over time.In this first episode, we discuss the history and progression of vitamin K use in newborns and why breast milk alone does not provide enough vitamin K to meet an infant’s needs. We also explore the unique physiology of the newborn period, including the limited vitamin K stores babies are born with and the challenges of establishing adequate levels after birth. The conversation touches on the complications that can result from vitamin K deficiency and why the birth process itself can create additional vulnerability.This episode provides important background for understanding why vitamin K prophylaxis has become a standard part of newborn care and sets the stage for the rest of the series.The Virtual Curbside is

In this Q&A episode, we wrap up our series on psychosis by exploring the important role of family, relationships, and support systems in caring for children and adolescents experiencing psychosis. Our host Paul Wirkus, MD, FAAP and guest Kristi Kleinschmit, MD discuss how household dynamics can influence recovery, including the importance of predictability, stability, and a supportive home environment. They also revisit the concept of low expressed emotion and whether it remains a recommended approach for families.The conversation addresses support following a first episode of psychosis, including the importance of recognizing and treating symptoms early. We discuss how to approach medication when a patient has limited awareness of their illness and may not recognize the need for treatment. Building trust and identifying people the patient trusts to help them recognize and describe changes in their thoughts, behaviors, or experiences can be an important part of this process.We also highlight NAMI as a res

This week, we take a brief detour from our series on psychosis for a special Book Club episode. Our host and guest discuss Stephen Covey’s classic The 7 Habits of Highly Effective People, exploring the seven habits and the ideas behind them.The conversation also considers how some of Covey’s principles can apply to pediatric practice and the everyday work of caring for patients and families.Next week, we’ll return to our series on psychosis with the Q&A episode.The Virtual Curbside is a podcast of the American Academy of Pediatrics, Utah Chapter (UTAAP), connecting pediatricians and subspecialists through practical, accessible pediatric education. Learn more about UTAAP at aaputah.org.

This week on The Virtual Curbside, we take a closer look at hallucinations and delusions in children and adolescents. Our host Paul Wirkus, MD, FAAP and guest Kristi Kleinschmit, MD discuss how to approach the diagnosis while keeping safety at the forefront. A thorough history is essential, including the patient’s family history, recent illnesses or infections, travel, changes in function, confusion, and the nature and timing of delusions or hallucinations. The conversation emphasizes the importance of considering both psychiatric and medical causes when a child presents with new or concerning symptoms.We also discuss the role of lab tests and imaging in the evaluation, including when additional medical workup is warranted and when symptoms require evaluation in the emergency department. The episode highlights the PREP program, a resource for young people experiencing a first episode of psychosis, and the Utah Psychiatric Call-Up Line, a publicly funded consultation resource available to primary care clinicia

In Episode 2 of our series on psychosis, we take a closer look at schizophrenia in children and adolescents, including the typical onset of symptoms, the role of genetics, and the relationship between cannabis use and psychosis. Our host Paul Paul Wirkus, MD, FAAP and guest Kristi Kleinschmit, MD review the disorders and conditions that commonly overlap with schizophrenia or occur at higher rates, including autism, major depressive disorder, bipolar disorder, schizoaffective disorder, anxiety, and substance use disorders.The conversation also explores how schizophrenia can progress over time and what clinicians can expect as the illness unfolds. We discuss the role of psychotherapy alongside other treatments and the important role pediatricians can play in supporting patients and families throughout the course of illness.Finally, we highlight the Utah Psychiatric Call-Up Line, a publicly funded resource available to Utah primary care and pediatricians for consultation and support when navigating psychiatric c

This month we turn to psychiatric topics, beginning with an important clinical question: when a child or adolescent presents with unusual thoughts, perceptions, or behaviors, how do we distinguish psychosis from other psychiatric or medical conditions?In this episode, our host Paul Wirkus, MD and guest Kristi Kleinschmit, MD discuss psychotic experiences and how they can occur in conditions including major depression, bipolar disorder, and OCD, as well as with substance use and trauma or PTSD. We explore how to think about experiences such as imaginary friends and vivid imagination, and when symptoms such as catatonia should prompt a closer evaluation.The conversation also emphasizes the importance of looking beyond a psychiatric diagnosis. Infection, other medical illnesses, and genetic syndromes can all play a role in changes in behavior or perception, making a thoughtful history and appropriate medical evaluation essential. The episode offers pediatricians a framework for recognizing concerning symptoms, c

This week we wrap up our series on supporting children’s social, emotional, and relational health with a conversation focused on what pediatricians and other clinicians can take from the series and put into practice. Our host Paul Wirkus, MD and guests Neal Davis, MD and Quang-Tuyen "Q" Nguyen join us to reflect on the key messages from the previous episodes and explore how clinicians can incorporate relational health into everyday pediatric care, particularly when working with families facing additional challenges.The discussion emphasizes that supporting children’s mental and relational health doesn’t always require a lengthy intervention. Sometimes, it happens in the small encounters - a pediatrician showing genuine care, listening to a family, noticing what they need, and helping parents feel supported. We also consider how clinical care can be strengthened when the policies and systems surrounding families are designed to work for them rather than create additional barriers.Q shares practical insights in

This week, we turn to one of the most common parenting questions in pediatric practice: screen time and digital wellness. Our host Paul Wirkus, MD, FAAP and guest Mark Witt, MD, discuss the unique role pediatricians have in helping families navigate technology use, while recognizing the challenge of addressing an increasingly complex topic within the limited time of a well-child visit.Rather than focusing only on a specific number of screen-time hours, the conversation emphasizes an age-specific approach and encourages pediatricians to consider what screen use may be displacing. We explore how increased screen time can affect physical activity, family time, sleep, and even where children use screens within the home. The discussion also highlights the value of establishing screen-free spaces and creating healthy boundaries around technology.Throughout the episode, our guest offers practical ways pediatricians can begin conversations about digital wellness and help families develop healthy, sustainable habits a

In Episode 2 of our quality improvement series on parenting advice in pediatric practice, we focus on the role pediatricians can play in supporting emotional resilience for both children and their parents. Host Paul Wirkus, MD, FAAP and guest Ryan Gottfredson, DO begin by discussing why quality improvement matters in clinical practice and how small, intentional changes can help pediatricians incorporate meaningful parenting guidance into routine care.The conversation explores modern parenting challenges, including stress, toxic levels of stress, and strategies for building resilience. We discuss how parents can teach resilience by modeling healthy behaviors, while maintaining balanced boundaries that provide children with both structure and support. Additional topics include helping children navigate failure, fostering independence, and finding the balance between parental authority and recognizing the humanity of both parents and children.Finally, we address a practical challenge familiar to every pediatrici

This month, we begin a new series on quality improvement initiatives that pediatric practices can implement to support families. Our first episode focuses on promoting social and emotional health by equipping pediatricians with practical strategies to help parents foster resilience, healthy relationships, and emotional well-being in their children.Our host Paul Wirkus, MD, FAAP and Cindy Brough, MD discuss the importance of building awareness, empathy, effective communication, problem-solving skills, self-confidence, and a strong sense of self from an early age. The conversation introduces a simple framework for coaching families through emotions: "notice, name, normalize, and navigate." We also explore how pediatricians can help parents provide consistent guidance, model healthy emotional regulation, and tailor expectations to a child's developmental stage.Additional topics include teaching conflict resolution, supporting positive peer relationships, recognizing when social withdrawal or changes in friendshi

In this Q&A episode of our Postural Orthostatic Tachycardia Syndrome (POTS) series, host Paul Wirkus, MD, FAAP and guest Kirti Sivakoti, MD, answer listener questions about diagnosing and managing POTS in pediatric patients. The discussion explores how to distinguish POTS from conditions with overlapping symptoms, including Mast Cell Activation Syndrome (MCAS) and other common POTS mimics, and when referral to an immunologist may be appropriate.We also review commonly used medications for symptom management, including practical considerations for initiating and tapering therapy as patients improve. Additional topics include the effects of caffeine, stimulant medications, ADHD treatments, and vasoconstrictors on orthostatic symptoms, helping clinicians navigate treatment decisions in children and adolescents with complex presentations.Throughout the episode, Dr. Sivakoti emphasizes the importance of individualized care, careful assessment, and ongoing follow-up to optimize outcomes for patients living with

In this episode of our Postural Orthostatic Tachycardia Syndrome (POTS) series, we look beyond diagnosis and treatment to discuss what the future holds for children and adolescents living with POTS. Host Paul Wirkus, MD, FAAP and guest Kirti Sivakoti, MD, review the long-term prognosis, highlighting what is currently known about recovery, symptom progression, and functional outcomes over time.The conversation also explores the complex relationship between POTS and other conditions, including the impact of COVID-19, eating disorders, chronic pain syndromes, and functional neurologic disorders. We discuss how these overlapping conditions can influence diagnosis, management, and quality of life, and examine where current research is headed as our understanding of POTS continues to evolve.Finally, our Dr. Sivakoti shares what they believe is the most misunderstood aspect of POTS and identifies one of the most undervalued interventions that can make a meaningful difference for patients. This episode offers practic

In Episode 2 of our series on Postural Orthostatic Tachycardia Syndrome (POTS), we focus on evidence-based treatment strategies to help children and adolescents manage symptoms and improve daily functioning. Our guest reviews the foundation of POTS management, emphasizing lifestyle interventions such as maintaining adequate hydration, increasing salt intake when appropriate, establishing healthy sleep habits, and implementing a gradual, structured exercise program.The discussion also explores the role of nutrition, compression garments, and heat avoidance in reducing symptom burden, along with practical accommodations that can support patients at school and in everyday activities. Finally, we review pharmacologic treatment options, discussing when medications may be appropriate and how they fit into an individualized care plan. Throughout the episode, the emphasis is on developing a comprehensive, patient-centered approach that helps children and adolescents regain function and improve their quality of life.H

This month we begin a new series on Postural Orthostatic Tachycardia Syndrome (POTS), exploring the diagnosis and management of this increasingly recognized condition in pediatric patients. In this episode, host Paul Wirkus, MD, FAAP and guest Kirti Sivakoti, MD, provide an overview of POTS before discussing current approaches to diagnosis and recent updates in the field. We review the diagnostic criteria, including orthostatic symptoms and the degree of functional impairment, and consider how these factors help guide clinical evaluation and management.The conversation also examines the growing understanding of POTS as a spectrum disorder, with many patients experiencing overlapping symptoms and contributing conditions. Finally, we discuss how to distinguish POTS from vasovagal syncope and review current thinking on the underlying causes and pathophysiology of POTS. This episode provides pediatricians with a practical framework for recognizing and evaluating children and adolescents with orthostatic intoleran

In months with five weeks, The Virtual Curbside takes a break from clinical topics for a pediatric book club discussion. This month, host Paul Wirkus, MD, FAAP, is joined by regular book club guest Angelo Giardino, MD, FAAP, and a special guest, fifth-grader Harry Thatcher, to discuss The Anxious Generation: A Graphic Novel by Jonathan Haidt.Together, they explore the book's central themes through the lens of two very different childhoods, comparing the play-based experiences of previous generations with today's phone-based childhoods. Harry offers a unique perspective as a member of the generation at the center of the discussion, while Drs. Wirkus and Giardino reflect on how growing up in a different era shaped their own experiences. The conversation examines the impact of technology, social connection, and unstructured play on child development, mental health, and what these changes mean for pediatricians and the families they serve.No credit available for this episode. See vcurb.com for additional episodes

In this Q&A episode of our pediatric neurology series, we answer listener questions about some of the most rapidly evolving areas in neurology and genetics. The discussion begins with the relationship between child abuse evaluations and Brief Resolved Unexplained Events (BRUE), including important considerations when assessing infants with unexplained symptoms.Host Paul Wirkus, MD, FAAP and guest Josh Bonkowsky, MD then explore the neurologic basis of developmental disorders and the growing role of advanced diagnostics such as genome sequencing and MRI. Our guests discuss how these tools can provide valuable insights into underlying conditions and increasingly influence treatment decisions and long-term care planning.The conversation also examines the complex relationship between genes, brain development, and the symptoms children experience. As genetic testing becomes more widely available, we consider the promise of gene therapy, the emerging field of precision medicine, and realistic timelines for tran