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

Wondering how to best protect your patients or your own baby this winter from RSV? We'll go over the different preventative options against RSV in today's episode!

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Kenneth Yau (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 pediagogypod@gmail.com

Key Points:

• RSV immunizations can stimulate an immune response to create antibodies against RSV or can directly give antibodies to an individual
• The RSV vaccine (Abrysvo) for adults can be given to pregnant individuals to provide passive immunity to infants after birth. It should be given at 32-36 weeks of gestational and 2 weeks prior to delivery
• After birth, infants can be given an RSV immunization, either nirsevimab (Beyfortus) or clesrovimab (Enflonsia), which are RSV antibodies. These can be given to all infants less than 8 months old if the pregnant parent did not receive Abrysvo. High risk infants 8-19 months should also receive RSV immunization.

Sources:

• CDC: https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/pregnant-people.html
• AAP Oct 2025: https://doi.org/10.1542/peds.2025-073923
• AAP Patient Care: https://www.aap.org/en/patient-care/respiratory-syncytial-virus-rsv-prevention/rsv-frequently-asked-questions/?srsltid=AfmBOopMfpneGvJVfI8lZGHlZg5gtqU7AtrR2NbqYzVh9OINyVnrXqT-