Virtual Curbside

This month we begin a new series on pediatric neurology issues, starting with a discussion with Josh Bonkowsky, MD, PhD, about his book Dancing Eyes, Dancing Feet. In this episode, our host Paul Wirkus, MD, FAAP and Dr. Bonkowsky trace the evolution of how clinicians understand and approach unexplained events in infants and children - from Sudden Infant Death Syndrome (SIDS) to Apparent Life-Threatening Events (ALTE), and more recently, Brief Resolved Unexplained Events (BRUE) and Functional Neurological Disorder (FND).The conversation explores how terminology, diagnostic approaches, and clinical thinking have changed over time, as well as the challenges providers face when balancing reassurance, evaluation, and uncertainty. We also discuss the important roles of the child’s pediatrician and pediatric hospitalists in coordinating care, supporting families, and guiding follow-up after these often frightening events.Have a question? Email questions@vcurb.com. Listener questions will be answered in episode four. For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP. Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In this episode of our infant formula and nutrition series, host Paul Wirkus, MD, FAAP and guest Steve Abrams, MD take a closer look at formula regulation, importation, and the growing influence of social media on infant feeding decisions. Our guests discuss the FDA registration process for infant formulas, what it means when products are not FDA registered, and the potential benefits and limitations of imported formulas. The conversation also explores how manufacturing and safety standards differ across countries and whether imported formulas are necessarily “cleaner” or safer.We also address the powerful role social media plays in shaping parent perceptions, including marketing claims that certain formulas can “cure” common infant concerns such as reflux, colic, or fussiness. Finally, the episode emphasizes the significant dangers of homemade formula and provides guidance on how pediatricians can counsel families using clear, evidence-based information while acknowledging the pressures and confusion many parents experience.Have a question? Email questions@vcurb.com. Listener questions will be answered next week. For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP. Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This month we turn our focus to infant formula and nutrition, beginning with a discussion of formula safety and supply. In this episode, our host Paul Wirkus, MD, FAAP and guest Steve Abrams, MD revisit Operation Fly Formula and the broader challenges of maintaining a safe and reliable formula supply in the U.S. We review safety concerns related to contamination - including bacteria, viruses, and rare but serious risks such as botulism - and discuss why recalls, while essential, can be complex for both families and providers to navigate.The conversation also explores differences between liquid and powdered formulas, with an emphasis on preparation practices and how improper bottle hygiene can increase contamination risk. We highlight current FDA guidance on boiling and cooling water for formula preparation and provide practical tips for counseling families. Importantly, our guests strongly caution against homemade formula and offer strategies for pediatricians to have clear, supportive conversations with caregivers.Finally, we touch on concerns about heavy metals in infant nutrition, including ongoing efforts such as the Closer to Zero initiative, and what clinicians should know when addressing parent questions about safety and quality.Have a question? Email questions@vcurb.com. Listener questions will be answered in episode four. For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP. Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In the third episode of our psychiatric “grab bag” series, we focus on the “angry adolescent” and the complex factors that can drive irritability and behavioral outbursts. Host Paul Wirkus, MD, FAAP and Jeremy Kendrick, MD discuss Disruptive Mood Dysregulation Disorder (DMDD) and how it differs from other mood and behavioral conditions. We explore how coexisting factors—such as substance use, trauma, and ADHD—can influence presentation, severity, and treatment outcomes.The conversation emphasizes the importance of identifying the underlying cause of a teen’s anger to guide appropriate, individualized treatment. Evidence-based approaches, including cognitive behavioral therapy (CBT), are reviewed alongside practical considerations for management in primary care. We also discuss when it’s appropriate to refer to a specialist or seek additional support, including use of the Utah Psychiatric Consultation Line (801-587-3636) for real-time guidance.Have a question? Email questions@vcurb.com. They will be answered next week.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP. Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This month we shift to a psychiatric “grab bag” series, beginning with a focused discussion on suicide risk assessment in pediatric practice. Host Paul Wirkus, MD, FAAP and Jeremy Kendrick, MD review how to ask about suicide in a direct, developmentally appropriate way and explore the differences between passive thoughts and active risk. The conversation also addresses the limits of risk prediction, emphasizing the importance of ongoing assessment rather than relying on a single point in time.We conclude with practical guidance on creating safety action plans, including how to engage patients and families, reduce immediate risk, and connect to appropriate resources. This episode equips clinicians with clear, compassionate strategies to navigate one of the most critical aspects of pediatric mental health care.Utah Psychiatric Call Up Line: 801.587.3636Have a question? Email questions@vcurb.com. They will be answered in week four.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP. Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In this Q&A episode of our Poison Control series, Host Paul Wirkus, MD, FAAP and guest Michael Moss, MD address emerging trends and high-risk behaviors contributing to pediatric and adolescent poison exposures. Our experts discuss substances sometimes used in social media challenges - including diphenhydramine, combination cold medications like NyQuil, and household items such as salt, nutmeg, cinnamon, and detergent pods - and the real dangers associated with these ingestions.The conversation also highlights serious risks tied to everyday household products, including tiki torch fuel and inhalant (“huffing”) exposures. Throughout the episode, we emphasize early recognition of concerning symptoms, proactive counseling for families and adolescents, and the importance of open, nonjudgmental conversations about risk-taking behaviors.If there is ever a concern about a possible poisoning, contact Poison Control at 1-800-222-1222 for immediate guidance anywhere in the United States.Have a question? Email questions@vcurb.com. For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP. Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In this episode of our Poison Control series, host, Paul Wirkus, MD, FAAP and guest Michael Moss, MD, focus on several high-risk exposures commonly encountered in pediatrics. Our guests review toxic thresholds for medications such as acetaminophen, discuss the dangers of prescription medication ingestions, and highlight particularly hazardous household items, including button batteries, magnets, hydrocarbons, and cleaning agents. The conversation emphasizes early recognition, appropriate initial management, and when to seek expert guidance. Listeners will gain practical insights to help prevent serious injury and respond effectively when exposures occur.If there is ever a concern about a possible poisoning, contact Poison Control at 1-800-222-1222 for immediate guidance anywhere in the United States.Have a question? Email questions@vcurb.com. They will be answered in week four.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP. Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In this Q&A episode of our neonatal opioid withdrawal syndrome (NOWS) series, we address challenging and nuanced clinical questions surrounding withdrawal, toxicology testing, and newborn exposures. Our host, Paul Wirkus, MD, FAAP, and guest Camille Fung, MD, review the early signs of withdrawal and discuss the process of obtaining consent for neonatal toxicology screening, clarifying when testing is considered diagnostic and how results may have reporting implications.We also explore common clinical scenarios, including the impact of maternal fentanyl administered via epidural on newborn toxicology results, and how in utero SSRI exposure may present with symptoms such as apnea, posturing, or seizure-like activity. The conversation further examines the effects of prenatal THC exposure, addressing common misconceptions, potential neonatal impacts, and the persistence of THC in breastmilk.Throughout the discussion, the emphasis remains on careful clinical assessment, clear communication with families, and a nonjudgmental, evidence-based approach to care.Have a question? Email questions@vcurb.com.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP. Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In this episode, we continue our series on neonatal opioid withdrawal syndrome (NOWS) with a discussion of substance exposure in the perinatal period and the practical considerations surrounding testing and discharge planning. Our host, Paul Wirkus, MD, FAAP and guest Camille Fung, MD review the fundamentals of prenatal substance exposure and the rationale for testing, including what different methods - such as urine, meconium, and umbilical cord testing - can and cannot tell us. The conversation explores the limitations of testing and how results should be interpreted in the clinical and social context of each family.We also discuss discharge planning, including referrals to primary care pediatricians and child welfare agencies when appropriate, and what clinicians and families can expect regarding developmental follow-up. Throughout the episode, Dr. Fung emphasizes the importance of a nonjudgmental, supportive approach that fosters trust and promotes the best outcomes for infants and their caregivers.Have a question? Email questions@vcurb.com. They will be answered in week four.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP. Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This month we are focusing on neonatal opioid withdrawal syndrome (NOWS), with an emphasis on the underlying physiology and clinical presentation. Our host, Paul Wirkus, MD, FAAP and guest Camille Fung, MD review the mechanisms of opioid exposure and withdrawal, including neuroexcitability and the gastrointestinal and autonomic manifestations commonly seen in affected newborns. The discussion also highlights the role of specialized clinics and coordinated care models that support mothers during pregnancy and the postpartum period. Together, this episode provides a foundational understanding of NOWS to help clinicians recognize symptoms early and deliver informed, compassionate care to both infants and their families. Have a question? Email questions@vcurb.com. They will be answered in week four.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP. Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In this episode, we turn our focus to allergic conjunctivitis. Host Paul Wirkus, MD, FAAP and Ophthalmologist Mitchell Strominger, MD guests review the clinical features of ocular allergy and discuss how characteristics such as discharge and symptom patterns can help distinguish allergic conjunctivitis from viral, bacterial, and other etiologies. The conversation also covers important mimics and red flags, including chemical conjunctivitis, corneal abrasions, and foreign bodies, with guidance on evaluation and management. This episode equips pediatricians with practical tools to accurately assess red eye complaints and determine when further intervention is needed. Have a question? Email questions@vcurb.com. They will be answered next week.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP. Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This month we begin a new series on common pediatric eye issues, starting with viral conjunctivitis. In this episode, host Paul Wirkus, MD, FAAP and Ophthalmologist Mitchell Strominger, MD review the clinical features that help distinguish viral conjunctivitis from other causes of red and pink eye, discuss typical disease course, and address common misconceptions around treatment and contagion. They also explore practical counseling points for families, including symptom management, infection control, and guidance on school and daycare attendance. This discussion is designed to help pediatricians confidently diagnose viral conjunctivitis and provide clear, evidence-based reassurance to families. Have a question? Email questions@vcurb.com. They will be answered in week four.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP. Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In this Q&A episode, host Paul Wirkus, MD, FAAP and guest Tim Bahr, MD, FAAP address important clinical questions surrounding hyperbilirubinemia, with a focus on longer-term complications and complex presentations. The discussion explores outcomes associated with severe or prolonged hyperbilirubinemia, including cases with late presentation or persistent jaundice, and how these scenarios may differ from typical newborn courses. We also review key considerations for escalation of care, including when transfer to a higher level of care is warranted and how to make those decisions in real-world practice. This episode offers practical guidance to support timely recognition, appropriate management, and improved outcomes for infants at risk. For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP. Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.