Hospital Medicine

Introduction

Osteomyelitis is a pyogenic infection of the bone or periosteum, whereas septic arthritis is an infection of the joint space. In children, these most commonly result from hematogenous spread. Osteomyelitis may also result from extension of contiguous skin or muscle infection. Septic arthritis may also result from either contiguous bone infection or direct inoculation of bacteria into the joint from penetrating trauma, intra-articular injection, or other causes. Either site of infection may represent a medical emergency in children. Bone and joint infections are commonly caused by Staphylococcus aureus, Streptococcus species, Kingella kingae, and Salmonella species. They most commonly occur in children <5 years of age. Males are nearly twice as likely to be affected as females. Prompt recognition and appropriate treatment are essential to reduce the risk of significant complications, including permanent bone or cartilage destruction with life-long disability. Pediatric hospitalists should render evidence-based care that minimizes harm, improves outcomes, and avoids use of unnecessary procedures and treatments.

Pediatric hospitalists should be able to:

• Discuss the differential diagnosis of common presenting signs and symptoms of bone and joint infections, including swollen joint, limp, and pain or limited movement of the affected bone or joint.
• Explain the pathophysiology of bone and joint infections.
• Compare and contrast the different clinical presentations of bone and joint infections between children of varying chronological ages.
• Explain risk factors for bone and joint infections, including sickle cell disease.
• Identify indications for admission to the hospital and goals for therapy while hospitalized for children with suspected osteomyelitis and septic arthritis.
• Classify the most likely pathogens based on age, underlying risk factors, and exposures and list appropriate antimicrobial agents for each.
• State relative local antimicrobial resistance rates for the most common organisms and explain the importance of these in prescribing therapy.
• Describe the relative advantages, disadvantages, and local availability of commonly used laboratory tests (such as C-reactive protein, blood cultures, bone aspirate, and others) and radiologic modalities (such as plain film, computed tomography, bone scan, magnetic resonance imaging, and others) in the evaluation of bone and joint infections.
• Identify risk factors for poor outcomes, including leg length discrepancy or chronic infection.
• Describe a comprehensive approach to pain management in children with bone and joint infections, including the roles of child life, occupational therapy, the pain service, and others according to local context.
• Discuss the relative advantages and disadvantages of intravenous versus oral antibiotic administration at discharge and identify the rare circumstances in which intravenous antibiotic therapy may be preferred.
• Define the role of the orthopedic surgeon and infectious diseases subspecialists in consultation, co-management, and follow-up care.
• Discuss criteria for patient transfer to a referral center in cases requiring pediatric-specific services not available at the local facility.
• Describe criteria, including specific measures of clinical improvement, antimicrobial treatment plan, and post-discharge management plan, which must be met before discharging patients with bone and joint infections.

Pediatric hospitalists should be able to:

• Diagnose osteomyelitis or septic arthritis by efficiently performing an accurate history and physical examination.
• Develop a cost-effective approach to diagnostic evaluation for children suspected of having a bone or joint infection, including laboratory and radiographic testing.
• Interpret laboratory and radiographic studies commonly ordered to assess for bone and joint infections.
• Manage pain effectively for children with bone and joint infections.
• Engage consultants (such as orthopedic surgeons, infectious disease specialists, physical therapists, and others) in a timely and effective manner when indicated.
• Access and arrange for pediatric home care services as appropriate.
• Coordinate care with subspecialists and the primary care provider and arrange an appropriate transition plan for hospital discharge.

Pediatric hospitalists should be able to:

• Acknowledge the need for effective communication with patients, the family/caregivers, and healthcare providers regarding findings and care plans.
• Collaborate with subspecialists and the primary care provider to ensure coordinated, longitudinal care for children with bone and joint infections.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways to standardize the evaluation and management for hospitalized children with bone and joint infections.
• Work with hospital administration to build a multidisciplinary team that can provide high value care to children with bone and joint infections, including nursing, social work, physical therapy, pharmacy, and care coordinators.
• Assist in creating systems to evaluate and improve pain management for children hospitalized with bone and joint infections.
• Lead, coordinate, or participate in efforts to increase pediatric-specific community health care resources that allow for an efficient transition to outpatient therapy and management after inpatient goals are achieved.

Introduction

Osteomyelitis is a pyogenic infection of the bone or periosteum, whereas septic arthritis is an infection of the joint space. In children, these most commonly result from hematogenous spread. Osteomyelitis may also result from extension of contiguous skin or muscle infection. Septic arthritis may also result from either contiguous bone infection or direct inoculation of bacteria into the joint from penetrating trauma, intra-articular injection, or other causes. Either site of infection may represent a medical emergency in children. Bone and joint infections are commonly caused by Staphylococcus aureus, Streptococcus species, Kingella kingae, and Salmonella species. They most commonly occur in children <5 years of age. Males are nearly twice as likely to be affected as females. Prompt recognition and appropriate treatment are essential to reduce the risk of significant complications, including permanent bone or cartilage destruction with life-long disability. Pediatric hospitalists should render evidence-based care that minimizes harm, improves outcomes, and avoids use of unnecessary procedures and treatments.

Pediatric hospitalists should be able to:

• Discuss the differential diagnosis of common presenting signs and symptoms of bone and joint infections, including swollen joint, limp, and pain or limited movement of the affected bone or joint.
• Explain the pathophysiology of bone and joint infections.
• Compare and contrast the different clinical presentations of bone and joint infections between children of varying chronological ages.
• Explain risk factors for bone and joint infections, including sickle cell disease.
• Identify indications for admission to the hospital and goals for therapy while hospitalized for children with suspected osteomyelitis and septic arthritis.
• Classify the most likely pathogens based on age, underlying risk factors, and exposures and list appropriate antimicrobial agents for each.
• State relative local antimicrobial resistance rates for the most common organisms and explain the importance of these in prescribing therapy.
• Describe the relative advantages, disadvantages, and local availability of commonly used laboratory tests (such as C-reactive protein, blood cultures, bone aspirate, and others) and radiologic modalities (such as plain film, computed tomography, bone scan, magnetic resonance imaging, and others) in the evaluation of bone and joint infections.
• Identify risk factors for poor outcomes, including leg length discrepancy or chronic infection.
• Describe a comprehensive approach to pain management in children with bone and joint infections, including the roles of child life, occupational therapy, the pain service, and others according to local context.
• Discuss the relative advantages and disadvantages of intravenous versus oral antibiotic administration at discharge and identify the rare circumstances in which intravenous antibiotic therapy may be preferred.
• Define the role of the orthopedic surgeon and infectious diseases subspecialists in consultation, co-management, and follow-up care.
• Discuss criteria for patient transfer to a referral center in cases requiring pediatric-specific services not available at the local facility.
• Describe criteria, including specific measures of clinical improvement, antimicrobial treatment plan, and post-discharge management plan, which must be met before discharging patients with bone and joint infections.

Pediatric hospitalists should be able to:

• Diagnose osteomyelitis or septic arthritis by efficiently performing an accurate history and physical examination.
• Develop a cost-effective approach to diagnostic evaluation for children suspected of having a bone or joint infection, including laboratory and radiographic testing.
• Interpret laboratory and radiographic studies commonly ordered to assess for bone and joint infections.
• Manage pain effectively for children with bone and joint infections.
• Engage consultants (such as orthopedic surgeons, infectious disease specialists, physical therapists, and others) in a timely and effective manner when indicated.
• Access and arrange for pediatric home care services as appropriate.
• Coordinate care with subspecialists and the primary care provider and arrange an appropriate transition plan for hospital discharge.

Pediatric hospitalists should be able to:

• Acknowledge the need for effective communication with patients, the family/caregivers, and healthcare providers regarding findings and care plans.
• Collaborate with subspecialists and the primary care provider to ensure coordinated, longitudinal care for children with bone and joint infections.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways to standardize the evaluation and management for hospitalized children with bone and joint infections.
• Work with hospital administration to build a multidisciplinary team that can provide high value care to children with bone and joint infections, including nursing, social work, physical therapy, pharmacy, and care coordinators.
• Assist in creating systems to evaluate and improve pain management for children hospitalized with bone and joint infections.
• Lead, coordinate, or participate in efforts to increase pediatric-specific community health care resources that allow for an efficient transition to outpatient therapy and management after inpatient goals are achieved.

Introduction

Osteomyelitis is a pyogenic infection of the bone or periosteum, whereas septic arthritis is an infection of the joint space. In children, these most commonly result from hematogenous spread. Osteomyelitis may also result from extension of contiguous skin or muscle infection. Septic arthritis may also result from either contiguous bone infection or direct inoculation of bacteria into the joint from penetrating trauma, intra-articular injection, or other causes. Either site of infection may represent a medical emergency in children. Bone and joint infections are commonly caused by Staphylococcus aureus, Streptococcus species, Kingella kingae, and Salmonella species. They most commonly occur in children <5 years of age. Males are nearly twice as likely to be affected as females. Prompt recognition and appropriate treatment are essential to reduce the risk of significant complications, including permanent bone or cartilage destruction with life-long disability. Pediatric hospitalists should render evidence-based care that minimizes harm, improves outcomes, and avoids use of unnecessary procedures and treatments.

Pediatric hospitalists should be able to:

• Discuss the differential diagnosis of common presenting signs and symptoms of bone and joint infections, including swollen joint, limp, and pain or limited movement of the affected bone or joint.
• Explain the pathophysiology of bone and joint infections.
• Compare and contrast the different clinical presentations of bone and joint infections between children of varying chronological ages.
• Explain risk factors for bone and joint infections, including sickle cell disease.
• Identify indications for admission to the hospital and goals for therapy while hospitalized for children with suspected osteomyelitis and septic arthritis.
• Classify the most likely pathogens based on age, underlying risk factors, and exposures and list appropriate antimicrobial agents for each.
• State relative local antimicrobial resistance rates for the most common organisms and explain the importance of these in prescribing therapy.
• Describe the relative advantages, disadvantages, and local availability of commonly used laboratory tests (such as C-reactive protein, blood cultures, bone aspirate, and others) and radiologic modalities (such as plain film, computed tomography, bone scan, magnetic resonance imaging, and others) in the evaluation of bone and joint infections.
• Identify risk factors for poor outcomes, including leg length discrepancy or chronic infection.
• Describe a comprehensive approach to pain management in children with bone and joint infections, including the roles of child life, occupational therapy, the pain service, and others according to local context.
• Discuss the relative advantages and disadvantages of intravenous versus oral antibiotic administration at discharge and identify the rare circumstances in which intravenous antibiotic therapy may be preferred.
• Define the role of the orthopedic surgeon and infectious diseases subspecialists in consultation, co-management, and follow-up care.
• Discuss criteria for patient transfer to a referral center in cases requiring pediatric-specific services not available at the local facility.
• Describe criteria, including specific measures of clinical improvement, antimicrobial treatment plan, and post-discharge management plan, which must be met before discharging patients with bone and joint infections.

Pediatric hospitalists should be able to:

• Diagnose osteomyelitis or septic arthritis by efficiently performing an accurate history and physical examination.
• Develop a cost-effective approach to diagnostic evaluation for children suspected of having a bone or joint infection, including laboratory and radiographic testing.
• Interpret laboratory and radiographic studies commonly ordered to assess for bone and joint infections.
• Manage pain effectively for children with bone and joint infections.
• Engage consultants (such as orthopedic surgeons, infectious disease specialists, physical therapists, and others) in a timely and effective manner when indicated.
• Access and arrange for pediatric home care services as appropriate.
• Coordinate care with subspecialists and the primary care provider and arrange an appropriate transition plan for hospital discharge.

Pediatric hospitalists should be able to:

• Acknowledge the need for effective communication with patients, the family/caregivers, and healthcare providers regarding findings and care plans.
• Collaborate with subspecialists and the primary care provider to ensure coordinated, longitudinal care for children with bone and joint infections.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways to standardize the evaluation and management for hospitalized children with bone and joint infections.
• Work with hospital administration to build a multidisciplinary team that can provide high value care to children with bone and joint infections, including nursing, social work, physical therapy, pharmacy, and care coordinators.
• Assist in creating systems to evaluate and improve pain management for children hospitalized with bone and joint infections.
• Lead, coordinate, or participate in efforts to increase pediatric-specific community health care resources that allow for an efficient transition to outpatient therapy and management after inpatient goals are achieved.

Introduction

Asthma is one of the most common, non-communicable, chronic childhood diseases. It is a leading cause of healthcare utilization resulting in a significant number of primary care visits, emergency room visits, and hospitalizations. It has direct impact on patient quality of life with a heavy financial burden to individuals and society. The prevalence of asthma continues to rise and is not equally distributed throughout the population, differing by sex, race, socioeconomic level, and geographic location. The Department of Health and Human Services (DHHS) recognizes the weight of asthma disease on our society, having directed the National Institute of Health to create evidence-based guidelines for asthma care. Additionally, the DHHS continues to recognize asthma as a key element of the Healthy People 2020 initiative with several specific health objectives related directly to inpatient management. Due to the chronic nature of this disease, pediatric hospitalists should not only treat acute exacerbations resulting in status asthmaticus, but also create or reaffirm long-term management plans.

Pediatric hospitalists should be able to:

• Discuss the pathophysiology of asthma addressing both bronchoconstrictive and inflammatory components, and state how each impact pharmacologic treatment choices.
• Compare and contrast the pathophysiology of asthma with other common small airway illnesses in children, such as bronchiolitis, viral pneumonia with bronchospasm, or chronic lung disease.
• Describe disparities in asthma prevalence by sex, race, socioeconomic level, and geographic location.
• Discuss the role psychosocial factors (such as housing, parental mental health, financial status, lack of health insurance, and others) play in the risk for exposure to allergens, non-compliance to medical regimens, and access to health care.
• List the differential diagnosis of wheezing for various age groups and delineate the defining features leading to a diagnosis of asthma.
• Define asthma groups by symptom severity and frequency based on current classification guidelines.
• Discuss the impact of risk factors, exacerbating factors, and chronic comorbidities on morbidity, treatment, and prognosis.
• List common asthma triggers and explain the importance of trigger avoidance and environmental controls in minimizing the frequency and severity of asthma exacerbations.
• State the basic pharmacology, safety profile, and potential adverse effects of commonly used medications, including bronchodilators, leukotriene modifiers, inhaled or systemic corticosteroids, and magnesium sulfate
• Compare and contrast indications for the use of high dose bronchodilator therapy via multiple meter dose inhaler or continuous nebulized albuterol.
• Describe the different formulations of systemic corticosteroids commonly used for treatment of acute asthma exacerbation and the indications for each.
• Describe the utility of alternate therapies such as magnesium sulfate for acute refractory asthma.
• Cite the common complications of asthma or asthma treatment, including pneumothorax, atelectasis, lobar collapse, respiratory failure, poor cardiac output, dysrhythmias, and others.
• Describe the utility of using asthma management plans to both monitor and treat asthma via early symptom recognition, pulmonary function testing (spirometry and/or peak flow), and proper use of controller and reliever medications.
• Discuss the goals of asthma management, including the maintenance of normal activity levels (including physical activity, uninterrupted sleep, and school attendance) and pulmonary function; the prevention of chronic symptoms, recurrent exacerbations, and hospitalizations; and the provision of optimal pharmacotherapy, while minimizing adverse events.
• List specific indications for referral to an asthma subspecialist.

Pediatric hospitalists should be able to:

• Diagnose and correctly classify asthma by efficiently performing an accurate history and physical examination.
• Assess clinical findings to determine the need for hospitalization and the appropriate level of care.
• Direct an evidence-based treatment plan for status asthmaticus.
• Identify and respond to side effects associated with asthma medications.
• Order and interpret objective measures of pulmonary function, including peak flow monitoring and spirometry.
• Order and interpret results of basic diagnostic tools, such as chest radiograph, blood gas, and others as indicated.
• Order appropriate monitoring and correctly interpret monitor data.
• Provide supplemental oxygen therapy and advanced airway management as necessary.
• Recognize signs and symptoms of serious complications of asthma, including pneumothorax or impending respiratory failure.
• Facilitate an effective transfer to a tertiary care center or intensive care setting when appropriate.
• Assess disease severity and modify the daily medication regimen based upon accurate assessment of changes in disease state, both for inpatient management and transition to home.
• Assess psychosocial factors that may impact care plans and provide appropriate interventions, including support, education, and referral to available resources.
• Initiate asthma education for patients and the family/caregivers as soon after admission as possible, as appropriate for the clinical context.
• Create a discharge plan that can be expediently activated when appropriate.
• Coordinate care with the primary care provider with a plan inclusive of discharge medications, home instructions, and follow-up plans.
• Complete a written asthma action plan and use it to educate patients and the family/caregivers on trigger avoidance, medication adherence, and disease control.

Pediatric hospitalists should be able to:

• Reinforce the role and responsibility of patients and the family/caregivers regarding self-care, recognition of symptoms, and disease management.
• Realize responsibility for effective communication with patients, the family/caregivers, and healthcare providers regarding care plans.
• Engage in a multi-disciplinary approach to the prevention, diagnosis, and treatment of asthma, involving when appropriate, social workers or case managers, respiratory therapists, and subspecialists.
• Collaborate with primary care providers and subspecialists to ensure coordinated longitudinal care for children with asthma.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in local and national initiatives to further the development and implementation of evidence-based clinical guidelines to promote effective resource utilization and improve quality of care for hospitalized children with asthma.
• Work with hospital administrators to implement and utilize performance feedback and quality improvement measures to assess outcomes of instituted guidelines for the management of inpatient asthma.
• Collaborate with primary care providers, subspecialists, social workers, and case managers to ensure a smooth transition to the outpatient setting, and to minimize the need for readmission.

Introduction

Asthma is one of the most common, non-communicable, chronic childhood diseases. It is a leading cause of healthcare utilization resulting in a significant number of primary care visits, emergency room visits, and hospitalizations. It has direct impact on patient quality of life with a heavy financial burden to individuals and society. The prevalence of asthma continues to rise and is not equally distributed throughout the population, differing by sex, race, socioeconomic level, and geographic location. The Department of Health and Human Services (DHHS) recognizes the weight of asthma disease on our society, having directed the National Institute of Health to create evidence-based guidelines for asthma care. Additionally, the DHHS continues to recognize asthma as a key element of the Healthy People 2020 initiative with several specific health objectives related directly to inpatient management. Due to the chronic nature of this disease, pediatric hospitalists should not only treat acute exacerbations resulting in status asthmaticus, but also create or reaffirm long-term management plans.

Pediatric hospitalists should be able to:

• Discuss the pathophysiology of asthma addressing both bronchoconstrictive and inflammatory components, and state how each impact pharmacologic treatment choices.
• Compare and contrast the pathophysiology of asthma with other common small airway illnesses in children, such as bronchiolitis, viral pneumonia with bronchospasm, or chronic lung disease.
• Describe disparities in asthma prevalence by sex, race, socioeconomic level, and geographic location.
• Discuss the role psychosocial factors (such as housing, parental mental health, financial status, lack of health insurance, and others) play in the risk for exposure to allergens, non-compliance to medical regimens, and access to health care.
• List the differential diagnosis of wheezing for various age groups and delineate the defining features leading to a diagnosis of asthma.
• Define asthma groups by symptom severity and frequency based on current classification guidelines.
• Discuss the impact of risk factors, exacerbating factors, and chronic comorbidities on morbidity, treatment, and prognosis.
• List common asthma triggers and explain the importance of trigger avoidance and environmental controls in minimizing the frequency and severity of asthma exacerbations.
• State the basic pharmacology, safety profile, and potential adverse effects of commonly used medications, including bronchodilators, leukotriene modifiers, inhaled or systemic corticosteroids, and magnesium sulfate
• Compare and contrast indications for the use of high dose bronchodilator therapy via multiple meter dose inhaler or continuous nebulized albuterol.
• Describe the different formulations of systemic corticosteroids commonly used for treatment of acute asthma exacerbation and the indications for each.
• Describe the utility of alternate therapies such as magnesium sulfate for acute refractory asthma.
• Cite the common complications of asthma or asthma treatment, including pneumothorax, atelectasis, lobar collapse, respiratory failure, poor cardiac output, dysrhythmias, and others.
• Describe the utility of using asthma management plans to both monitor and treat asthma via early symptom recognition, pulmonary function testing (spirometry and/or peak flow), and proper use of controller and reliever medications.
• Discuss the goals of asthma management, including the maintenance of normal activity levels (including physical activity, uninterrupted sleep, and school attendance) and pulmonary function; the prevention of chronic symptoms, recurrent exacerbations, and hospitalizations; and the provision of optimal pharmacotherapy, while minimizing adverse events.
• List specific indications for referral to an asthma subspecialist.

Pediatric hospitalists should be able to:

• Diagnose and correctly classify asthma by efficiently performing an accurate history and physical examination.
• Assess clinical findings to determine the need for hospitalization and the appropriate level of care.
• Direct an evidence-based treatment plan for status asthmaticus.
• Identify and respond to side effects associated with asthma medications.
• Order and interpret objective measures of pulmonary function, including peak flow monitoring and spirometry.
• Order and interpret results of basic diagnostic tools, such as chest radiograph, blood gas, and others as indicated.
• Order appropriate monitoring and correctly interpret monitor data.
• Provide supplemental oxygen therapy and advanced airway management as necessary.
• Recognize signs and symptoms of serious complications of asthma, including pneumothorax or impending respiratory failure.
• Facilitate an effective transfer to a tertiary care center or intensive care setting when appropriate.
• Assess disease severity and modify the daily medication regimen based upon accurate assessment of changes in disease state, both for inpatient management and transition to home.
• Assess psychosocial factors that may impact care plans and provide appropriate interventions, including support, education, and referral to available resources.
• Initiate asthma education for patients and the family/caregivers as soon after admission as possible, as appropriate for the clinical context.
• Create a discharge plan that can be expediently activated when appropriate.
• Coordinate care with the primary care provider with a plan inclusive of discharge medications, home instructions, and follow-up plans.
• Complete a written asthma action plan and use it to educate patients and the family/caregivers on trigger avoidance, medication adherence, and disease control.

Pediatric hospitalists should be able to:

• Reinforce the role and responsibility of patients and the family/caregivers regarding self-care, recognition of symptoms, and disease management.
• Realize responsibility for effective communication with patients, the family/caregivers, and healthcare providers regarding care plans.
• Engage in a multi-disciplinary approach to the prevention, diagnosis, and treatment of asthma, involving when appropriate, social workers or case managers, respiratory therapists, and subspecialists.
• Collaborate with primary care providers and subspecialists to ensure coordinated longitudinal care for children with asthma.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in local and national initiatives to further the development and implementation of evidence-based clinical guidelines to promote effective resource utilization and improve quality of care for hospitalized children with asthma.
• Work with hospital administrators to implement and utilize performance feedback and quality improvement measures to assess outcomes of instituted guidelines for the management of inpatient asthma.
• Collaborate with primary care providers, subspecialists, social workers, and case managers to ensure a smooth transition to the outpatient setting, and to minimize the need for readmission.

Introduction

Asthma is one of the most common, non-communicable, chronic childhood diseases. It is a leading cause of healthcare utilization resulting in a significant number of primary care visits, emergency room visits, and hospitalizations. It has direct impact on patient quality of life with a heavy financial burden to individuals and society. The prevalence of asthma continues to rise and is not equally distributed throughout the population, differing by sex, race, socioeconomic level, and geographic location. The Department of Health and Human Services (DHHS) recognizes the weight of asthma disease on our society, having directed the National Institute of Health to create evidence-based guidelines for asthma care. Additionally, the DHHS continues to recognize asthma as a key element of the Healthy People 2020 initiative with several specific health objectives related directly to inpatient management. Due to the chronic nature of this disease, pediatric hospitalists should not only treat acute exacerbations resulting in status asthmaticus, but also create or reaffirm long-term management plans.

Pediatric hospitalists should be able to:

• Discuss the pathophysiology of asthma addressing both bronchoconstrictive and inflammatory components, and state how each impact pharmacologic treatment choices.
• Compare and contrast the pathophysiology of asthma with other common small airway illnesses in children, such as bronchiolitis, viral pneumonia with bronchospasm, or chronic lung disease.
• Describe disparities in asthma prevalence by sex, race, socioeconomic level, and geographic location.
• Discuss the role psychosocial factors (such as housing, parental mental health, financial status, lack of health insurance, and others) play in the risk for exposure to allergens, non-compliance to medical regimens, and access to health care.
• List the differential diagnosis of wheezing for various age groups and delineate the defining features leading to a diagnosis of asthma.
• Define asthma groups by symptom severity and frequency based on current classification guidelines.
• Discuss the impact of risk factors, exacerbating factors, and chronic comorbidities on morbidity, treatment, and prognosis.
• List common asthma triggers and explain the importance of trigger avoidance and environmental controls in minimizing the frequency and severity of asthma exacerbations.
• State the basic pharmacology, safety profile, and potential adverse effects of commonly used medications, including bronchodilators, leukotriene modifiers, inhaled or systemic corticosteroids, and magnesium sulfate
• Compare and contrast indications for the use of high dose bronchodilator therapy via multiple meter dose inhaler or continuous nebulized albuterol.
• Describe the different formulations of systemic corticosteroids commonly used for treatment of acute asthma exacerbation and the indications for each.
• Describe the utility of alternate therapies such as magnesium sulfate for acute refractory asthma.
• Cite the common complications of asthma or asthma treatment, including pneumothorax, atelectasis, lobar collapse, respiratory failure, poor cardiac output, dysrhythmias, and others.
• Describe the utility of using asthma management plans to both monitor and treat asthma via early symptom recognition, pulmonary function testing (spirometry and/or peak flow), and proper use of controller and reliever medications.
• Discuss the goals of asthma management, including the maintenance of normal activity levels (including physical activity, uninterrupted sleep, and school attendance) and pulmonary function; the prevention of chronic symptoms, recurrent exacerbations, and hospitalizations; and the provision of optimal pharmacotherapy, while minimizing adverse events.
• List specific indications for referral to an asthma subspecialist.

Pediatric hospitalists should be able to:

• Diagnose and correctly classify asthma by efficiently performing an accurate history and physical examination.
• Assess clinical findings to determine the need for hospitalization and the appropriate level of care.
• Direct an evidence-based treatment plan for status asthmaticus.
• Identify and respond to side effects associated with asthma medications.
• Order and interpret objective measures of pulmonary function, including peak flow monitoring and spirometry.
• Order and interpret results of basic diagnostic tools, such as chest radiograph, blood gas, and others as indicated.
• Order appropriate monitoring and correctly interpret monitor data.
• Provide supplemental oxygen therapy and advanced airway management as necessary.
• Recognize signs and symptoms of serious complications of asthma, including pneumothorax or impending respiratory failure.
• Facilitate an effective transfer to a tertiary care center or intensive care setting when appropriate.
• Assess disease severity and modify the daily medication regimen based upon accurate assessment of changes in disease state, both for inpatient management and transition to home.
• Assess psychosocial factors that may impact care plans and provide appropriate interventions, including support, education, and referral to available resources.
• Initiate asthma education for patients and the family/caregivers as soon after admission as possible, as appropriate for the clinical context.
• Create a discharge plan that can be expediently activated when appropriate.
• Coordinate care with the primary care provider with a plan inclusive of discharge medications, home instructions, and follow-up plans.
• Complete a written asthma action plan and use it to educate patients and the family/caregivers on trigger avoidance, medication adherence, and disease control.

Pediatric hospitalists should be able to:

• Reinforce the role and responsibility of patients and the family/caregivers regarding self-care, recognition of symptoms, and disease management.
• Realize responsibility for effective communication with patients, the family/caregivers, and healthcare providers regarding care plans.
• Engage in a multi-disciplinary approach to the prevention, diagnosis, and treatment of asthma, involving when appropriate, social workers or case managers, respiratory therapists, and subspecialists.
• Collaborate with primary care providers and subspecialists to ensure coordinated longitudinal care for children with asthma.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in local and national initiatives to further the development and implementation of evidence-based clinical guidelines to promote effective resource utilization and improve quality of care for hospitalized children with asthma.
• Work with hospital administrators to implement and utilize performance feedback and quality improvement measures to assess outcomes of instituted guidelines for the management of inpatient asthma.
• Collaborate with primary care providers, subspecialists, social workers, and case managers to ensure a smooth transition to the outpatient setting, and to minimize the need for readmission.

Introduction

Altered mental status (AMS) is a descriptive term that encompasses a wide spectrum of signs and symptoms, ranging from vague complaints of atypical behavior and irritability, to more specific concerns related to both hyperactive states (such as agitation) and hypoactive states (such as lethargy, depressed levels of responsiveness, and loss of consciousness). AMS may be particularly difficult to recognize in very young children and children with medical complexity. Pediatric hospitalists frequently encounter children with AMS, either as a primary cause for admission or a secondary finding during hospitalization, and therefore they must be knowledgeable about the differential diagnosis and various organ system manifestations that may be involved. Pediatric hospitalists must be able to accurately recognize early signs of AMS, triage acuity, and provide prompt stabilization, which is critical to effective management of patients with this condition.

Pediatric Hospitalists should be able to:

• Compare and contrast the different presentations of AMS, and describe the differential diagnosis associated with each for varying chronological or developmental ages.
• Identify the elements of the Glasgow Coma Scale and discuss the implications of the score or a change in score on management of a child with AMS.
• Discuss the features of the medical history and physical examination that prompt specific diagnostic evaluation, including signs and symptoms that warrant urgent management.
• Compare and contrast different features of toxidromes that may present with AMS.
• Discuss approaches to stabilization of a child with AMS, including evaluation of airway, breathing, circulation, disability, exposure, and intracranial perfusion.
• Define the indications to activate a rapid response, code blue, or other local emergency system for children with AMS.
• Explain indications for hospitalization of children with AMS.
• Summarize the initial approach to management of common conditions presenting with AMS, including but not limited to: seizures, increased intracranial pressure, intracranial hemorrhage, infectious or inflammatory encephalitis, sepsis, shock, hypoglycemia, diabetic ketoacidosis, renal or liver failure, neoplastic syndromes, suspected toxic ingestion, medication overdose, and adverse drug reaction.
• Discuss specific considerations for children with medical complexity presenting with AMS, including those with intellectual disability, impaired communication, epilepsy, dystonia, ventricular shunts, ventilator dependence, enteral feeding tubes, and multiple medications.
• Discuss the mechanisms of action of common medications used for delirium or agitation.
• Discuss the mechanisms of action of medications used for increased intracranial pressure (such as mannitol, 3% hypertonic saline, and others).
• List medications commonly used in the inpatient setting that may cause AMS as a side effect of use or withdrawal of use, such as seizure medications, opioids, benzodiazepines, anti-cholinergic medications, barbiturates, cannabinoids, and others.
• Explain the indications for chemical versus physical restraints, one-to-one supervision, and involvement of hospital security to ensure safety of the patient, family, and staff.
• Describe indications for urgent subspecialist consultation for children with AMS (such as toxicology, rheumatology, neurology, neurosurgery, and others).
• Discuss reasons for transfer to higher level of care, within the institution or elsewhere if pediatric-specific or psychiatric services are not available at the local facility.
• Describe the reasons for ancillary service involvement (such as physical, occupational, speech, feeding, behavioral therapies, and others) and durable medical equipment procurement for children with AMS.
• List criteria for inpatient rehabilitation.
• Discuss indications for involvement of social work, child protective services, or law enforcement for children with AMS.

Pediatric Hospitalists should be able to:

• Elicit a thorough medical history, attending to a detailed care provider history, past medical history, exposures, medications, and medications in the home.
• Perform a physical exam to elicit signs of AMS, including evaluation of airway, breathing, circulation, psychiatric status, and the central and autonomic nervous system.
• Assign an accurate Glasgow Coma Scale score.
• Identify children with potentially reversible, life-threatening conditions, and promptly provide stabilizing measures, activating code or rapid response teams as indicated.
• Review medication list and note any potentially relevant interactions or adverse effects.
• Direct an appropriate, cost-effective evaluation to identify the cause of AMS and correctly interpret results, including performance of a lumbar puncture as indicated.
• Perform careful reassessments (such as serial neurological exams, Glasgow Coma Scale scoring, and others), identifying indications for adjustment to the plan of care, frequency of monitoring, and type of monitoring indicated.
• Identify and manage children who present with altered mental status secondary to common conditions, such as seizures, increased intracranial pressure, intracranial hemorrhage, infectious or inflammatory encephalitis, sepsis, shock, hypoglycemia, diabetic ketoacidosis, renal or liver failure, neoplastic syndromes, suspected toxic ingestion, medication overdose, and adverse drug reaction.
• Engage consultants, including neurologists, neurosurgeons, neuroradiologists, toxicologists, psychiatrists, and psychologists efficiently and appropriately.
• Coordinate care and communicate effectively with caregivers, primary care providers, and consultants about the mental status at the time of discharge and the transition plan, referring to ancillary or rehabilitation services as appropriate.

Pediatric Hospitalists should be able to:

• Realize responsibility for reporting of iatrogenic etiologies as appropriate.
• Acknowledge the need for effective communication with subspecialty providers, primary care providers, and the patients and the family/caregivers to ensure ongoing support and coordinated care.
• Realize responsibility for effective and compassionate communication with patients/caregivers regarding findings, prognosis, and treatments, accounting for the stresses of hospitalization.
• Collaborate with social work, child protective services, and law enforcement when indicated.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Work with hospital administration and staff to develop, implement, and assess outcomes of intervention strategies for hospitalized patients with deterioration of mental status to prevent adverse outcomes (such as rapid response, code blue, stroke teams, and others).
• Coordinate educational programs for front-line providers to promote early recognition of AMS.
• Lead, coordinate, or participate in institutional efforts to report and reduce cases of AMS due to iatrogenic causes or adverse effects of medications.

1. Lehman RK, Mink J. Altered mental status. Clin Pediatr Emerg Med. 2008; 9:68-75.

2. Avner JR. Altered states of consciousness. Pediatr Rev. 2006; 27:331-338. https://doi.org/10.1542/pir.27-9-331.

3. Malas N, Brahmbhatt K, McDermott C, Smith A. Ortiz-Aguayo R, Turkel S. Pediatric delirium: Evaluation, management, and special considerations. Curr Psychiatry Rep. 2017;19(9):65. https://doi.org/10.1007/s11920-017-0817-3.

Introduction

Altered mental status (AMS) is a descriptive term that encompasses a wide spectrum of signs and symptoms, ranging from vague complaints of atypical behavior and irritability, to more specific concerns related to both hyperactive states (such as agitation) and hypoactive states (such as lethargy, depressed levels of responsiveness, and loss of consciousness). AMS may be particularly difficult to recognize in very young children and children with medical complexity. Pediatric hospitalists frequently encounter children with AMS, either as a primary cause for admission or a secondary finding during hospitalization, and therefore they must be knowledgeable about the differential diagnosis and various organ system manifestations that may be involved. Pediatric hospitalists must be able to accurately recognize early signs of AMS, triage acuity, and provide prompt stabilization, which is critical to effective management of patients with this condition.

Pediatric Hospitalists should be able to:

• Compare and contrast the different presentations of AMS, and describe the differential diagnosis associated with each for varying chronological or developmental ages.
• Identify the elements of the Glasgow Coma Scale and discuss the implications of the score or a change in score on management of a child with AMS.
• Discuss the features of the medical history and physical examination that prompt specific diagnostic evaluation, including signs and symptoms that warrant urgent management.
• Compare and contrast different features of toxidromes that may present with AMS.
• Discuss approaches to stabilization of a child with AMS, including evaluation of airway, breathing, circulation, disability, exposure, and intracranial perfusion.
• Define the indications to activate a rapid response, code blue, or other local emergency system for children with AMS.
• Explain indications for hospitalization of children with AMS.
• Summarize the initial approach to management of common conditions presenting with AMS, including but not limited to: seizures, increased intracranial pressure, intracranial hemorrhage, infectious or inflammatory encephalitis, sepsis, shock, hypoglycemia, diabetic ketoacidosis, renal or liver failure, neoplastic syndromes, suspected toxic ingestion, medication overdose, and adverse drug reaction.
• Discuss specific considerations for children with medical complexity presenting with AMS, including those with intellectual disability, impaired communication, epilepsy, dystonia, ventricular shunts, ventilator dependence, enteral feeding tubes, and multiple medications.
• Discuss the mechanisms of action of common medications used for delirium or agitation.
• Discuss the mechanisms of action of medications used for increased intracranial pressure (such as mannitol, 3% hypertonic saline, and others).
• List medications commonly used in the inpatient setting that may cause AMS as a side effect of use or withdrawal of use, such as seizure medications, opioids, benzodiazepines, anti-cholinergic medications, barbiturates, cannabinoids, and others.
• Explain the indications for chemical versus physical restraints, one-to-one supervision, and involvement of hospital security to ensure safety of the patient, family, and staff.
• Describe indications for urgent subspecialist consultation for children with AMS (such as toxicology, rheumatology, neurology, neurosurgery, and others).
• Discuss reasons for transfer to higher level of care, within the institution or elsewhere if pediatric-specific or psychiatric services are not available at the local facility.
• Describe the reasons for ancillary service involvement (such as physical, occupational, speech, feeding, behavioral therapies, and others) and durable medical equipment procurement for children with AMS.
• List criteria for inpatient rehabilitation.
• Discuss indications for involvement of social work, child protective services, or law enforcement for children with AMS.

Pediatric Hospitalists should be able to:

• Elicit a thorough medical history, attending to a detailed care provider history, past medical history, exposures, medications, and medications in the home.
• Perform a physical exam to elicit signs of AMS, including evaluation of airway, breathing, circulation, psychiatric status, and the central and autonomic nervous system.
• Assign an accurate Glasgow Coma Scale score.
• Identify children with potentially reversible, life-threatening conditions, and promptly provide stabilizing measures, activating code or rapid response teams as indicated.
• Review medication list and note any potentially relevant interactions or adverse effects.
• Direct an appropriate, cost-effective evaluation to identify the cause of AMS and correctly interpret results, including performance of a lumbar puncture as indicated.
• Perform careful reassessments (such as serial neurological exams, Glasgow Coma Scale scoring, and others), identifying indications for adjustment to the plan of care, frequency of monitoring, and type of monitoring indicated.
• Identify and manage children who present with altered mental status secondary to common conditions, such as seizures, increased intracranial pressure, intracranial hemorrhage, infectious or inflammatory encephalitis, sepsis, shock, hypoglycemia, diabetic ketoacidosis, renal or liver failure, neoplastic syndromes, suspected toxic ingestion, medication overdose, and adverse drug reaction.
• Engage consultants, including neurologists, neurosurgeons, neuroradiologists, toxicologists, psychiatrists, and psychologists efficiently and appropriately.
• Coordinate care and communicate effectively with caregivers, primary care providers, and consultants about the mental status at the time of discharge and the transition plan, referring to ancillary or rehabilitation services as appropriate.

Pediatric Hospitalists should be able to:

• Realize responsibility for reporting of iatrogenic etiologies as appropriate.
• Acknowledge the need for effective communication with subspecialty providers, primary care providers, and the patients and the family/caregivers to ensure ongoing support and coordinated care.
• Realize responsibility for effective and compassionate communication with patients/caregivers regarding findings, prognosis, and treatments, accounting for the stresses of hospitalization.
• Collaborate with social work, child protective services, and law enforcement when indicated.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Work with hospital administration and staff to develop, implement, and assess outcomes of intervention strategies for hospitalized patients with deterioration of mental status to prevent adverse outcomes (such as rapid response, code blue, stroke teams, and others).
• Coordinate educational programs for front-line providers to promote early recognition of AMS.
• Lead, coordinate, or participate in institutional efforts to report and reduce cases of AMS due to iatrogenic causes or adverse effects of medications.

1. Lehman RK, Mink J. Altered mental status. Clin Pediatr Emerg Med. 2008; 9:68-75.

2. Avner JR. Altered states of consciousness. Pediatr Rev. 2006; 27:331-338. https://doi.org/10.1542/pir.27-9-331.

3. Malas N, Brahmbhatt K, McDermott C, Smith A. Ortiz-Aguayo R, Turkel S. Pediatric delirium: Evaluation, management, and special considerations. Curr Psychiatry Rep. 2017;19(9):65. https://doi.org/10.1007/s11920-017-0817-3.

Introduction

Altered mental status (AMS) is a descriptive term that encompasses a wide spectrum of signs and symptoms, ranging from vague complaints of atypical behavior and irritability, to more specific concerns related to both hyperactive states (such as agitation) and hypoactive states (such as lethargy, depressed levels of responsiveness, and loss of consciousness). AMS may be particularly difficult to recognize in very young children and children with medical complexity. Pediatric hospitalists frequently encounter children with AMS, either as a primary cause for admission or a secondary finding during hospitalization, and therefore they must be knowledgeable about the differential diagnosis and various organ system manifestations that may be involved. Pediatric hospitalists must be able to accurately recognize early signs of AMS, triage acuity, and provide prompt stabilization, which is critical to effective management of patients with this condition.

Pediatric Hospitalists should be able to:

• Compare and contrast the different presentations of AMS, and describe the differential diagnosis associated with each for varying chronological or developmental ages.
• Identify the elements of the Glasgow Coma Scale and discuss the implications of the score or a change in score on management of a child with AMS.
• Discuss the features of the medical history and physical examination that prompt specific diagnostic evaluation, including signs and symptoms that warrant urgent management.
• Compare and contrast different features of toxidromes that may present with AMS.
• Discuss approaches to stabilization of a child with AMS, including evaluation of airway, breathing, circulation, disability, exposure, and intracranial perfusion.
• Define the indications to activate a rapid response, code blue, or other local emergency system for children with AMS.
• Explain indications for hospitalization of children with AMS.
• Summarize the initial approach to management of common conditions presenting with AMS, including but not limited to: seizures, increased intracranial pressure, intracranial hemorrhage, infectious or inflammatory encephalitis, sepsis, shock, hypoglycemia, diabetic ketoacidosis, renal or liver failure, neoplastic syndromes, suspected toxic ingestion, medication overdose, and adverse drug reaction.
• Discuss specific considerations for children with medical complexity presenting with AMS, including those with intellectual disability, impaired communication, epilepsy, dystonia, ventricular shunts, ventilator dependence, enteral feeding tubes, and multiple medications.
• Discuss the mechanisms of action of common medications used for delirium or agitation.
• Discuss the mechanisms of action of medications used for increased intracranial pressure (such as mannitol, 3% hypertonic saline, and others).
• List medications commonly used in the inpatient setting that may cause AMS as a side effect of use or withdrawal of use, such as seizure medications, opioids, benzodiazepines, anti-cholinergic medications, barbiturates, cannabinoids, and others.
• Explain the indications for chemical versus physical restraints, one-to-one supervision, and involvement of hospital security to ensure safety of the patient, family, and staff.
• Describe indications for urgent subspecialist consultation for children with AMS (such as toxicology, rheumatology, neurology, neurosurgery, and others).
• Discuss reasons for transfer to higher level of care, within the institution or elsewhere if pediatric-specific or psychiatric services are not available at the local facility.
• Describe the reasons for ancillary service involvement (such as physical, occupational, speech, feeding, behavioral therapies, and others) and durable medical equipment procurement for children with AMS.
• List criteria for inpatient rehabilitation.
• Discuss indications for involvement of social work, child protective services, or law enforcement for children with AMS.

Pediatric Hospitalists should be able to:

• Elicit a thorough medical history, attending to a detailed care provider history, past medical history, exposures, medications, and medications in the home.
• Perform a physical exam to elicit signs of AMS, including evaluation of airway, breathing, circulation, psychiatric status, and the central and autonomic nervous system.
• Assign an accurate Glasgow Coma Scale score.
• Identify children with potentially reversible, life-threatening conditions, and promptly provide stabilizing measures, activating code or rapid response teams as indicated.
• Review medication list and note any potentially relevant interactions or adverse effects.
• Direct an appropriate, cost-effective evaluation to identify the cause of AMS and correctly interpret results, including performance of a lumbar puncture as indicated.
• Perform careful reassessments (such as serial neurological exams, Glasgow Coma Scale scoring, and others), identifying indications for adjustment to the plan of care, frequency of monitoring, and type of monitoring indicated.
• Identify and manage children who present with altered mental status secondary to common conditions, such as seizures, increased intracranial pressure, intracranial hemorrhage, infectious or inflammatory encephalitis, sepsis, shock, hypoglycemia, diabetic ketoacidosis, renal or liver failure, neoplastic syndromes, suspected toxic ingestion, medication overdose, and adverse drug reaction.
• Engage consultants, including neurologists, neurosurgeons, neuroradiologists, toxicologists, psychiatrists, and psychologists efficiently and appropriately.
• Coordinate care and communicate effectively with caregivers, primary care providers, and consultants about the mental status at the time of discharge and the transition plan, referring to ancillary or rehabilitation services as appropriate.

Pediatric Hospitalists should be able to:

• Realize responsibility for reporting of iatrogenic etiologies as appropriate.
• Acknowledge the need for effective communication with subspecialty providers, primary care providers, and the patients and the family/caregivers to ensure ongoing support and coordinated care.
• Realize responsibility for effective and compassionate communication with patients/caregivers regarding findings, prognosis, and treatments, accounting for the stresses of hospitalization.
• Collaborate with social work, child protective services, and law enforcement when indicated.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Work with hospital administration and staff to develop, implement, and assess outcomes of intervention strategies for hospitalized patients with deterioration of mental status to prevent adverse outcomes (such as rapid response, code blue, stroke teams, and others).
• Coordinate educational programs for front-line providers to promote early recognition of AMS.
• Lead, coordinate, or participate in institutional efforts to report and reduce cases of AMS due to iatrogenic causes or adverse effects of medications.

1. Lehman RK, Mink J. Altered mental status. Clin Pediatr Emerg Med. 2008; 9:68-75.

2. Avner JR. Altered states of consciousness. Pediatr Rev. 2006; 27:331-338. https://doi.org/10.1542/pir.27-9-331.

3. Malas N, Brahmbhatt K, McDermott C, Smith A. Ortiz-Aguayo R, Turkel S. Pediatric delirium: Evaluation, management, and special considerations. Curr Psychiatry Rep. 2017;19(9):65. https://doi.org/10.1007/s11920-017-0817-3.

Introduction

Respiratory failure is defined by inadequate gas exchange by the respiratory system that results in ineffective alveolar ventilation and/or oxygenation. Acute respiratory failure is more common in children than adults and is the primary cause of cardiopulmonary arrest in children. The differential diagnosis for acute respiratory failure in children is extensive, as failure may stem from any portion of the respiratory system or be a consequence of systemic disease. Pediatric hospitalists frequently encounter children with conditions affecting the respiratory system and should be able to anticipate, identify, and treat acute respiratory distress and acute respiratory failure in children, including those with chronic respiratory conditions and other comorbidities.

Pediatric hospitalists should be able to:

• Describe the structure and function respiratory system components, including upper and lower airways, muscles of respiration, and central and peripheral regulation systems.
• Explain developmental differences that contribute to acute respiratory failure in infants and young children, including upper airway size, lower airway growth and development, diaphragmatic muscle reserve, chest wall compliance, and respiratory regulatory center maturity.
• Discuss the basic principles of respiratory physiology, including the alveolar gas equation, minute ventilation, and alveolar-arterial gradient.
• Summarize the five causes of hypoxemia: ventilation-perfusion mismatch, hypoventilation, right to left shunt, diffusion impairment, and low inspired oxygen.
• Construct an age-based differential diagnosis for acute respiratory distress in children.
• List causes of poor respiratory muscle function, attending to age, neuromuscular disorders, central nervous system dysfunction, nerve injury, and others.
• Discuss comorbidities that place children at higher risk for acute respiratory failure.
• Summarize evaluation, monitoring, and treatment options for patients with worsening respiratory status, including mental status assessment, blood gas analysis, medications, and respiratory support.
• Describe the signs and symptoms of impending acute respiratory failure, including criteria for transfer to a higher level of care.
• Discuss the advantages and disadvantages of different supplemental oxygen delivery devices for children with and without medical complexity, such as low flow and heated high-flow nasal cannula, simple mask, partial rebreather or non-rebreather, and tracheostomy collar or mask.
• Summarize the modalities commonly available to support the airway and adequate gas exchange in children with worsening respiratory distress, including nasopharyngeal or oropharyngeal airways, bag-valve-mask ventilation, bi-level positive airway pressure, continuous positive airway pressure, endotracheal tube, and laryngeal-mask-airway intubation.
• Describe criteria for, risks of, and complications due to endotracheal or laryngeal-mask-airway intubation, including strategies to reduce these risks.
• Compare and contrast optimal treatment strategies for acute respiratory failure in children with common acute respiratory conditions, including asthma, bronchiolitis, croup, and pneumonia.

Pediatric hospitalists should be able to:

• Perform and teach other health care providers to perform a thorough respiratory assessment of a child with acute respiratory distress.
• Identify early warning signs of acute respiratory distress and institute corrective actions and therapies to avert further deterioration.
• Identify patients with comorbidities and other risk factors for progression to acute respiratory failure.
• Order appropriate monitoring and relevant testing (such as radiographs and blood gases) and correctly interpret their results.
• Diagnose and initiate medical management for systemic causes of acute respiratory failure.
• Identify signs and symptoms of impending acute respiratory failure and activate local emergency response teams and/or transfer patients to an appropriate site with critical care services in a safe and efficient manner.
• Initiate oxygen supplementation via oxygen delivery devices and escalate as required to manage hypoxia and/or acute respiratory distress.
• Stabilize the airway, using non-invasive airway management techniques independently and invasive airway management in collaboration with other services.
• Demonstrate proficiency in basic management of patients with chronic respiratory support needs.
• Identify patients requiring subspecialty care and obtain timely consults.

Pediatric hospitalists should be able to:

• Acknowledge the importance of collaboration with patients, the family/caregivers, hospital staff, and subspecialists to ensure family-centered, coordinated hospital care for children with conditions at risk for acute respiratory failure.
• Realize the value of providing consultation for healthcare providers in community settings to ensure transport of patients to higher acuity settings as needed.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in educational programs for the family/caregivers, hospital staff, and other healthcare providers regarding recognition of signs and symptoms of acute respiratory distress in children, particularly those at higher risk for acute respiratory failure.
• Work with hospital administration, hospital staff, subspecialists, and others to develop, implement, and assess outcomes of intervention strategies such as rapid response teams and early warning scores for hospitalized patients with deterioration in respiratory status in order to prevent adverse outcomes.
• Work with hospital administration, hospital staff, pharmacy, and others to ensure availability of medications and appropriately sized equipment for use in the management of acute respiratory failure in children.

Introduction

Respiratory failure is defined by inadequate gas exchange by the respiratory system that results in ineffective alveolar ventilation and/or oxygenation. Acute respiratory failure is more common in children than adults and is the primary cause of cardiopulmonary arrest in children. The differential diagnosis for acute respiratory failure in children is extensive, as failure may stem from any portion of the respiratory system or be a consequence of systemic disease. Pediatric hospitalists frequently encounter children with conditions affecting the respiratory system and should be able to anticipate, identify, and treat acute respiratory distress and acute respiratory failure in children, including those with chronic respiratory conditions and other comorbidities.

Pediatric hospitalists should be able to:

• Describe the structure and function respiratory system components, including upper and lower airways, muscles of respiration, and central and peripheral regulation systems.
• Explain developmental differences that contribute to acute respiratory failure in infants and young children, including upper airway size, lower airway growth and development, diaphragmatic muscle reserve, chest wall compliance, and respiratory regulatory center maturity.
• Discuss the basic principles of respiratory physiology, including the alveolar gas equation, minute ventilation, and alveolar-arterial gradient.
• Summarize the five causes of hypoxemia: ventilation-perfusion mismatch, hypoventilation, right to left shunt, diffusion impairment, and low inspired oxygen.
• Construct an age-based differential diagnosis for acute respiratory distress in children.
• List causes of poor respiratory muscle function, attending to age, neuromuscular disorders, central nervous system dysfunction, nerve injury, and others.
• Discuss comorbidities that place children at higher risk for acute respiratory failure.
• Summarize evaluation, monitoring, and treatment options for patients with worsening respiratory status, including mental status assessment, blood gas analysis, medications, and respiratory support.
• Describe the signs and symptoms of impending acute respiratory failure, including criteria for transfer to a higher level of care.
• Discuss the advantages and disadvantages of different supplemental oxygen delivery devices for children with and without medical complexity, such as low flow and heated high-flow nasal cannula, simple mask, partial rebreather or non-rebreather, and tracheostomy collar or mask.
• Summarize the modalities commonly available to support the airway and adequate gas exchange in children with worsening respiratory distress, including nasopharyngeal or oropharyngeal airways, bag-valve-mask ventilation, bi-level positive airway pressure, continuous positive airway pressure, endotracheal tube, and laryngeal-mask-airway intubation.
• Describe criteria for, risks of, and complications due to endotracheal or laryngeal-mask-airway intubation, including strategies to reduce these risks.
• Compare and contrast optimal treatment strategies for acute respiratory failure in children with common acute respiratory conditions, including asthma, bronchiolitis, croup, and pneumonia.

Pediatric hospitalists should be able to:

• Perform and teach other health care providers to perform a thorough respiratory assessment of a child with acute respiratory distress.
• Identify early warning signs of acute respiratory distress and institute corrective actions and therapies to avert further deterioration.
• Identify patients with comorbidities and other risk factors for progression to acute respiratory failure.
• Order appropriate monitoring and relevant testing (such as radiographs and blood gases) and correctly interpret their results.
• Diagnose and initiate medical management for systemic causes of acute respiratory failure.
• Identify signs and symptoms of impending acute respiratory failure and activate local emergency response teams and/or transfer patients to an appropriate site with critical care services in a safe and efficient manner.
• Initiate oxygen supplementation via oxygen delivery devices and escalate as required to manage hypoxia and/or acute respiratory distress.
• Stabilize the airway, using non-invasive airway management techniques independently and invasive airway management in collaboration with other services.
• Demonstrate proficiency in basic management of patients with chronic respiratory support needs.
• Identify patients requiring subspecialty care and obtain timely consults.

Pediatric hospitalists should be able to:

• Acknowledge the importance of collaboration with patients, the family/caregivers, hospital staff, and subspecialists to ensure family-centered, coordinated hospital care for children with conditions at risk for acute respiratory failure.
• Realize the value of providing consultation for healthcare providers in community settings to ensure transport of patients to higher acuity settings as needed.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in educational programs for the family/caregivers, hospital staff, and other healthcare providers regarding recognition of signs and symptoms of acute respiratory distress in children, particularly those at higher risk for acute respiratory failure.
• Work with hospital administration, hospital staff, subspecialists, and others to develop, implement, and assess outcomes of intervention strategies such as rapid response teams and early warning scores for hospitalized patients with deterioration in respiratory status in order to prevent adverse outcomes.
• Work with hospital administration, hospital staff, pharmacy, and others to ensure availability of medications and appropriately sized equipment for use in the management of acute respiratory failure in children.

Introduction

Respiratory failure is defined by inadequate gas exchange by the respiratory system that results in ineffective alveolar ventilation and/or oxygenation. Acute respiratory failure is more common in children than adults and is the primary cause of cardiopulmonary arrest in children. The differential diagnosis for acute respiratory failure in children is extensive, as failure may stem from any portion of the respiratory system or be a consequence of systemic disease. Pediatric hospitalists frequently encounter children with conditions affecting the respiratory system and should be able to anticipate, identify, and treat acute respiratory distress and acute respiratory failure in children, including those with chronic respiratory conditions and other comorbidities.

Pediatric hospitalists should be able to:

• Describe the structure and function respiratory system components, including upper and lower airways, muscles of respiration, and central and peripheral regulation systems.
• Explain developmental differences that contribute to acute respiratory failure in infants and young children, including upper airway size, lower airway growth and development, diaphragmatic muscle reserve, chest wall compliance, and respiratory regulatory center maturity.
• Discuss the basic principles of respiratory physiology, including the alveolar gas equation, minute ventilation, and alveolar-arterial gradient.
• Summarize the five causes of hypoxemia: ventilation-perfusion mismatch, hypoventilation, right to left shunt, diffusion impairment, and low inspired oxygen.
• Construct an age-based differential diagnosis for acute respiratory distress in children.
• List causes of poor respiratory muscle function, attending to age, neuromuscular disorders, central nervous system dysfunction, nerve injury, and others.
• Discuss comorbidities that place children at higher risk for acute respiratory failure.
• Summarize evaluation, monitoring, and treatment options for patients with worsening respiratory status, including mental status assessment, blood gas analysis, medications, and respiratory support.
• Describe the signs and symptoms of impending acute respiratory failure, including criteria for transfer to a higher level of care.
• Discuss the advantages and disadvantages of different supplemental oxygen delivery devices for children with and without medical complexity, such as low flow and heated high-flow nasal cannula, simple mask, partial rebreather or non-rebreather, and tracheostomy collar or mask.
• Summarize the modalities commonly available to support the airway and adequate gas exchange in children with worsening respiratory distress, including nasopharyngeal or oropharyngeal airways, bag-valve-mask ventilation, bi-level positive airway pressure, continuous positive airway pressure, endotracheal tube, and laryngeal-mask-airway intubation.
• Describe criteria for, risks of, and complications due to endotracheal or laryngeal-mask-airway intubation, including strategies to reduce these risks.
• Compare and contrast optimal treatment strategies for acute respiratory failure in children with common acute respiratory conditions, including asthma, bronchiolitis, croup, and pneumonia.

Pediatric hospitalists should be able to:

• Perform and teach other health care providers to perform a thorough respiratory assessment of a child with acute respiratory distress.
• Identify early warning signs of acute respiratory distress and institute corrective actions and therapies to avert further deterioration.
• Identify patients with comorbidities and other risk factors for progression to acute respiratory failure.
• Order appropriate monitoring and relevant testing (such as radiographs and blood gases) and correctly interpret their results.
• Diagnose and initiate medical management for systemic causes of acute respiratory failure.
• Identify signs and symptoms of impending acute respiratory failure and activate local emergency response teams and/or transfer patients to an appropriate site with critical care services in a safe and efficient manner.
• Initiate oxygen supplementation via oxygen delivery devices and escalate as required to manage hypoxia and/or acute respiratory distress.
• Stabilize the airway, using non-invasive airway management techniques independently and invasive airway management in collaboration with other services.
• Demonstrate proficiency in basic management of patients with chronic respiratory support needs.
• Identify patients requiring subspecialty care and obtain timely consults.

Pediatric hospitalists should be able to:

• Acknowledge the importance of collaboration with patients, the family/caregivers, hospital staff, and subspecialists to ensure family-centered, coordinated hospital care for children with conditions at risk for acute respiratory failure.
• Realize the value of providing consultation for healthcare providers in community settings to ensure transport of patients to higher acuity settings as needed.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in educational programs for the family/caregivers, hospital staff, and other healthcare providers regarding recognition of signs and symptoms of acute respiratory distress in children, particularly those at higher risk for acute respiratory failure.
• Work with hospital administration, hospital staff, subspecialists, and others to develop, implement, and assess outcomes of intervention strategies such as rapid response teams and early warning scores for hospitalized patients with deterioration in respiratory status in order to prevent adverse outcomes.
• Work with hospital administration, hospital staff, pharmacy, and others to ensure availability of medications and appropriately sized equipment for use in the management of acute respiratory failure in children.

Introduction

Acute gastroenteritis (AGE) is one of the most common diseases of childhood. Admission to the hospital can be prevented in many cases with appropriate use of oral rehydration. Despite this, annual hospitalization rates in the United States have been reported to be as high 3 to 5 per 1000 US children, and the financial burden of emergency department care and hospitalization accounts for up to $350 million in costs annually. Although uncommon in developed countries, morbidity can be profound, and mortality can occur. Among hospitalized patients, complications including electrolyte abnormalities, sepsis, and malnutrition have been noted. Misdiagnosis of AGE may occur, particularly when vomiting is the predominant symptom, which can lead to inappropriate treatment for potentially life-threatening conditions. Pediatric hospitalists routinely encounter patients with AGE and should provide immediate medical care in an efficient and effective manner.

Pediatric hospitalists should be able to:

• Describe the signs, symptoms, and common or concerning complications of AGE, including electrolyte disturbances, dehydration, ileus, and hemolytic uremic syndrome.
• List the common pathogens and related epidemiologic factors for AGE depending upon age, immunization status, geographic location, and exposure and travel history.
• Discuss the pathophysiology of electrolyte disturbances in AGE.
• Discuss the indications for hospital admission, including the need for intravenous fluids, correction of fluid, electrolyte and acid base disturbances, close clinical monitoring, and/or further diagnostic evaluation.
• Discuss essential elements of the history for patients with AGE, including immunization status, water and food sources, method of food preparation, daycare attendance, and recent travel.
• Describe the elements of the physical examination that aid in the diagnosis of AGE and associated complications.
• Compare and contrast clinical findings associated with viral, bacterial, and parasitic AGE.
• Compare and contrast conditions with presentations like that of AGE or its complications, including critical medical and surgical diagnoses such as diabetic ketoacidosis, inborn errors of metabolism, malrotation with midgut volvulus, and bowel obstruction.
• Compare and contrast the differential diagnoses of isolated emesis, bilious emesis, and emesis with diarrhea.
• Describe the differences in approach toward diagnosis and treatment for patients with co-morbid conditions or immunosuppression.
• Discuss the role of infection control in the hospital, as well as public health reporting mandates.
• Describe the indications for diagnostic laboratory tests, including stool, blood, and urine studies, attending to age groups, predictive value of tests, and cost-effectiveness.
• Describe the indications and contraindications of the interventions used to manage the symptoms of AGE, including the role of oral rehydration solutions in the treatment of related dehydration.
• Discuss indications for specialty consultation, such as gastroenterology, nutrition, surgery, and others.
• Describe criteria for hospital discharge, including specific measures of clinical stability for safe care transition.

Pediatric hospitalists should be able to:

• Diagnose gastroenteritis by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
• Identify and correctly manage fluid, electrolyte, and acid base derangements.
• Assess patients efficiently and effectively for complications of gastroenteritis such as sepsis, ileus, and hemolytic uremic syndrome.
• Identify and appropriately treat patients at risk for AGE secondary to unusual pathogens.
• Direct a cost-effective and evidence-based evaluation and treatment plan, especially regarding laboratory studies, antibiotics, and oral or intravenous fluid resuscitation.
• Adhere consistently to infection control practices.
• Perform careful reassessments daily and as needed, note changes in clinical status, and respond with appropriate actions, taking care to consider alternative conditions as appropriate.
• Engage consultants efficiently when indicated.
• Communicate effectively with the family/caregivers and healthcare providers regarding findings and plans.
• Ensure coordination of care for diagnostic tests and treatment between subspecialists.
• Create a comprehensive discharge plan that can be expediently activated when appropriate.

Pediatric hospitalists should be able to:

• Realize responsibility for educating the family/caregivers on the natural course of the disease, identification and management of common complications, and infection control practices to manage expectations and decrease pathogen transmission.
• Ensure coordination of care for diagnostic tests and treatments between subspecialists.
• Exemplify and advocate for strict adherence to infection control practices.
• Exemplify effective communication with patients, the family/caregivers, and healthcare providers regarding findings, care plans, and anticipated health needs after discharge.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways to standardize the evaluation and management for hospitalized children with AGE.
• Collaborate with hospital administration to create and sustain a process to follow up on laboratory tests pending at discharge.
• Collaborate with institutional infection control practitioners to improve processes to prevent nosocomial infection related to gastroenteritis.
• Lead, coordinate, or participate in efforts to assure consistent public health reporting of appropriate infections and response to trends.

Introduction

Acute gastroenteritis (AGE) is one of the most common diseases of childhood. Admission to the hospital can be prevented in many cases with appropriate use of oral rehydration. Despite this, annual hospitalization rates in the United States have been reported to be as high 3 to 5 per 1000 US children, and the financial burden of emergency department care and hospitalization accounts for up to $350 million in costs annually. Although uncommon in developed countries, morbidity can be profound, and mortality can occur. Among hospitalized patients, complications including electrolyte abnormalities, sepsis, and malnutrition have been noted. Misdiagnosis of AGE may occur, particularly when vomiting is the predominant symptom, which can lead to inappropriate treatment for potentially life-threatening conditions. Pediatric hospitalists routinely encounter patients with AGE and should provide immediate medical care in an efficient and effective manner.

Pediatric hospitalists should be able to:

• Describe the signs, symptoms, and common or concerning complications of AGE, including electrolyte disturbances, dehydration, ileus, and hemolytic uremic syndrome.
• List the common pathogens and related epidemiologic factors for AGE depending upon age, immunization status, geographic location, and exposure and travel history.
• Discuss the pathophysiology of electrolyte disturbances in AGE.
• Discuss the indications for hospital admission, including the need for intravenous fluids, correction of fluid, electrolyte and acid base disturbances, close clinical monitoring, and/or further diagnostic evaluation.
• Discuss essential elements of the history for patients with AGE, including immunization status, water and food sources, method of food preparation, daycare attendance, and recent travel.
• Describe the elements of the physical examination that aid in the diagnosis of AGE and associated complications.
• Compare and contrast clinical findings associated with viral, bacterial, and parasitic AGE.
• Compare and contrast conditions with presentations like that of AGE or its complications, including critical medical and surgical diagnoses such as diabetic ketoacidosis, inborn errors of metabolism, malrotation with midgut volvulus, and bowel obstruction.
• Compare and contrast the differential diagnoses of isolated emesis, bilious emesis, and emesis with diarrhea.
• Describe the differences in approach toward diagnosis and treatment for patients with co-morbid conditions or immunosuppression.
• Discuss the role of infection control in the hospital, as well as public health reporting mandates.
• Describe the indications for diagnostic laboratory tests, including stool, blood, and urine studies, attending to age groups, predictive value of tests, and cost-effectiveness.
• Describe the indications and contraindications of the interventions used to manage the symptoms of AGE, including the role of oral rehydration solutions in the treatment of related dehydration.
• Discuss indications for specialty consultation, such as gastroenterology, nutrition, surgery, and others.
• Describe criteria for hospital discharge, including specific measures of clinical stability for safe care transition.

Pediatric hospitalists should be able to:

• Diagnose gastroenteritis by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
• Identify and correctly manage fluid, electrolyte, and acid base derangements.
• Assess patients efficiently and effectively for complications of gastroenteritis such as sepsis, ileus, and hemolytic uremic syndrome.
• Identify and appropriately treat patients at risk for AGE secondary to unusual pathogens.
• Direct a cost-effective and evidence-based evaluation and treatment plan, especially regarding laboratory studies, antibiotics, and oral or intravenous fluid resuscitation.
• Adhere consistently to infection control practices.
• Perform careful reassessments daily and as needed, note changes in clinical status, and respond with appropriate actions, taking care to consider alternative conditions as appropriate.
• Engage consultants efficiently when indicated.
• Communicate effectively with the family/caregivers and healthcare providers regarding findings and plans.
• Ensure coordination of care for diagnostic tests and treatment between subspecialists.
• Create a comprehensive discharge plan that can be expediently activated when appropriate.

Pediatric hospitalists should be able to:

• Realize responsibility for educating the family/caregivers on the natural course of the disease, identification and management of common complications, and infection control practices to manage expectations and decrease pathogen transmission.
• Ensure coordination of care for diagnostic tests and treatments between subspecialists.
• Exemplify and advocate for strict adherence to infection control practices.
• Exemplify effective communication with patients, the family/caregivers, and healthcare providers regarding findings, care plans, and anticipated health needs after discharge.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways to standardize the evaluation and management for hospitalized children with AGE.
• Collaborate with hospital administration to create and sustain a process to follow up on laboratory tests pending at discharge.
• Collaborate with institutional infection control practitioners to improve processes to prevent nosocomial infection related to gastroenteritis.
• Lead, coordinate, or participate in efforts to assure consistent public health reporting of appropriate infections and response to trends.

Introduction

Acute gastroenteritis (AGE) is one of the most common diseases of childhood. Admission to the hospital can be prevented in many cases with appropriate use of oral rehydration. Despite this, annual hospitalization rates in the United States have been reported to be as high 3 to 5 per 1000 US children, and the financial burden of emergency department care and hospitalization accounts for up to $350 million in costs annually. Although uncommon in developed countries, morbidity can be profound, and mortality can occur. Among hospitalized patients, complications including electrolyte abnormalities, sepsis, and malnutrition have been noted. Misdiagnosis of AGE may occur, particularly when vomiting is the predominant symptom, which can lead to inappropriate treatment for potentially life-threatening conditions. Pediatric hospitalists routinely encounter patients with AGE and should provide immediate medical care in an efficient and effective manner.

Pediatric hospitalists should be able to:

• Describe the signs, symptoms, and common or concerning complications of AGE, including electrolyte disturbances, dehydration, ileus, and hemolytic uremic syndrome.
• List the common pathogens and related epidemiologic factors for AGE depending upon age, immunization status, geographic location, and exposure and travel history.
• Discuss the pathophysiology of electrolyte disturbances in AGE.
• Discuss the indications for hospital admission, including the need for intravenous fluids, correction of fluid, electrolyte and acid base disturbances, close clinical monitoring, and/or further diagnostic evaluation.
• Discuss essential elements of the history for patients with AGE, including immunization status, water and food sources, method of food preparation, daycare attendance, and recent travel.
• Describe the elements of the physical examination that aid in the diagnosis of AGE and associated complications.
• Compare and contrast clinical findings associated with viral, bacterial, and parasitic AGE.
• Compare and contrast conditions with presentations like that of AGE or its complications, including critical medical and surgical diagnoses such as diabetic ketoacidosis, inborn errors of metabolism, malrotation with midgut volvulus, and bowel obstruction.
• Compare and contrast the differential diagnoses of isolated emesis, bilious emesis, and emesis with diarrhea.
• Describe the differences in approach toward diagnosis and treatment for patients with co-morbid conditions or immunosuppression.
• Discuss the role of infection control in the hospital, as well as public health reporting mandates.
• Describe the indications for diagnostic laboratory tests, including stool, blood, and urine studies, attending to age groups, predictive value of tests, and cost-effectiveness.
• Describe the indications and contraindications of the interventions used to manage the symptoms of AGE, including the role of oral rehydration solutions in the treatment of related dehydration.
• Discuss indications for specialty consultation, such as gastroenterology, nutrition, surgery, and others.
• Describe criteria for hospital discharge, including specific measures of clinical stability for safe care transition.

Pediatric hospitalists should be able to:

• Diagnose gastroenteritis by efficiently performing an accurate history and physical examination, determining if key features of the disease are present.
• Identify and correctly manage fluid, electrolyte, and acid base derangements.
• Assess patients efficiently and effectively for complications of gastroenteritis such as sepsis, ileus, and hemolytic uremic syndrome.
• Identify and appropriately treat patients at risk for AGE secondary to unusual pathogens.
• Direct a cost-effective and evidence-based evaluation and treatment plan, especially regarding laboratory studies, antibiotics, and oral or intravenous fluid resuscitation.
• Adhere consistently to infection control practices.
• Perform careful reassessments daily and as needed, note changes in clinical status, and respond with appropriate actions, taking care to consider alternative conditions as appropriate.
• Engage consultants efficiently when indicated.
• Communicate effectively with the family/caregivers and healthcare providers regarding findings and plans.
• Ensure coordination of care for diagnostic tests and treatment between subspecialists.
• Create a comprehensive discharge plan that can be expediently activated when appropriate.

Pediatric hospitalists should be able to:

• Realize responsibility for educating the family/caregivers on the natural course of the disease, identification and management of common complications, and infection control practices to manage expectations and decrease pathogen transmission.
• Ensure coordination of care for diagnostic tests and treatments between subspecialists.
• Exemplify and advocate for strict adherence to infection control practices.
• Exemplify effective communication with patients, the family/caregivers, and healthcare providers regarding findings, care plans, and anticipated health needs after discharge.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in the development and implementation of cost-effective, safe, evidence-based care pathways to standardize the evaluation and management for hospitalized children with AGE.
• Collaborate with hospital administration to create and sustain a process to follow up on laboratory tests pending at discharge.
• Collaborate with institutional infection control practitioners to improve processes to prevent nosocomial infection related to gastroenteritis.
• Lead, coordinate, or participate in efforts to assure consistent public health reporting of appropriate infections and response to trends.

Introduction

Acute abdominal pain is a common presenting symptom of children and adolescents and prompts the consideration of an extensive differential diagnosis. Pediatric hospitalists frequently encounter children with acute abdominal pain. Acute abdominal pain may be due to common and self-limited medical conditions such as gastroenteritis or constipation, but it may also herald life threatening surgical conditions or systemic illness. The differential diagnosis of acute abdominal pain is broad, making a careful, skilled, and thorough history and physical examination essential in the evaluation of children presenting with this symptom. Identifying children with a true medical or surgical emergency is critical. Early diagnosis and treatment reduce morbidity, mortality, and length of hospital stay.

Pediatric hospitalists should be able to:

• Describe features of the medical history and physical examination that prompt specific and expedient diagnostic evaluation.
• Compare and contrast the differential diagnoses of acute abdominal pain and acute abdomen for children of varying ages.
• Describe and differentiate the clinical presentation consistent with intestinal obstruction from other causes of acute abdominal pain such as appendicitis, acute cholecystitis, and others.
• Differentiate etiologies of acute abdominal pain related to biological sex, such as testicular torsion, ovarian cyst rupture, ectopic pregnancy, and others.
• Discuss the presenting symptoms associated with abdominal emergencies (such as mid-gut volvulus and intussusception), including bilious emesis, bloody diarrhea, and severe pain.
• List the appropriate radiological studies for evaluation of various abdominal emergencies.
• Identify how the presentation of abdominal emergencies may differ in neonates and infants by including nonspecific symptoms, such as vomiting or lethargy.
• List conditions that may mimic the acute abdomen, including lower lobe pneumonia, diabetic ketoacidosis, and others.
• Discuss the benefits, risks, and limitations of commonly performed diagnostic studies, including abdominal radiography, ultrasonography, computed tomography, magnetic resonance imaging, and nuclear medicine scans, noting the benefits of and barriers to use of contrast enhancement for these studies.
• Describe the laboratory tests indicated to evaluate acute abdominal pain and acute abdomen.
• Discuss the importance of and indications for early surgical consultation in the child with an acute abdomen.
• Describe the principles of stabilization of the child with an acute abdomen, including volume resuscitation, antibiotics, and bowel decompression.
• Discuss the approach toward pain management in patients presenting with acute abdominal pain, including the impact of medication on serial exams.
• Describe indications for patient placement in various locations in the hospital system, such as an observation unit, surgical or medical ward, step-down, or intensive care unit.
• Discuss indications for patient transfer to a referral center, such as need for pediatric-specific services not available at the local facility.

Pediatric hospitalists should be able to:

• Obtain an accurate and thorough history to identify symptoms, triggers, and clinical course of acute abdominal pain and acute abdomen.
• Perform a physical exam to elicit signs of abdominal pain, differentiate findings of acute abdomen, and assess illness severity.
• Formulate a targeted differential diagnosis based on elements from the history and physical examination.
• Identify the child with an acute abdomen who requires emergent surgical consultation.
• Identify and manage the child with concomitant hypovolemia or sepsis requiring immediate medical stabilization.
• Direct an appropriate and cost-effective evaluation for acute abdominal pain and acute abdomen.
• Create and implement a treatment plan for non-surgical causes of abdominal pain.
• Order and correctly interpret basic diagnostic imaging and laboratory studies.
• Consult surgeons and other subspecialists effectively and efficiently when indicated.
• Provide pre- and post-operative general pediatric care for the child requiring surgery, including pain management, according to local practice parameters.
• Coordinate care with the primary care provider and subspecialists to arrange an appropriate transition plan for hospital discharge.

Pediatric hospitalists should be able to:

• Exemplify collaborative practice with subspecialists, including surgical teams and primary care providers, to ensure efficient care within the hospital setting and coordinated longitudinal care.
• Realize responsibility for promoting effective communication with patients, family/caregivers, and healthcare providers regarding findings and care plans.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in education of healthcare providers, trainees, the family/caregivers regarding the signs and symptoms of the acute abdomen to encourage early detection and prompt evaluation.
• Lead, coordinate, or participate in a multidisciplinary team to provide optimal care for children with acute abdominal pain with and without acute abdomen.
• Lead, coordinate, or participate in institutional efforts to improve the expediency of diagnostic laboratory and radiographic studies, availability of specialty care, and other resources for children with acute abdominal pain and acute abdomen.
• Lead, coordinate, or participate in institutional efforts to develop surgical consultation or co-management models, clearly defining roles to ensure timely, high quality, and comprehensive care for pediatric patients requiring surgical care.

Introduction

Acute abdominal pain is a common presenting symptom of children and adolescents and prompts the consideration of an extensive differential diagnosis. Pediatric hospitalists frequently encounter children with acute abdominal pain. Acute abdominal pain may be due to common and self-limited medical conditions such as gastroenteritis or constipation, but it may also herald life threatening surgical conditions or systemic illness. The differential diagnosis of acute abdominal pain is broad, making a careful, skilled, and thorough history and physical examination essential in the evaluation of children presenting with this symptom. Identifying children with a true medical or surgical emergency is critical. Early diagnosis and treatment reduce morbidity, mortality, and length of hospital stay.

Pediatric hospitalists should be able to:

• Describe features of the medical history and physical examination that prompt specific and expedient diagnostic evaluation.
• Compare and contrast the differential diagnoses of acute abdominal pain and acute abdomen for children of varying ages.
• Describe and differentiate the clinical presentation consistent with intestinal obstruction from other causes of acute abdominal pain such as appendicitis, acute cholecystitis, and others.
• Differentiate etiologies of acute abdominal pain related to biological sex, such as testicular torsion, ovarian cyst rupture, ectopic pregnancy, and others.
• Discuss the presenting symptoms associated with abdominal emergencies (such as mid-gut volvulus and intussusception), including bilious emesis, bloody diarrhea, and severe pain.
• List the appropriate radiological studies for evaluation of various abdominal emergencies.
• Identify how the presentation of abdominal emergencies may differ in neonates and infants by including nonspecific symptoms, such as vomiting or lethargy.
• List conditions that may mimic the acute abdomen, including lower lobe pneumonia, diabetic ketoacidosis, and others.
• Discuss the benefits, risks, and limitations of commonly performed diagnostic studies, including abdominal radiography, ultrasonography, computed tomography, magnetic resonance imaging, and nuclear medicine scans, noting the benefits of and barriers to use of contrast enhancement for these studies.
• Describe the laboratory tests indicated to evaluate acute abdominal pain and acute abdomen.
• Discuss the importance of and indications for early surgical consultation in the child with an acute abdomen.
• Describe the principles of stabilization of the child with an acute abdomen, including volume resuscitation, antibiotics, and bowel decompression.
• Discuss the approach toward pain management in patients presenting with acute abdominal pain, including the impact of medication on serial exams.
• Describe indications for patient placement in various locations in the hospital system, such as an observation unit, surgical or medical ward, step-down, or intensive care unit.
• Discuss indications for patient transfer to a referral center, such as need for pediatric-specific services not available at the local facility.

Pediatric hospitalists should be able to:

• Obtain an accurate and thorough history to identify symptoms, triggers, and clinical course of acute abdominal pain and acute abdomen.
• Perform a physical exam to elicit signs of abdominal pain, differentiate findings of acute abdomen, and assess illness severity.
• Formulate a targeted differential diagnosis based on elements from the history and physical examination.
• Identify the child with an acute abdomen who requires emergent surgical consultation.
• Identify and manage the child with concomitant hypovolemia or sepsis requiring immediate medical stabilization.
• Direct an appropriate and cost-effective evaluation for acute abdominal pain and acute abdomen.
• Create and implement a treatment plan for non-surgical causes of abdominal pain.
• Order and correctly interpret basic diagnostic imaging and laboratory studies.
• Consult surgeons and other subspecialists effectively and efficiently when indicated.
• Provide pre- and post-operative general pediatric care for the child requiring surgery, including pain management, according to local practice parameters.
• Coordinate care with the primary care provider and subspecialists to arrange an appropriate transition plan for hospital discharge.

Pediatric hospitalists should be able to:

• Exemplify collaborative practice with subspecialists, including surgical teams and primary care providers, to ensure efficient care within the hospital setting and coordinated longitudinal care.
• Realize responsibility for promoting effective communication with patients, family/caregivers, and healthcare providers regarding findings and care plans.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in education of healthcare providers, trainees, the family/caregivers regarding the signs and symptoms of the acute abdomen to encourage early detection and prompt evaluation.
• Lead, coordinate, or participate in a multidisciplinary team to provide optimal care for children with acute abdominal pain with and without acute abdomen.
• Lead, coordinate, or participate in institutional efforts to improve the expediency of diagnostic laboratory and radiographic studies, availability of specialty care, and other resources for children with acute abdominal pain and acute abdomen.
• Lead, coordinate, or participate in institutional efforts to develop surgical consultation or co-management models, clearly defining roles to ensure timely, high quality, and comprehensive care for pediatric patients requiring surgical care.

Introduction

Acute abdominal pain is a common presenting symptom of children and adolescents and prompts the consideration of an extensive differential diagnosis. Pediatric hospitalists frequently encounter children with acute abdominal pain. Acute abdominal pain may be due to common and self-limited medical conditions such as gastroenteritis or constipation, but it may also herald life threatening surgical conditions or systemic illness. The differential diagnosis of acute abdominal pain is broad, making a careful, skilled, and thorough history and physical examination essential in the evaluation of children presenting with this symptom. Identifying children with a true medical or surgical emergency is critical. Early diagnosis and treatment reduce morbidity, mortality, and length of hospital stay.

Pediatric hospitalists should be able to:

• Describe features of the medical history and physical examination that prompt specific and expedient diagnostic evaluation.
• Compare and contrast the differential diagnoses of acute abdominal pain and acute abdomen for children of varying ages.
• Describe and differentiate the clinical presentation consistent with intestinal obstruction from other causes of acute abdominal pain such as appendicitis, acute cholecystitis, and others.
• Differentiate etiologies of acute abdominal pain related to biological sex, such as testicular torsion, ovarian cyst rupture, ectopic pregnancy, and others.
• Discuss the presenting symptoms associated with abdominal emergencies (such as mid-gut volvulus and intussusception), including bilious emesis, bloody diarrhea, and severe pain.
• List the appropriate radiological studies for evaluation of various abdominal emergencies.
• Identify how the presentation of abdominal emergencies may differ in neonates and infants by including nonspecific symptoms, such as vomiting or lethargy.
• List conditions that may mimic the acute abdomen, including lower lobe pneumonia, diabetic ketoacidosis, and others.
• Discuss the benefits, risks, and limitations of commonly performed diagnostic studies, including abdominal radiography, ultrasonography, computed tomography, magnetic resonance imaging, and nuclear medicine scans, noting the benefits of and barriers to use of contrast enhancement for these studies.
• Describe the laboratory tests indicated to evaluate acute abdominal pain and acute abdomen.
• Discuss the importance of and indications for early surgical consultation in the child with an acute abdomen.
• Describe the principles of stabilization of the child with an acute abdomen, including volume resuscitation, antibiotics, and bowel decompression.
• Discuss the approach toward pain management in patients presenting with acute abdominal pain, including the impact of medication on serial exams.
• Describe indications for patient placement in various locations in the hospital system, such as an observation unit, surgical or medical ward, step-down, or intensive care unit.
• Discuss indications for patient transfer to a referral center, such as need for pediatric-specific services not available at the local facility.

Pediatric hospitalists should be able to:

• Obtain an accurate and thorough history to identify symptoms, triggers, and clinical course of acute abdominal pain and acute abdomen.
• Perform a physical exam to elicit signs of abdominal pain, differentiate findings of acute abdomen, and assess illness severity.
• Formulate a targeted differential diagnosis based on elements from the history and physical examination.
• Identify the child with an acute abdomen who requires emergent surgical consultation.
• Identify and manage the child with concomitant hypovolemia or sepsis requiring immediate medical stabilization.
• Direct an appropriate and cost-effective evaluation for acute abdominal pain and acute abdomen.
• Create and implement a treatment plan for non-surgical causes of abdominal pain.
• Order and correctly interpret basic diagnostic imaging and laboratory studies.
• Consult surgeons and other subspecialists effectively and efficiently when indicated.
• Provide pre- and post-operative general pediatric care for the child requiring surgery, including pain management, according to local practice parameters.
• Coordinate care with the primary care provider and subspecialists to arrange an appropriate transition plan for hospital discharge.

Pediatric hospitalists should be able to:

• Exemplify collaborative practice with subspecialists, including surgical teams and primary care providers, to ensure efficient care within the hospital setting and coordinated longitudinal care.
• Realize responsibility for promoting effective communication with patients, family/caregivers, and healthcare providers regarding findings and care plans.

In order to improve efficiency and quality within their organizations, pediatric hospitalists should:

• Lead, coordinate, or participate in education of healthcare providers, trainees, the family/caregivers regarding the signs and symptoms of the acute abdomen to encourage early detection and prompt evaluation.
• Lead, coordinate, or participate in a multidisciplinary team to provide optimal care for children with acute abdominal pain with and without acute abdomen.
• Lead, coordinate, or participate in institutional efforts to improve the expediency of diagnostic laboratory and radiographic studies, availability of specialty care, and other resources for children with acute abdominal pain and acute abdomen.
• Lead, coordinate, or participate in institutional efforts to develop surgical consultation or co-management models, clearly defining roles to ensure timely, high quality, and comprehensive care for pediatric patients requiring surgical care.

Authors and Editors.............................................................3
External Reviewers.............................................................11

The Pediatric Hospital Medicine Core Competencies: 
2020 Revision—Introduction and Methodology.............................................................12
Jennifer Maniscalco, MD, MPH, MAcM, FAAP; Sandra Gage, MD, PhD, SFHM, FAAP; Sofia Teferi, MD, SFHM, FAAP; Erin Stucky Fisher, MD, MHM, FAAP

1.01 Acute Abdominal Pain and Acute Abdomen.............................................................18
1.02 Acute Gastroenteritis.............................................................20
1.03 Acute Respiratory Failure.............................................................22
1.04 Altered Mental Status.............................................................24
1.05 Asthma.............................................................26
1.06 Bone and Joint Infections.............................................................28
1.07 Brief Resolved Unexplained Event.............................................................30
1.08 Bronchiolitis.............................................................32
1.09 Central Nervous System Infections.............................................................34
1.10 Constipation.............................................................36
1.11 Diabetes Mellitus.............................................................37
1.12 Failure to Thrive.............................................................39
1.13 Fever of Unknown Origin.............................................................41
1.14 Fluid and Electrolyte Management.............................................................43
1.15 Gastrointestinal and Digestive Disorders.............................................................45
1.16 Head and Neck Disorders.............................................................47
1.17 Kawasaki Disease.............................................................49
1.18 Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome.............................................................50
1.19 Neonatal Fever.............................................................52
1.20 Neonatal Jaundice.............................................................54
1.21 Pneumonia.............................................................56
1.22 Seizures.............................................................57
1.23 Sepsis and Shock.............................................................59
1.24 Sickle Cell Disease.............................................................61
1.25 Skin and Soft Tissue Infections.............................................................63
1.26 Toxin Ingestion and Exposure.............................................................65
1.27 Urinary Tract Infections.............................................................67

2.01 Bladder Catheterization and Interpretation 
of Urinalysis.............................................................68
2.02 Communication.............................................................70
2.03 Diagnostic Imaging.............................................................72
2.04 Electrocardiogram Interpretation.............................................................74
2.05 Feeding Tubes.............................................................75
2.06 Intravenous Access and Phlebotomy.............................................................77
2.07 Lumbar Puncture.............................................................79
2.08 Non-invasive Monitoring.............................................................81
2.09 Nutrition.............................................................82
2.10 Oxygen Delivery and Airway Management.............................................................84
2.11 Pain Management.............................................................86
2.12 Pediatric Advanced Life Support.............................................................88
2.13 Peri-procedural Care.............................................................90
2.14 Preventive Care Services.............................................................92
2.15 Procedural Sedation.............................................................94

3.01 Acute Behavioral and Psychiatric Conditions.............................................................96
3.02 Adolescent and Young Adult Medicine.............................................................98
3.03 Child Abuse and Neglect.............................................................100
3.04 Child with Medical Complexity.............................................................102
3.05 Chronic Behavioral and Psychiatric Conditions.............................................................104
3.06 Newborn Care and Delivery Room Management.............................................................106
3.07 Palliative Care and Hospice.............................................................108
3.08 Pediatric Interfacility Transport.............................................................110

4.01 Advocacy.............................................................112
4.02 Business Practices.............................................................114
4.03 Consultation and Co-management.............................................................116
4.04 Education.............................................................118
4.05 Ethics.............................................................120
4.06 Evidence-based Medicine.............................................................122
4.07 Family Centered Care.............................................................123
4.08 Handoffs and Transitions of Care.............................................................125
4.09 Health Information Technology.............................................................127
4.10 High Value Care.............................................................129
4.11 Infection Control and Antimicrobial Stewardship.............................................................131
4.12 Leadership in Healthcare.............................................................133
4.13 Legal Issues and Risk Management.............................................................134
4.14 Patient Safety.............................................................136
4.15 Quality Improvement.............................................................138
4.16 Research.............................................................140

Chapter Links.............................................................142
These chapter links are guides to assist the reader in identifying chapters where some key relationships across knowledge, skills, attitudes, and systems organization and improvement may overlap. Chapter links are limited to 5 per chapter, are not comprehensive, and are intended as a general guide for the reader.
Figure: Needs Assessment Survey.............................................................145
Dedication.............................................................153
To Michael Burke, our friend and colleague

Authors and Editors.............................................................3
External Reviewers.............................................................11

The Pediatric Hospital Medicine Core Competencies: 
2020 Revision—Introduction and Methodology.............................................................12
Jennifer Maniscalco, MD, MPH, MAcM, FAAP; Sandra Gage, MD, PhD, SFHM, FAAP; Sofia Teferi, MD, SFHM, FAAP; Erin Stucky Fisher, MD, MHM, FAAP

1.01 Acute Abdominal Pain and Acute Abdomen.............................................................18
1.02 Acute Gastroenteritis.............................................................20
1.03 Acute Respiratory Failure.............................................................22
1.04 Altered Mental Status.............................................................24
1.05 Asthma.............................................................26
1.06 Bone and Joint Infections.............................................................28
1.07 Brief Resolved Unexplained Event.............................................................30
1.08 Bronchiolitis.............................................................32
1.09 Central Nervous System Infections.............................................................34
1.10 Constipation.............................................................36
1.11 Diabetes Mellitus.............................................................37
1.12 Failure to Thrive.............................................................39
1.13 Fever of Unknown Origin.............................................................41
1.14 Fluid and Electrolyte Management.............................................................43
1.15 Gastrointestinal and Digestive Disorders.............................................................45
1.16 Head and Neck Disorders.............................................................47
1.17 Kawasaki Disease.............................................................49
1.18 Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome.............................................................50
1.19 Neonatal Fever.............................................................52
1.20 Neonatal Jaundice.............................................................54
1.21 Pneumonia.............................................................56
1.22 Seizures.............................................................57
1.23 Sepsis and Shock.............................................................59
1.24 Sickle Cell Disease.............................................................61
1.25 Skin and Soft Tissue Infections.............................................................63
1.26 Toxin Ingestion and Exposure.............................................................65
1.27 Urinary Tract Infections.............................................................67

2.01 Bladder Catheterization and Interpretation 
of Urinalysis.............................................................68
2.02 Communication.............................................................70
2.03 Diagnostic Imaging.............................................................72
2.04 Electrocardiogram Interpretation.............................................................74
2.05 Feeding Tubes.............................................................75
2.06 Intravenous Access and Phlebotomy.............................................................77
2.07 Lumbar Puncture.............................................................79
2.08 Non-invasive Monitoring.............................................................81
2.09 Nutrition.............................................................82
2.10 Oxygen Delivery and Airway Management.............................................................84
2.11 Pain Management.............................................................86
2.12 Pediatric Advanced Life Support.............................................................88
2.13 Peri-procedural Care.............................................................90
2.14 Preventive Care Services.............................................................92
2.15 Procedural Sedation.............................................................94

3.01 Acute Behavioral and Psychiatric Conditions.............................................................96
3.02 Adolescent and Young Adult Medicine.............................................................98
3.03 Child Abuse and Neglect.............................................................100
3.04 Child with Medical Complexity.............................................................102
3.05 Chronic Behavioral and Psychiatric Conditions.............................................................104
3.06 Newborn Care and Delivery Room Management.............................................................106
3.07 Palliative Care and Hospice.............................................................108
3.08 Pediatric Interfacility Transport.............................................................110

4.01 Advocacy.............................................................112
4.02 Business Practices.............................................................114
4.03 Consultation and Co-management.............................................................116
4.04 Education.............................................................118
4.05 Ethics.............................................................120
4.06 Evidence-based Medicine.............................................................122
4.07 Family Centered Care.............................................................123
4.08 Handoffs and Transitions of Care.............................................................125
4.09 Health Information Technology.............................................................127
4.10 High Value Care.............................................................129
4.11 Infection Control and Antimicrobial Stewardship.............................................................131
4.12 Leadership in Healthcare.............................................................133
4.13 Legal Issues and Risk Management.............................................................134
4.14 Patient Safety.............................................................136
4.15 Quality Improvement.............................................................138
4.16 Research.............................................................140

Chapter Links.............................................................142
These chapter links are guides to assist the reader in identifying chapters where some key relationships across knowledge, skills, attitudes, and systems organization and improvement may overlap. Chapter links are limited to 5 per chapter, are not comprehensive, and are intended as a general guide for the reader.
Figure: Needs Assessment Survey.............................................................145
Dedication.............................................................153
To Michael Burke, our friend and colleague

Authors and Editors.............................................................3
External Reviewers.............................................................11

The Pediatric Hospital Medicine Core Competencies: 
2020 Revision—Introduction and Methodology.............................................................12
Jennifer Maniscalco, MD, MPH, MAcM, FAAP; Sandra Gage, MD, PhD, SFHM, FAAP; Sofia Teferi, MD, SFHM, FAAP; Erin Stucky Fisher, MD, MHM, FAAP

1.01 Acute Abdominal Pain and Acute Abdomen.............................................................18
1.02 Acute Gastroenteritis.............................................................20
1.03 Acute Respiratory Failure.............................................................22
1.04 Altered Mental Status.............................................................24
1.05 Asthma.............................................................26
1.06 Bone and Joint Infections.............................................................28
1.07 Brief Resolved Unexplained Event.............................................................30
1.08 Bronchiolitis.............................................................32
1.09 Central Nervous System Infections.............................................................34
1.10 Constipation.............................................................36
1.11 Diabetes Mellitus.............................................................37
1.12 Failure to Thrive.............................................................39
1.13 Fever of Unknown Origin.............................................................41
1.14 Fluid and Electrolyte Management.............................................................43
1.15 Gastrointestinal and Digestive Disorders.............................................................45
1.16 Head and Neck Disorders.............................................................47
1.17 Kawasaki Disease.............................................................49
1.18 Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome.............................................................50
1.19 Neonatal Fever.............................................................52
1.20 Neonatal Jaundice.............................................................54
1.21 Pneumonia.............................................................56
1.22 Seizures.............................................................57
1.23 Sepsis and Shock.............................................................59
1.24 Sickle Cell Disease.............................................................61
1.25 Skin and Soft Tissue Infections.............................................................63
1.26 Toxin Ingestion and Exposure.............................................................65
1.27 Urinary Tract Infections.............................................................67

2.01 Bladder Catheterization and Interpretation 
of Urinalysis.............................................................68
2.02 Communication.............................................................70
2.03 Diagnostic Imaging.............................................................72
2.04 Electrocardiogram Interpretation.............................................................74
2.05 Feeding Tubes.............................................................75
2.06 Intravenous Access and Phlebotomy.............................................................77
2.07 Lumbar Puncture.............................................................79
2.08 Non-invasive Monitoring.............................................................81
2.09 Nutrition.............................................................82
2.10 Oxygen Delivery and Airway Management.............................................................84
2.11 Pain Management.............................................................86
2.12 Pediatric Advanced Life Support.............................................................88
2.13 Peri-procedural Care.............................................................90
2.14 Preventive Care Services.............................................................92
2.15 Procedural Sedation.............................................................94

3.01 Acute Behavioral and Psychiatric Conditions.............................................................96
3.02 Adolescent and Young Adult Medicine.............................................................98
3.03 Child Abuse and Neglect.............................................................100
3.04 Child with Medical Complexity.............................................................102
3.05 Chronic Behavioral and Psychiatric Conditions.............................................................104
3.06 Newborn Care and Delivery Room Management.............................................................106
3.07 Palliative Care and Hospice.............................................................108
3.08 Pediatric Interfacility Transport.............................................................110

4.01 Advocacy.............................................................112
4.02 Business Practices.............................................................114
4.03 Consultation and Co-management.............................................................116
4.04 Education.............................................................118
4.05 Ethics.............................................................120
4.06 Evidence-based Medicine.............................................................122
4.07 Family Centered Care.............................................................123
4.08 Handoffs and Transitions of Care.............................................................125
4.09 Health Information Technology.............................................................127
4.10 High Value Care.............................................................129
4.11 Infection Control and Antimicrobial Stewardship.............................................................131
4.12 Leadership in Healthcare.............................................................133
4.13 Legal Issues and Risk Management.............................................................134
4.14 Patient Safety.............................................................136
4.15 Quality Improvement.............................................................138
4.16 Research.............................................................140

Chapter Links.............................................................142
These chapter links are guides to assist the reader in identifying chapters where some key relationships across knowledge, skills, attitudes, and systems organization and improvement may overlap. Chapter links are limited to 5 per chapter, are not comprehensive, and are intended as a general guide for the reader.
Figure: Needs Assessment Survey.............................................................145
Dedication.............................................................153
To Michael Burke, our friend and colleague

Thank you, Michael, for making us a stronger and more compassionate PHM Community.

The Editors and Associate Editors of The Pediatric Hospital Medicine Core Competencies: 2020 Revision:

Francisco Alvarez; Weijen Chang; Erin Fisher; Sandra Gage; Jennifer Maniscalco; Vineeta Mittal; Anand Sekaran; Amit Singh; Sofia Teferi

Thank you, Michael, for making us a stronger and more compassionate PHM Community.

The Editors and Associate Editors of The Pediatric Hospital Medicine Core Competencies: 2020 Revision:

Francisco Alvarez; Weijen Chang; Erin Fisher; Sandra Gage; Jennifer Maniscalco; Vineeta Mittal; Anand Sekaran; Amit Singh; Sofia Teferi

Thank you, Michael, for making us a stronger and more compassionate PHM Community.

The Editors and Associate Editors of The Pediatric Hospital Medicine Core Competencies: 2020 Revision:

Francisco Alvarez; Weijen Chang; Erin Fisher; Sandra Gage; Jennifer Maniscalco; Vineeta Mittal; Anand Sekaran; Amit Singh; Sofia Teferi

NEEDS ASSESSMENT SURVEY

The editors conducted a needs assessment survey with several stakeholder groups, including SHM’s Pediatrics and Medicine-Pediatrics SIGs, AAP Section on Hospital Medicine and its subcommittees, APA Hospital Medicine SIG, PHM Fellowship Directors Council,and PHM Division Directors, with encouragement to pass the survey link to others in the PHM community interested in providing input (Appendix Figure). The solicitation asked for comment  on existing chapters and suggestions for new chapters. For any new chapter, respondents were asked to note the intended purpose of the chapter and the anticipated value that chapter would bring to our profession and the children and the caregivers served by pediatric hospitalists.

CHAPTER LINKS

These chapter links are guides to assist the reader in identifying chapters where some key relationships across knowledge, skills, attitudes, and systems organization and improvement may overlap. Chapter links are limited to 5 per chapter, are not comprehensive, and are intended as a general guide for the reader.

NEEDS ASSESSMENT SURVEY

The editors conducted a needs assessment survey with several stakeholder groups, including SHM’s Pediatrics and Medicine-Pediatrics SIGs, AAP Section on Hospital Medicine and its subcommittees, APA Hospital Medicine SIG, PHM Fellowship Directors Council,and PHM Division Directors, with encouragement to pass the survey link to others in the PHM community interested in providing input (Appendix Figure). The solicitation asked for comment  on existing chapters and suggestions for new chapters. For any new chapter, respondents were asked to note the intended purpose of the chapter and the anticipated value that chapter would bring to our profession and the children and the caregivers served by pediatric hospitalists.

CHAPTER LINKS

These chapter links are guides to assist the reader in identifying chapters where some key relationships across knowledge, skills, attitudes, and systems organization and improvement may overlap. Chapter links are limited to 5 per chapter, are not comprehensive, and are intended as a general guide for the reader.

NEEDS ASSESSMENT SURVEY

The editors conducted a needs assessment survey with several stakeholder groups, including SHM’s Pediatrics and Medicine-Pediatrics SIGs, AAP Section on Hospital Medicine and its subcommittees, APA Hospital Medicine SIG, PHM Fellowship Directors Council,and PHM Division Directors, with encouragement to pass the survey link to others in the PHM community interested in providing input (Appendix Figure). The solicitation asked for comment  on existing chapters and suggestions for new chapters. For any new chapter, respondents were asked to note the intended purpose of the chapter and the anticipated value that chapter would bring to our profession and the children and the caregivers served by pediatric hospitalists.

CHAPTER LINKS

These chapter links are guides to assist the reader in identifying chapters where some key relationships across knowledge, skills, attitudes, and systems organization and improvement may overlap. Chapter links are limited to 5 per chapter, are not comprehensive, and are intended as a general guide for the reader.

Francisco Alvarez, MD
Associate Chief, Regional Pediatric Hospitalist Programs
Lucile Packard Children’s Hospital
Clinical Associate Professor
Stanford University School of Medicine
Stanford, CA
Fever of Unknown Origin

Brian Alverson, MD
Director, Division of Pediatric Hospital Medicine
Hasbro Children’s Hospital
Professor of Pediatrics
Alpert School of Medicine, Brown University
Providence, RI
Pneumonia

Eric Balighian, MD
Director, Pediatric Emergency Department
St. Agnes Hospital
Asistant Professor, Department of Pediatrics
Johns Hopkins University School of Medicine
Baltimore, MD
Acute Abdominal Pain and Acute Abdomen

Julia Beauchamp-Walters, MD
Medical Director, Helen Bernardy Center for Medically Fragile Children
Medical Director, Home Care
Co-Medical Director, Emergency Transport Program
Rady Children’s Hospital
Clinical Professor of Pediatrics
University of California, San Diego
San Diego, CA
Feeding Tubes
Pediatric Interfacility Transport

Eric Biondi, MD, MS
Director, Pediatric Hospital Medicine Division
Johns Hopkins Children’s Center
Associate Professor of Pediatrics
The Johns Hopkins Hospital University School of Medicine
Baltimore, MD
Neonatal Fever

Rebecca Blankenberg, MD, MPH
Associate Chair of Education
Stanford Lucile Packard Children’s Hospital
Clinical Associate Professor of Pediatrics and Emergency Medicine
Stanford University School of Medicine
Stanford, CA
Education

Colin Bridgeman, MD
Penn State Children’s Hospital
Assistant Professor of Pediatrics
Division of General Inpatient Pediatrics
Penn State College of Medicine
Hershey, PA
Head and Neck Disorders

Jeffrey Brown, MD, MPH, CAP, FAAP
Texas Newborn Services/Pediatrix Medical Group
Clinical Professor of Pediatrics
University of Colorado School of Medicine
Fort Worth, TX
Business Practices

April O. Buchanan, MD
Associate Dean for Curriculum
Prisma Health Children’s Hospital at Greenville
Associate Professor of Clinical Pediatrics
University of South Carolina School of Medicine
Greenville, SC
Sepsis and Shock

Douglas Carlson, MD
Medical Director
HSHS St. John’s Children’s Hospital
Professor and Chair of Pediatrics
Southern Illinois University School of Medicine
Springfield, MO
Procedural Sedation

Pearl Chang, MD
Seattle Children’s Hospital
Assistant Professor
Department of Pediatrics, University of Washington
Seattle, WA
Neonatal Jaundice

Eric Coon, MD, MS
Co-Director, Pediatric Hospital Medicine Fellowship
Primary Children’s Medical Center
Assistant Professor of Pediatrics
University of Utah Health Science
Salt Lake City, UT
Research

Yasmeen N. Daud, MD
St. Louis Children’s Hospital
Associate Professor of Pediatrics
Washington University School of Medicine
St. Louise, MO
Oxygen Delivery and Airway Management

Sarah Denniston, MD, FAAP
Fellowship Director, Pediatric Hospital Medicine
The Floating Hospital for Children at Tufts Medical Center
Assistant Professor of Pediatrics
Tufts University School of Medicine
Associate DIO for Quality and Safety
Tufts Medical Center
Boston, MA
Peri-procedural Care

Craig C. DeWolfe, MD, MEd, FAAP
Children’s National Health System
Director of Medical Student Education in Pediatrics
Associate Professor of Pediatrics,
George Washington University School of Medicine
Washington, DC
Brief Resolved Unexplained Event

Stephanie Anne Deutsch, MD, MS, FAAP
Section Chief, Child Abuse Pediatrics
Nemours/Alfred I. duPont Hospital for Children
Co-medical Director, CARE (Children at Risk Evaluation) Program
Assistant Clinical Professor of Pediatrics
Sidney Kimmel Medical College at Thomas Jefferson University
Wilmington, Delaware
Child Abuse and Neglect

Ami Doshi, MD
Medical Director, Inpatient Palliative Care Program
Rady Children’s Hospital San Diego
Clinical Associate Professor of Pediatrics
University of California San Diego School of Medicine
San Diego, CA
Palliative Care and Hospice

Erin Fisher, MD, FAAP, MHM
Medical Director, Quality Improvement
Rady Children’s Hospital San Diego
Professor of Clinical Pediatrics
Director, Pediatric Quality and Safety Graduate Medical Education
Fellowship Director and Division Director, Pediatric Hospital Medicine
University of California San Diego School of Medicine
San Diego, CA
Quality Improvement

Sandra Gage, MD, PhD, FAAP, SFHM
Associate Division Chief and Associate Fellowship Director
Division of Hospital Medicine
Phoenix Children’s Hospital
Clinical Associate Professor
University of Arizona College of Medicine – Phoenix
Department of Child Health
Phoenix, AZ
Acute Gastroenteritis
Gastrointestinal and Digestive Disorders

Mary Pat Gallagher, MD
Director, Pediatric Diabetes Center
Division of Pediatric Endocrinology, Hassenfeld Children’s Hospital
Assistant Professor
Department of Pediatrics
NYU Langone
New York, NY
Diabetes Mellitus

Amrit Gill, MD
Cleveland Clinic Children’s Hospital
Clinical Assistant Professor of Pediatrics
Case Western Reserve University School of Medicine
Cleveland, OH
Patient Safety

Veena Goel Jones, MD, FAAP
Medical Director, Digital Patient Experience, Sutter Health
Sutter Palo Alto Medical Foundation
Palo Alto, CA
Health Information Technology

Jeffrey Grill, MD
Vice Chair, Community Relations and Outreach
Chief, Division of Pediatric Hospital Medicine
Director, Just for Kids Hospitalist Service
Norton Children’s Hospital
Professor, Department of Pediatrics
University of Louisville School of Medicine
Louisville, KY
Constipation

Arun Gupta, MD
Director, Neonatal Hospitalist Program
Lucile Packard Children’s Hospital Stanford
Clinical Associate Professor, Pediatrics
Stanford University School of Medicine
Stanford, CA
Newborn Care and Delivery Room Management

Brian F Herbst Jr, MD
Medical Director, Hospital Medicine Adult Care
Division of Hospital Medicine
Cincinnati Children’s Hospital Medical Center
Assistant Professor of Internal Medicine and Pediatrics
University of Cincinnati College of Medicine
Cincinnati, OH
Adolescent and Young Adult Medicine

Daniel Hershey, MD, SFHM
Rady Children’s Hospital
Clinical Professor of Pediatrics
University of California, San Diego
San Diego, CA
Non-invasive Monitoring

Kim Hoang, MD, FAAP
Lucile Packard Children’s Hospital
Clinical Assistant Professor
Stanford University School of Medicine
Stanford, CA
Education

Alison Volpe Holmes, MD, MPH
Children’s Hospital at Dartmouth-Hitchcock
Associate Dean for Student Affairs, Career Advising
Vice-Chair for Education, Department of Pediatrics
Associate Professor of Pediatrics and of The Dartmouth Institute
Geisel School of Medicine at Dartmouth
Hanover, NH
Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome

Akshata Hopkins, MD, FAAP, FHM
Director, Pediatric Residency Program
Johns Hopkins All Children’s Hospital
Assistant Professor of Pediatrics
Johns Hopkins University School of Medicine
St. Petersburg, FL
High Value Care

Yemisi Jones, MD, FAAP, FHM
Co-Medical Director, Continuing Medical Education
Co-Director Liberty Simulation Education
Cincinnati Children’s Hospital Medical Center
Assistant Professor of Clinical Pediatrics
University of Cincinnati College of Medicine
Cincinnati, OH
Intravenous Access and Phlebotomy

Alisa Khan, MD, MPH
Health Services Researcher
Division of General Pediatrics, Boston Children’s Hospital
Clinical Instructor in Pediatrics
Harvard Medical School
Boston, MA
Family Centered Care

Vivian Lee, MD
Children’s Hospital Los Angeles
Clinical Assistant Professor of Pediatrics
University of Southern California Keck School of Medicine
Los Angeles, CA
Altered Mental Status

Su-Ting T. Li, MD, MPH
Associate Vice Chair of Education
Pediatric Residency Program Director
University of California Davis Children’s Hospital
Professor of Pediatrics
University of California, Davis
Sacramento, CA
Skin and Soft Tissue Infections

Patricia S. Lye, MD, MEd, FAAP
Children’s Hospital of Wisconsin
Professor of Pediatrics, Retired
Medical College of Wisconsin
Milwaukee, WI
Handoffs and Transitions of Care

Tamara Maginot, PhD
Pediatric Psychologist
Program Director, Medical Behavioral Unit
Rady Children’s Hospital San Diego
Assistant Professor, Department of Psychiatry
UC San Diego Eating Disorders Center for Treatment and Research Behavioral Medicine
San Diego, CA
Chronic Behavioral and Psychiatric Conditions

Christopher Maloney, MD, PhD, FAAP
Chief Medical Officer and Senior Vice President
Children’s Hospital & Medical Center
Professor of Pediatrics and Pediatric Critical Care
Department of Pediatrics
University of Nebraska Medical Center College of Medicine
Omaha, NE 
Pediatric Advanced Life Support

Jennifer Maniscalco, MD, MPH, MAcM, FAAP
Designated Institutional Official
Johns Hopkins All Children’s Hospital
Assistant Professor
Department of Pediatrics
Johns Hopkins University School of Medicine
St. Petersburg, FL
Failure to Thrive

Elizabeth Mannino Avila, MD
Rady Children’s Hospital
Assistant Clinical Professor of Pediatrics
University of California, San Diego
San Diego, CA
Kawasaki Disease

Alison Markowsky, MD, MSHS, FAAP
Medical Director
Children’s National Pediatric Hospitalist Program at Mary Washington Healthcare
Children’s National Health System
Assistant Professor of Pediatrics
The George Washington University School of Medicine & Health Sciences
Washington, DC
Newborn Care and Delivery Room Management

Michelle Marks, DO, FAAP, SFHM
Chair, Pediatric Hospital Medicine
Cleveland Clinic Children’s Hospital
Clinical Associate Professor
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University
Cleveland, OH
Nutrition

Armand H. Matheny Antommaria, MD, PhD, FAAP
Lee Ault Carter Chair Pediatric Ethics and Pediatric Hospitalist
Cincinnati Children’s Hospital
Associate Professor of Clinical-Affiliated
University of Cincinnati School of Medicine
Cincinnati, OH
Ethics

Erich Maul, MD
Division Chief, Hospital Medicine
Medical Director, Acute Care and Progressive Care
Kentucky Children’s Hospital
Professor of Pediatrics
University of Kentucky School of Medicine
Lexington, KY
Electrocardiogram Interpretation

Rusty McCulloh, MD
Chief, Division of Hospital Medicine
Children’s Hospital & Medical Center
Associate Professor, Division of Hospital Medicine
University of Nebraska College of Medicine
Omaha, NE
Infection Control and Antimicrobial Stewardship

Anjna Melwani, MD
Director, Preoperative Care Clinic
Children’s National Medical Center
Associate Professor of Pediatrics
George Washington University School of Medicine and Health Sciences
Washington, DC
Consultation and Co-management

Christopher Miller, MD
Pediatric Allergist
Children’s Mercy Hospitals and Clinics
Assistant Professor of Pediatrics
Section of Allergy and Immunology
University of Missouri-Kansas City School of Medicine
Kansas City, MO
Asthma

Vineeta Mittal, MD, MBA
Imm. Past President of the Medical/Dental Staff
Children’s Medical Center
Associate Professor of Pediatrics
Director of Pediatric Hospital Medicine
Department of Pediatrics
UT Southwestern Medical Center & Children’s Health System Dallas
Dallas, TX
Acute Respiratory Failure

Beth Natt, MD, MPH, FAAP, SFHM
Director, Pediatric Hospital Medicine, Regional Programs
Connecticut Children’s Medical Center
Associate Professor of Pediatrics
University of Connecticut School of Medicine
Farmington, CT
Bladder Catheterization and Interpretation of Urinalysis

Jennifer O’Toole, MD, MEd, FAAP, SFHM
Program Director, Internal Medicine – Pediatrics Residency
Director of Education, Division of Hospital Medicine
Cincinnati Children’s Hospital Medical Center
Associate Professor of Pediatrics and Internal Medicine
University of Cincinnati College of Medicine
Cincinnati, OH
Adolescent and Young Adult Medicine

Mary Ottolini, MD, MPH, MEd, FAAP
George W. Hallett Chair of Pediatrics
Barbara Bush Children’s Hospital at Maine Medical Center
Professor of Pediatrics
Tufts University School of Medicine
Portland, ME
Fluid and Electrolyte Management

Jack Percelay, MD, MPH, FAAP, MHM
Stanford Lucile Packard Children’s Hospital
Clinical Associate Professor of Pediatrics
Stanford University School of Medicine
Stanford, CA
Advocacy
Seizures

Shannon Phillips, MD, MPH
Chief Patient Safety and Experience Officer
Primary Children’s Medical Center
Intermountain Healthcare, Inc.
Adjunct Associate Professor of Pediatrics
University of Utah Health Sciences
Salt Lake City, UT
Patient Safety

David Pressel, MD, PhD, FAAP, FHM
Medical Director, Pediatric Hospitalist Program
Capital Health Medical Center- Hopewell
Pennington, NJ
Acute Behavioral and Psychiatric Conditions
Child Abuse and Neglect

Ricardo Quinonez, MD, FAAP
Chief, Pediatric Hospital Medicine
Texas Children’s Hospital
Associate Professor of Pediatrics
Baylor College of Medicine
Houston, TX
High Value Care

Shawn Ralston, MA, MD, MS
Johns Hopkins Children’s Center
Editor, Hospital Pediatrics, American Academy of Pediatrics
Associate Professor of Pediatrics
Division of Pediatric Quality and Safety
The Johns Hopkins Hospital University School of Medicine
Baltimore, MD
Evidence Based Medicine

David I. Rappaport, MD, FAAP, FHM
Associate Residency Program Director
Division of General Pediatrics
Nemours/AI duPont Hospital for Children
Wilmington, DE
Associate Professor of Pediatrics
Sidney Kimmel Medical College at Jefferson
Philadelphia, PA
Consultation and Co-management

Daniel Rauch, MD, FAAP, SFHM
Chief, Pediatric Hospital Medicine
The Floating Hospital for Children at Tufts Medical Center.
Professor of Pediatrics
Tufts University School of Medicine
Boston, MA
Preventive Care Services

Kyung (Kay) Rhee, MD, MSc, MA
Director of Research, Division of Pediatric Hospital Medicine
Medical Director, Medical Behavioral Unit
Rady Children’s Hospital San Diego
Professor of Clinical Pediatrics
Department of Pediatrics, Division of General Academic Pediatrics, Developmental Pediatrics, and Center for Community Health
University of San Diego School of Medicine
San Diego, CA
Chronic Behavioral and Psychiatric Conditions

Jeffrey Riese, MD
Associate Pediatric Residency Program Director
Hasbro Children’s Hospital
Associate Professor of Pediatrics
Warren Alpert School of Medicine at Brown University
Providence, RI
Neonatal Fever

Ken Roberts, MD, FAAP
Professor Emeritus of Pediatrics
University of North Carolina School of Medicine
Chapel Hill, NC
Urinary Tract Infections

Amanda Rogers, MD
Associate Pediatric Residency Program Director
Children’s Hospital of Wisconsin
Assistant Professor, Section of Hospital Medicine
Medical College of Wisconsin
Milwaukee, WI
Lumbar Puncture

Rebecca E. Rosenberg, MD, MPH
Chief, Section of Hospital Medicine, Division of General Pediatrics
Hassenfeld Children’s Hospital at NYU Langone Health
Associate Professor of Pediatrics
NYU School of Medicine
New York, NY
Peri-procedural Care

Michael Ruhlen, MD, MHCM, FHM, FACHE
Vice President, Division of Medical Education
Vice Chair, RRC ACGME
Atrium Health System
Charlotte, NC
Legal Issues and Risk Management

Christopher J. Russell, MD, MS, FAAP
Research Director, Division of Hospital Medicine
Children’s Hospital Los Angeles
Assistant Professor of Clinical Pediatrics
Keck School of Medicine, University of Southern California
Los Angeles, CA
Child with Medical Complexity

Christopher Russo, MD
Director of Pediatrics
Central Lynchburg General Hospital
Assistant Professor of Pediatrics
Liberty University College of Osteopathic Medicine
Lynchburg, VA
Advocacy

Klint M. Schwenk, MD, MBA, FAAP, FHM
Associate Division Chief, Pediatric Hospital Medicine
Norton Children’s Hospital
Associate Professor of Pediatrics
University of Louisville
Louisville, KY
Acute Gastroenteritis
Gastrointestinal and Digestive Disorders

Anand Sekaran, MD, FAAP
Associate Chair of Pediatrics, Clinical Affairs
Division Chief, Hospital Medicine
Connecticut Children’s Medical Center
Associate Professor of Pediatrics
University of Connecticut School of Medicine
Hartford, CT
Diagnostic Imaging

Kristin A. Shadman, MD, FAAP
American Family Children’s Hospital
Associate Professor of Pediatrics
Division of Hospital Medicine
University of Wisconsin School of Medicine and Public Health
Madison, WI
Oxygen Delivery and Airway Management

Samir S. Shah, MD, MSCE
Director, Division of Hospital Medicine
James M. Ewell Endowed Chair
Attending Physician in Hospital Medicine & Infectious Diseases
Chief Metrics Officer
Cincinnati Children’s Hospital Medical Center
Professor, Department of Pediatrics
University of Cincinnati College of Medicine
Cincinnati, OH
Bone and Joint Infections

Mark Shen, MD, MBA, FAAP, SFHM
Associate Professor of Pediatrics
Dell Medical School at the University of Texas at Austin
Austin, TX
Leadership in Healthcare

Tamara Simon, MD, MSPH, FAAP
Principal Investigator, Center for Clinical and Translational Research
Seattle Children’s Research Institute
Associate Professor of Pediatrics
Divisions of Hospital Medicine and General Pediatrics, Department of Pediatrics
University of Washington
Seattle, WA
Child with Medical Complexity

Amit Singh, MD, FAAP
Lucile Packard Children’s Hospital
Clinical Assistant Professor
Division of Pediatric Hospital Medicine, Department of Pediatrics
Stanford University School of Medicine
Stanford, CA
Communication

Karen Smith, MD, MEd, SFHM, FAAP
Chief, Division of Pediatric Hospital Medicine
Children’s National Medical Center
Associate Professor of Pediatrics
The George Washington School of Medicine and Health Sciences
Washington, DC
Business Practices

Nita Srinivas, MD
Pediatric Hospitalist and Infectious Disease Specialist
Fellowship Director, Pediatric Hospital Medicine
Lucile Packard Children’s Hospital
Clinical Assistant Professor
Stanford University School of Medicine
Stanford, CA
Fever of Unknown Origin

Rajendu Srivastava, MD, FRCP(C), MPH
Primary Children’s Medical Center
Assistant Vice President of Research and Medical Director of the Office of Research
Intermountain Healthcare Inc.
Professor of Pediatrics
University of Utah Health Sciences
Salt Lake City, UT
Research

Lynne Sterni, MD
Pediatric Anesthesiology and Pain Medicine
Naval Medical Center San Diego
Assistant Professor
Uniformed Services University School of Health Sciences
San Diego, CA
Pain Management

E. Douglas Thompson Jr, MD, FAAP
Chief, Section of Hospital Medicine
Associate Chair, Access and Partnerships
St. Christopher’s Hospital for Children
Associate Professor of Pediatrics
Drexel University School of Medicine and Health Sciences
Philadelphia, PA
Sickle Cell Disease

Joanna Thomson, MD, MPH, FAAP
Associate Fellowship Program Director, Pediatric Hospital Medicine
Cincinnati Children’s Hospital Medical Center
Assistant Professor, Department of Pediatrics
University of Cincinnati School of Medicine
Cincinnati, OH
Acute Respiratory Failure

Joel Tieder, MD, MPH
Seattle Children’s Hospital
Associate Professor of Pediatrics, Division of Hospital Medicine
University of Washington School of Medicine
Seattle, WA
Brief Resolved Unexplained Event

Adriana Tremoulet, MD, MAS
Associate Director, Kawasaki Disease Research Center
Division of Host-Microbe Systems and Therapeutics
Pediatric Infectious Diseases and Kawasaki Disease
Associate Professor of Pediatrics, University of California San Diego
San Diego, CA
Kawasaki Disease

Marie E. Wang, MD, MPH, FAAP
Associate Fellowship Program Director, Pediatric Hospital Medicine
Lucile Packard Children’s Hospital
Clinical Assistant Professor 
Stanford University School of Medicine
Stanford, CA
Central Nervous System Infections

Ronald Williams, MD, FAAP, FACP
Director, Combined Internal Medicine/Pediatrics Residency Program
Penn State Hershey Children’s Hospital
Professor of Pediatrics and Medicine
Penn State College of Medicine
Hershey, PA
Head and Neck Disorders

Susan Wu, MD, FAAP
Children’s Hospital Los Angeles
Associate Professor of Clinical Pediatrics
Division of Hospital Medicine, Department of Pediatrics
USC Keck School of Medicine
Los Angeles, CA
Bronchiolitis

Sandra Gage, MD, PhD, FAAP, SFHM
Associate Division Chief and Associate Fellowship Director
Division of Hospital Medicine
Phoenix Children’s Hospital
Clinical Associate Professor
University of Arizona College of Medicine – Phoenix
Department of Child Health
Phoenix, AZ

Jennifer Maniscalco, MD, MPH, MAcM, FAAP
Designated Institutional Official
Johns Hopkins All Children’s Hospital
Assistant Professor
Department of Pediatrics
Johns Hopkins University School of Medicine
St. Petersburg, FL

Erin Fisher, MD, MHM, FAAP
Medical Director Quality Improvement
Rady Children’s Hospital
Professor of Clinical Pediatrics
Director of Pediatric Quality and Safety Graduate Medical Education
Fellowship Director and Division Director, Pediatric Hospital Medicine
University of California San Diego School of Medicine
Department of Pediatrics
San Diego, CA

Sofia Teferi, MD, FAAP, SFHM
Physician Executive
Richmond, VA

ASSOCIATE EDITORS

Francisco Alvarez, MD, FAAP
Associate Chief, Regional Pediatric Hospital Medicine Programs
Lucile Packard Children’s Hospital
Clinical Associate Professor
Stanford School of Medicine
Stanford, CA 

Michael Burke, MD (1957 – 2019)
In memory: Chairman of Pediatrics
Saint Agnes Hospital
Associate Professor of Pediatrics
Johns Hopkins University School of Medicine
Baltimore, MD

Weijen Chang, MD
Division Chief, Pediatric Hospital Medicine
Vice Chair for Clinical Affairs, Department of Pediatrics
Baystate Children’s Hospital
Associate Professor of Pediatrics
University of Massachusetts Medical School-Baystate
Springfield, MA

Vineeta Mittal, MD, MBA
Imm. Past President of the Medical/Dental Staff
Children’s Medical Center
Associate Professor of Pediatrics
Director of Pediatric Hospital Medicine
Department of Pediatrics
UT Southwestern Medical Center & Children’s Health System, Dallas
Dallas, TX

Anand Sekaran, MD
Associate Chair of Pediatrics, Clinical Affairs
Division Chief, Hospital Medicine
Connecticut Children’s Medical Center
Associate Professor of Pediatrics
University of Connecticut School of Medicine
Hartford, CT

Amit Singh, MD, FAAP
Lucile Packard Children’s Hospital
Clinical Assistant Professor
Division of Pediatric Hospital Medicine
Department of Pediatrics
Stanford University School of Medicine
Stanford, CA

Academic Pediatric Association Hospital Medicine Special Interest Group

American Academy of Pediatrics

• Committee on Psychological Aspects of Child and Family Health
• Council on Children with Disabilities
• Council on Community Pediatrics
• Disaster Preparedness Advisory Council
• Family Partnerships Network
• Section on Anesthesiology and Pain Medicine
• Section on Breastfeeding
• Section on Cardiology and Cardiac Surgery
• Section on Critical Care
• Section on Hematology/Oncology
• Section on Hospice and Palliative Medicine
• Section on Hospital Medicine
• Section on LGBT Health and Wellness
• Section on Medicine-Pediatrics
• Section on Nephrology
• Section on Neurology
• Section on Pediatric Trainees
• Section on Surgery
• Section on Transport Medicine
• Section on Urology

Association of Pediatric Program Directors Curriculum Committee

Society of Hospital Medicine Pediatrics Special Interest Group

Society of Hospital Medicine Medicine-Pediatrics Special Interest Group

Francisco Alvarez, MD
Associate Chief, Regional Pediatric Hospitalist Programs
Lucile Packard Children’s Hospital
Clinical Associate Professor
Stanford University School of Medicine
Stanford, CA
Fever of Unknown Origin

Brian Alverson, MD
Director, Division of Pediatric Hospital Medicine
Hasbro Children’s Hospital
Professor of Pediatrics
Alpert School of Medicine, Brown University
Providence, RI
Pneumonia

Eric Balighian, MD
Director, Pediatric Emergency Department
St. Agnes Hospital
Asistant Professor, Department of Pediatrics
Johns Hopkins University School of Medicine
Baltimore, MD
Acute Abdominal Pain and Acute Abdomen

Julia Beauchamp-Walters, MD
Medical Director, Helen Bernardy Center for Medically Fragile Children
Medical Director, Home Care
Co-Medical Director, Emergency Transport Program
Rady Children’s Hospital
Clinical Professor of Pediatrics
University of California, San Diego
San Diego, CA
Feeding Tubes
Pediatric Interfacility Transport

Eric Biondi, MD, MS
Director, Pediatric Hospital Medicine Division
Johns Hopkins Children’s Center
Associate Professor of Pediatrics
The Johns Hopkins Hospital University School of Medicine
Baltimore, MD
Neonatal Fever

Rebecca Blankenberg, MD, MPH
Associate Chair of Education
Stanford Lucile Packard Children’s Hospital
Clinical Associate Professor of Pediatrics and Emergency Medicine
Stanford University School of Medicine
Stanford, CA
Education

Colin Bridgeman, MD
Penn State Children’s Hospital
Assistant Professor of Pediatrics
Division of General Inpatient Pediatrics
Penn State College of Medicine
Hershey, PA
Head and Neck Disorders

Jeffrey Brown, MD, MPH, CAP, FAAP
Texas Newborn Services/Pediatrix Medical Group
Clinical Professor of Pediatrics
University of Colorado School of Medicine
Fort Worth, TX
Business Practices

April O. Buchanan, MD
Associate Dean for Curriculum
Prisma Health Children’s Hospital at Greenville
Associate Professor of Clinical Pediatrics
University of South Carolina School of Medicine
Greenville, SC
Sepsis and Shock

Douglas Carlson, MD
Medical Director
HSHS St. John’s Children’s Hospital
Professor and Chair of Pediatrics
Southern Illinois University School of Medicine
Springfield, MO
Procedural Sedation

Pearl Chang, MD
Seattle Children’s Hospital
Assistant Professor
Department of Pediatrics, University of Washington
Seattle, WA
Neonatal Jaundice

Eric Coon, MD, MS
Co-Director, Pediatric Hospital Medicine Fellowship
Primary Children’s Medical Center
Assistant Professor of Pediatrics
University of Utah Health Science
Salt Lake City, UT
Research

Yasmeen N. Daud, MD
St. Louis Children’s Hospital
Associate Professor of Pediatrics
Washington University School of Medicine
St. Louise, MO
Oxygen Delivery and Airway Management

Sarah Denniston, MD, FAAP
Fellowship Director, Pediatric Hospital Medicine
The Floating Hospital for Children at Tufts Medical Center
Assistant Professor of Pediatrics
Tufts University School of Medicine
Associate DIO for Quality and Safety
Tufts Medical Center
Boston, MA
Peri-procedural Care

Craig C. DeWolfe, MD, MEd, FAAP
Children’s National Health System
Director of Medical Student Education in Pediatrics
Associate Professor of Pediatrics,
George Washington University School of Medicine
Washington, DC
Brief Resolved Unexplained Event

Stephanie Anne Deutsch, MD, MS, FAAP
Section Chief, Child Abuse Pediatrics
Nemours/Alfred I. duPont Hospital for Children
Co-medical Director, CARE (Children at Risk Evaluation) Program
Assistant Clinical Professor of Pediatrics
Sidney Kimmel Medical College at Thomas Jefferson University
Wilmington, Delaware
Child Abuse and Neglect

Ami Doshi, MD
Medical Director, Inpatient Palliative Care Program
Rady Children’s Hospital San Diego
Clinical Associate Professor of Pediatrics
University of California San Diego School of Medicine
San Diego, CA
Palliative Care and Hospice

Erin Fisher, MD, FAAP, MHM
Medical Director, Quality Improvement
Rady Children’s Hospital San Diego
Professor of Clinical Pediatrics
Director, Pediatric Quality and Safety Graduate Medical Education
Fellowship Director and Division Director, Pediatric Hospital Medicine
University of California San Diego School of Medicine
San Diego, CA
Quality Improvement

Sandra Gage, MD, PhD, FAAP, SFHM
Associate Division Chief and Associate Fellowship Director
Division of Hospital Medicine
Phoenix Children’s Hospital
Clinical Associate Professor
University of Arizona College of Medicine – Phoenix
Department of Child Health
Phoenix, AZ
Acute Gastroenteritis
Gastrointestinal and Digestive Disorders

Mary Pat Gallagher, MD
Director, Pediatric Diabetes Center
Division of Pediatric Endocrinology, Hassenfeld Children’s Hospital
Assistant Professor
Department of Pediatrics
NYU Langone
New York, NY
Diabetes Mellitus

Amrit Gill, MD
Cleveland Clinic Children’s Hospital
Clinical Assistant Professor of Pediatrics
Case Western Reserve University School of Medicine
Cleveland, OH
Patient Safety

Veena Goel Jones, MD, FAAP
Medical Director, Digital Patient Experience, Sutter Health
Sutter Palo Alto Medical Foundation
Palo Alto, CA
Health Information Technology

Jeffrey Grill, MD
Vice Chair, Community Relations and Outreach
Chief, Division of Pediatric Hospital Medicine
Director, Just for Kids Hospitalist Service
Norton Children’s Hospital
Professor, Department of Pediatrics
University of Louisville School of Medicine
Louisville, KY
Constipation

Arun Gupta, MD
Director, Neonatal Hospitalist Program
Lucile Packard Children’s Hospital Stanford
Clinical Associate Professor, Pediatrics
Stanford University School of Medicine
Stanford, CA
Newborn Care and Delivery Room Management

Brian F Herbst Jr, MD
Medical Director, Hospital Medicine Adult Care
Division of Hospital Medicine
Cincinnati Children’s Hospital Medical Center
Assistant Professor of Internal Medicine and Pediatrics
University of Cincinnati College of Medicine
Cincinnati, OH
Adolescent and Young Adult Medicine

Daniel Hershey, MD, SFHM
Rady Children’s Hospital
Clinical Professor of Pediatrics
University of California, San Diego
San Diego, CA
Non-invasive Monitoring

Kim Hoang, MD, FAAP
Lucile Packard Children’s Hospital
Clinical Assistant Professor
Stanford University School of Medicine
Stanford, CA
Education

Alison Volpe Holmes, MD, MPH
Children’s Hospital at Dartmouth-Hitchcock
Associate Dean for Student Affairs, Career Advising
Vice-Chair for Education, Department of Pediatrics
Associate Professor of Pediatrics and of The Dartmouth Institute
Geisel School of Medicine at Dartmouth
Hanover, NH
Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome

Akshata Hopkins, MD, FAAP, FHM
Director, Pediatric Residency Program
Johns Hopkins All Children’s Hospital
Assistant Professor of Pediatrics
Johns Hopkins University School of Medicine
St. Petersburg, FL
High Value Care

Yemisi Jones, MD, FAAP, FHM
Co-Medical Director, Continuing Medical Education
Co-Director Liberty Simulation Education
Cincinnati Children’s Hospital Medical Center
Assistant Professor of Clinical Pediatrics
University of Cincinnati College of Medicine
Cincinnati, OH
Intravenous Access and Phlebotomy

Alisa Khan, MD, MPH
Health Services Researcher
Division of General Pediatrics, Boston Children’s Hospital
Clinical Instructor in Pediatrics
Harvard Medical School
Boston, MA
Family Centered Care

Vivian Lee, MD
Children’s Hospital Los Angeles
Clinical Assistant Professor of Pediatrics
University of Southern California Keck School of Medicine
Los Angeles, CA
Altered Mental Status

Su-Ting T. Li, MD, MPH
Associate Vice Chair of Education
Pediatric Residency Program Director
University of California Davis Children’s Hospital
Professor of Pediatrics
University of California, Davis
Sacramento, CA
Skin and Soft Tissue Infections

Patricia S. Lye, MD, MEd, FAAP
Children’s Hospital of Wisconsin
Professor of Pediatrics, Retired
Medical College of Wisconsin
Milwaukee, WI
Handoffs and Transitions of Care

Tamara Maginot, PhD
Pediatric Psychologist
Program Director, Medical Behavioral Unit
Rady Children’s Hospital San Diego
Assistant Professor, Department of Psychiatry
UC San Diego Eating Disorders Center for Treatment and Research Behavioral Medicine
San Diego, CA
Chronic Behavioral and Psychiatric Conditions

Christopher Maloney, MD, PhD, FAAP
Chief Medical Officer and Senior Vice President
Children’s Hospital & Medical Center
Professor of Pediatrics and Pediatric Critical Care
Department of Pediatrics
University of Nebraska Medical Center College of Medicine
Omaha, NE 
Pediatric Advanced Life Support

Jennifer Maniscalco, MD, MPH, MAcM, FAAP
Designated Institutional Official
Johns Hopkins All Children’s Hospital
Assistant Professor
Department of Pediatrics
Johns Hopkins University School of Medicine
St. Petersburg, FL
Failure to Thrive

Elizabeth Mannino Avila, MD
Rady Children’s Hospital
Assistant Clinical Professor of Pediatrics
University of California, San Diego
San Diego, CA
Kawasaki Disease

Alison Markowsky, MD, MSHS, FAAP
Medical Director
Children’s National Pediatric Hospitalist Program at Mary Washington Healthcare
Children’s National Health System
Assistant Professor of Pediatrics
The George Washington University School of Medicine & Health Sciences
Washington, DC
Newborn Care and Delivery Room Management

Michelle Marks, DO, FAAP, SFHM
Chair, Pediatric Hospital Medicine
Cleveland Clinic Children’s Hospital
Clinical Associate Professor
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University
Cleveland, OH
Nutrition

Armand H. Matheny Antommaria, MD, PhD, FAAP
Lee Ault Carter Chair Pediatric Ethics and Pediatric Hospitalist
Cincinnati Children’s Hospital
Associate Professor of Clinical-Affiliated
University of Cincinnati School of Medicine
Cincinnati, OH
Ethics

Erich Maul, MD
Division Chief, Hospital Medicine
Medical Director, Acute Care and Progressive Care
Kentucky Children’s Hospital
Professor of Pediatrics
University of Kentucky School of Medicine
Lexington, KY
Electrocardiogram Interpretation

Rusty McCulloh, MD
Chief, Division of Hospital Medicine
Children’s Hospital & Medical Center
Associate Professor, Division of Hospital Medicine
University of Nebraska College of Medicine
Omaha, NE
Infection Control and Antimicrobial Stewardship

Anjna Melwani, MD
Director, Preoperative Care Clinic
Children’s National Medical Center
Associate Professor of Pediatrics
George Washington University School of Medicine and Health Sciences
Washington, DC
Consultation and Co-management

Christopher Miller, MD
Pediatric Allergist
Children’s Mercy Hospitals and Clinics
Assistant Professor of Pediatrics
Section of Allergy and Immunology
University of Missouri-Kansas City School of Medicine
Kansas City, MO
Asthma

Vineeta Mittal, MD, MBA
Imm. Past President of the Medical/Dental Staff
Children’s Medical Center
Associate Professor of Pediatrics
Director of Pediatric Hospital Medicine
Department of Pediatrics
UT Southwestern Medical Center & Children’s Health System Dallas
Dallas, TX
Acute Respiratory Failure

Beth Natt, MD, MPH, FAAP, SFHM
Director, Pediatric Hospital Medicine, Regional Programs
Connecticut Children’s Medical Center
Associate Professor of Pediatrics
University of Connecticut School of Medicine
Farmington, CT
Bladder Catheterization and Interpretation of Urinalysis

Jennifer O’Toole, MD, MEd, FAAP, SFHM
Program Director, Internal Medicine – Pediatrics Residency
Director of Education, Division of Hospital Medicine
Cincinnati Children’s Hospital Medical Center
Associate Professor of Pediatrics and Internal Medicine
University of Cincinnati College of Medicine
Cincinnati, OH
Adolescent and Young Adult Medicine

Mary Ottolini, MD, MPH, MEd, FAAP
George W. Hallett Chair of Pediatrics
Barbara Bush Children’s Hospital at Maine Medical Center
Professor of Pediatrics
Tufts University School of Medicine
Portland, ME
Fluid and Electrolyte Management

Jack Percelay, MD, MPH, FAAP, MHM
Stanford Lucile Packard Children’s Hospital
Clinical Associate Professor of Pediatrics
Stanford University School of Medicine
Stanford, CA
Advocacy
Seizures

Shannon Phillips, MD, MPH
Chief Patient Safety and Experience Officer
Primary Children’s Medical Center
Intermountain Healthcare, Inc.
Adjunct Associate Professor of Pediatrics
University of Utah Health Sciences
Salt Lake City, UT
Patient Safety

David Pressel, MD, PhD, FAAP, FHM
Medical Director, Pediatric Hospitalist Program
Capital Health Medical Center- Hopewell
Pennington, NJ
Acute Behavioral and Psychiatric Conditions
Child Abuse and Neglect

Ricardo Quinonez, MD, FAAP
Chief, Pediatric Hospital Medicine
Texas Children’s Hospital
Associate Professor of Pediatrics
Baylor College of Medicine
Houston, TX
High Value Care

Shawn Ralston, MA, MD, MS
Johns Hopkins Children’s Center
Editor, Hospital Pediatrics, American Academy of Pediatrics
Associate Professor of Pediatrics
Division of Pediatric Quality and Safety
The Johns Hopkins Hospital University School of Medicine
Baltimore, MD
Evidence Based Medicine

David I. Rappaport, MD, FAAP, FHM
Associate Residency Program Director
Division of General Pediatrics
Nemours/AI duPont Hospital for Children
Wilmington, DE
Associate Professor of Pediatrics
Sidney Kimmel Medical College at Jefferson
Philadelphia, PA
Consultation and Co-management

Daniel Rauch, MD, FAAP, SFHM
Chief, Pediatric Hospital Medicine
The Floating Hospital for Children at Tufts Medical Center.
Professor of Pediatrics
Tufts University School of Medicine
Boston, MA
Preventive Care Services

Kyung (Kay) Rhee, MD, MSc, MA
Director of Research, Division of Pediatric Hospital Medicine
Medical Director, Medical Behavioral Unit
Rady Children’s Hospital San Diego
Professor of Clinical Pediatrics
Department of Pediatrics, Division of General Academic Pediatrics, Developmental Pediatrics, and Center for Community Health
University of San Diego School of Medicine
San Diego, CA
Chronic Behavioral and Psychiatric Conditions

Jeffrey Riese, MD
Associate Pediatric Residency Program Director
Hasbro Children’s Hospital
Associate Professor of Pediatrics
Warren Alpert School of Medicine at Brown University
Providence, RI
Neonatal Fever

Ken Roberts, MD, FAAP
Professor Emeritus of Pediatrics
University of North Carolina School of Medicine
Chapel Hill, NC
Urinary Tract Infections

Amanda Rogers, MD
Associate Pediatric Residency Program Director
Children’s Hospital of Wisconsin
Assistant Professor, Section of Hospital Medicine
Medical College of Wisconsin
Milwaukee, WI
Lumbar Puncture

Rebecca E. Rosenberg, MD, MPH
Chief, Section of Hospital Medicine, Division of General Pediatrics
Hassenfeld Children’s Hospital at NYU Langone Health
Associate Professor of Pediatrics
NYU School of Medicine
New York, NY
Peri-procedural Care

Michael Ruhlen, MD, MHCM, FHM, FACHE
Vice President, Division of Medical Education
Vice Chair, RRC ACGME
Atrium Health System
Charlotte, NC
Legal Issues and Risk Management

Christopher J. Russell, MD, MS, FAAP
Research Director, Division of Hospital Medicine
Children’s Hospital Los Angeles
Assistant Professor of Clinical Pediatrics
Keck School of Medicine, University of Southern California
Los Angeles, CA
Child with Medical Complexity

Christopher Russo, MD
Director of Pediatrics
Central Lynchburg General Hospital
Assistant Professor of Pediatrics
Liberty University College of Osteopathic Medicine
Lynchburg, VA
Advocacy

Klint M. Schwenk, MD, MBA, FAAP, FHM
Associate Division Chief, Pediatric Hospital Medicine
Norton Children’s Hospital
Associate Professor of Pediatrics
University of Louisville
Louisville, KY
Acute Gastroenteritis
Gastrointestinal and Digestive Disorders

Anand Sekaran, MD, FAAP
Associate Chair of Pediatrics, Clinical Affairs
Division Chief, Hospital Medicine
Connecticut Children’s Medical Center
Associate Professor of Pediatrics
University of Connecticut School of Medicine
Hartford, CT
Diagnostic Imaging

Kristin A. Shadman, MD, FAAP
American Family Children’s Hospital
Associate Professor of Pediatrics
Division of Hospital Medicine
University of Wisconsin School of Medicine and Public Health
Madison, WI
Oxygen Delivery and Airway Management

Samir S. Shah, MD, MSCE
Director, Division of Hospital Medicine
James M. Ewell Endowed Chair
Attending Physician in Hospital Medicine & Infectious Diseases
Chief Metrics Officer
Cincinnati Children’s Hospital Medical Center
Professor, Department of Pediatrics
University of Cincinnati College of Medicine
Cincinnati, OH
Bone and Joint Infections

Mark Shen, MD, MBA, FAAP, SFHM
Associate Professor of Pediatrics
Dell Medical School at the University of Texas at Austin
Austin, TX
Leadership in Healthcare

Tamara Simon, MD, MSPH, FAAP
Principal Investigator, Center for Clinical and Translational Research
Seattle Children’s Research Institute
Associate Professor of Pediatrics
Divisions of Hospital Medicine and General Pediatrics, Department of Pediatrics
University of Washington
Seattle, WA
Child with Medical Complexity

Amit Singh, MD, FAAP
Lucile Packard Children’s Hospital
Clinical Assistant Professor
Division of Pediatric Hospital Medicine, Department of Pediatrics
Stanford University School of Medicine
Stanford, CA
Communication

Karen Smith, MD, MEd, SFHM, FAAP
Chief, Division of Pediatric Hospital Medicine
Children’s National Medical Center
Associate Professor of Pediatrics
The George Washington School of Medicine and Health Sciences
Washington, DC
Business Practices

Nita Srinivas, MD
Pediatric Hospitalist and Infectious Disease Specialist
Fellowship Director, Pediatric Hospital Medicine
Lucile Packard Children’s Hospital
Clinical Assistant Professor
Stanford University School of Medicine
Stanford, CA
Fever of Unknown Origin

Rajendu Srivastava, MD, FRCP(C), MPH
Primary Children’s Medical Center
Assistant Vice President of Research and Medical Director of the Office of Research
Intermountain Healthcare Inc.
Professor of Pediatrics
University of Utah Health Sciences
Salt Lake City, UT
Research

Lynne Sterni, MD
Pediatric Anesthesiology and Pain Medicine
Naval Medical Center San Diego
Assistant Professor
Uniformed Services University School of Health Sciences
San Diego, CA
Pain Management

E. Douglas Thompson Jr, MD, FAAP
Chief, Section of Hospital Medicine
Associate Chair, Access and Partnerships
St. Christopher’s Hospital for Children
Associate Professor of Pediatrics
Drexel University School of Medicine and Health Sciences
Philadelphia, PA
Sickle Cell Disease

Joanna Thomson, MD, MPH, FAAP
Associate Fellowship Program Director, Pediatric Hospital Medicine
Cincinnati Children’s Hospital Medical Center
Assistant Professor, Department of Pediatrics
University of Cincinnati School of Medicine
Cincinnati, OH
Acute Respiratory Failure

Joel Tieder, MD, MPH
Seattle Children’s Hospital
Associate Professor of Pediatrics, Division of Hospital Medicine
University of Washington School of Medicine
Seattle, WA
Brief Resolved Unexplained Event

Adriana Tremoulet, MD, MAS
Associate Director, Kawasaki Disease Research Center
Division of Host-Microbe Systems and Therapeutics
Pediatric Infectious Diseases and Kawasaki Disease
Associate Professor of Pediatrics, University of California San Diego
San Diego, CA
Kawasaki Disease

Marie E. Wang, MD, MPH, FAAP
Associate Fellowship Program Director, Pediatric Hospital Medicine
Lucile Packard Children’s Hospital
Clinical Assistant Professor 
Stanford University School of Medicine
Stanford, CA
Central Nervous System Infections

Ronald Williams, MD, FAAP, FACP
Director, Combined Internal Medicine/Pediatrics Residency Program
Penn State Hershey Children’s Hospital
Professor of Pediatrics and Medicine
Penn State College of Medicine
Hershey, PA
Head and Neck Disorders

Susan Wu, MD, FAAP
Children’s Hospital Los Angeles
Associate Professor of Clinical Pediatrics
Division of Hospital Medicine, Department of Pediatrics
USC Keck School of Medicine
Los Angeles, CA
Bronchiolitis

Sandra Gage, MD, PhD, FAAP, SFHM
Associate Division Chief and Associate Fellowship Director
Division of Hospital Medicine
Phoenix Children’s Hospital
Clinical Associate Professor
University of Arizona College of Medicine – Phoenix
Department of Child Health
Phoenix, AZ

Jennifer Maniscalco, MD, MPH, MAcM, FAAP
Designated Institutional Official
Johns Hopkins All Children’s Hospital
Assistant Professor
Department of Pediatrics
Johns Hopkins University School of Medicine
St. Petersburg, FL

Erin Fisher, MD, MHM, FAAP
Medical Director Quality Improvement
Rady Children’s Hospital
Professor of Clinical Pediatrics
Director of Pediatric Quality and Safety Graduate Medical Education
Fellowship Director and Division Director, Pediatric Hospital Medicine
University of California San Diego School of Medicine
Department of Pediatrics
San Diego, CA

Sofia Teferi, MD, FAAP, SFHM
Physician Executive
Richmond, VA

ASSOCIATE EDITORS

Francisco Alvarez, MD, FAAP
Associate Chief, Regional Pediatric Hospital Medicine Programs
Lucile Packard Children’s Hospital
Clinical Associate Professor
Stanford School of Medicine
Stanford, CA 

Michael Burke, MD (1957 – 2019)
In memory: Chairman of Pediatrics
Saint Agnes Hospital
Associate Professor of Pediatrics
Johns Hopkins University School of Medicine
Baltimore, MD

Weijen Chang, MD
Division Chief, Pediatric Hospital Medicine
Vice Chair for Clinical Affairs, Department of Pediatrics
Baystate Children’s Hospital
Associate Professor of Pediatrics
University of Massachusetts Medical School-Baystate
Springfield, MA

Vineeta Mittal, MD, MBA
Imm. Past President of the Medical/Dental Staff
Children’s Medical Center
Associate Professor of Pediatrics
Director of Pediatric Hospital Medicine
Department of Pediatrics
UT Southwestern Medical Center & Children’s Health System, Dallas
Dallas, TX

Anand Sekaran, MD
Associate Chair of Pediatrics, Clinical Affairs
Division Chief, Hospital Medicine
Connecticut Children’s Medical Center
Associate Professor of Pediatrics
University of Connecticut School of Medicine
Hartford, CT

Amit Singh, MD, FAAP
Lucile Packard Children’s Hospital
Clinical Assistant Professor
Division of Pediatric Hospital Medicine
Department of Pediatrics
Stanford University School of Medicine
Stanford, CA

Academic Pediatric Association Hospital Medicine Special Interest Group

American Academy of Pediatrics

• Committee on Psychological Aspects of Child and Family Health
• Council on Children with Disabilities
• Council on Community Pediatrics
• Disaster Preparedness Advisory Council
• Family Partnerships Network
• Section on Anesthesiology and Pain Medicine
• Section on Breastfeeding
• Section on Cardiology and Cardiac Surgery
• Section on Critical Care
• Section on Hematology/Oncology
• Section on Hospice and Palliative Medicine
• Section on Hospital Medicine
• Section on LGBT Health and Wellness
• Section on Medicine-Pediatrics
• Section on Nephrology
• Section on Neurology
• Section on Pediatric Trainees
• Section on Surgery
• Section on Transport Medicine
• Section on Urology

Association of Pediatric Program Directors Curriculum Committee

Society of Hospital Medicine Pediatrics Special Interest Group

Society of Hospital Medicine Medicine-Pediatrics Special Interest Group

Francisco Alvarez, MD
Associate Chief, Regional Pediatric Hospitalist Programs
Lucile Packard Children’s Hospital
Clinical Associate Professor
Stanford University School of Medicine
Stanford, CA
Fever of Unknown Origin

Brian Alverson, MD
Director, Division of Pediatric Hospital Medicine
Hasbro Children’s Hospital
Professor of Pediatrics
Alpert School of Medicine, Brown University
Providence, RI
Pneumonia

Eric Balighian, MD
Director, Pediatric Emergency Department
St. Agnes Hospital
Asistant Professor, Department of Pediatrics
Johns Hopkins University School of Medicine
Baltimore, MD
Acute Abdominal Pain and Acute Abdomen

Julia Beauchamp-Walters, MD
Medical Director, Helen Bernardy Center for Medically Fragile Children
Medical Director, Home Care
Co-Medical Director, Emergency Transport Program
Rady Children’s Hospital
Clinical Professor of Pediatrics
University of California, San Diego
San Diego, CA
Feeding Tubes
Pediatric Interfacility Transport

Eric Biondi, MD, MS
Director, Pediatric Hospital Medicine Division
Johns Hopkins Children’s Center
Associate Professor of Pediatrics
The Johns Hopkins Hospital University School of Medicine
Baltimore, MD
Neonatal Fever

Rebecca Blankenberg, MD, MPH
Associate Chair of Education
Stanford Lucile Packard Children’s Hospital
Clinical Associate Professor of Pediatrics and Emergency Medicine
Stanford University School of Medicine
Stanford, CA
Education

Colin Bridgeman, MD
Penn State Children’s Hospital
Assistant Professor of Pediatrics
Division of General Inpatient Pediatrics
Penn State College of Medicine
Hershey, PA
Head and Neck Disorders

Jeffrey Brown, MD, MPH, CAP, FAAP
Texas Newborn Services/Pediatrix Medical Group
Clinical Professor of Pediatrics
University of Colorado School of Medicine
Fort Worth, TX
Business Practices

April O. Buchanan, MD
Associate Dean for Curriculum
Prisma Health Children’s Hospital at Greenville
Associate Professor of Clinical Pediatrics
University of South Carolina School of Medicine
Greenville, SC
Sepsis and Shock

Douglas Carlson, MD
Medical Director
HSHS St. John’s Children’s Hospital
Professor and Chair of Pediatrics
Southern Illinois University School of Medicine
Springfield, MO
Procedural Sedation

Pearl Chang, MD
Seattle Children’s Hospital
Assistant Professor
Department of Pediatrics, University of Washington
Seattle, WA
Neonatal Jaundice

Eric Coon, MD, MS
Co-Director, Pediatric Hospital Medicine Fellowship
Primary Children’s Medical Center
Assistant Professor of Pediatrics
University of Utah Health Science
Salt Lake City, UT
Research

Yasmeen N. Daud, MD
St. Louis Children’s Hospital
Associate Professor of Pediatrics
Washington University School of Medicine
St. Louise, MO
Oxygen Delivery and Airway Management

Sarah Denniston, MD, FAAP
Fellowship Director, Pediatric Hospital Medicine
The Floating Hospital for Children at Tufts Medical Center
Assistant Professor of Pediatrics
Tufts University School of Medicine
Associate DIO for Quality and Safety
Tufts Medical Center
Boston, MA
Peri-procedural Care

Craig C. DeWolfe, MD, MEd, FAAP
Children’s National Health System
Director of Medical Student Education in Pediatrics
Associate Professor of Pediatrics,
George Washington University School of Medicine
Washington, DC
Brief Resolved Unexplained Event

Stephanie Anne Deutsch, MD, MS, FAAP
Section Chief, Child Abuse Pediatrics
Nemours/Alfred I. duPont Hospital for Children
Co-medical Director, CARE (Children at Risk Evaluation) Program
Assistant Clinical Professor of Pediatrics
Sidney Kimmel Medical College at Thomas Jefferson University
Wilmington, Delaware
Child Abuse and Neglect

Ami Doshi, MD
Medical Director, Inpatient Palliative Care Program
Rady Children’s Hospital San Diego
Clinical Associate Professor of Pediatrics
University of California San Diego School of Medicine
San Diego, CA
Palliative Care and Hospice

Erin Fisher, MD, FAAP, MHM
Medical Director, Quality Improvement
Rady Children’s Hospital San Diego
Professor of Clinical Pediatrics
Director, Pediatric Quality and Safety Graduate Medical Education
Fellowship Director and Division Director, Pediatric Hospital Medicine
University of California San Diego School of Medicine
San Diego, CA
Quality Improvement

Sandra Gage, MD, PhD, FAAP, SFHM
Associate Division Chief and Associate Fellowship Director
Division of Hospital Medicine
Phoenix Children’s Hospital
Clinical Associate Professor
University of Arizona College of Medicine – Phoenix
Department of Child Health
Phoenix, AZ
Acute Gastroenteritis
Gastrointestinal and Digestive Disorders

Mary Pat Gallagher, MD
Director, Pediatric Diabetes Center
Division of Pediatric Endocrinology, Hassenfeld Children’s Hospital
Assistant Professor
Department of Pediatrics
NYU Langone
New York, NY
Diabetes Mellitus

Amrit Gill, MD
Cleveland Clinic Children’s Hospital
Clinical Assistant Professor of Pediatrics
Case Western Reserve University School of Medicine
Cleveland, OH
Patient Safety

Veena Goel Jones, MD, FAAP
Medical Director, Digital Patient Experience, Sutter Health
Sutter Palo Alto Medical Foundation
Palo Alto, CA
Health Information Technology

Jeffrey Grill, MD
Vice Chair, Community Relations and Outreach
Chief, Division of Pediatric Hospital Medicine
Director, Just for Kids Hospitalist Service
Norton Children’s Hospital
Professor, Department of Pediatrics
University of Louisville School of Medicine
Louisville, KY
Constipation

Arun Gupta, MD
Director, Neonatal Hospitalist Program
Lucile Packard Children’s Hospital Stanford
Clinical Associate Professor, Pediatrics
Stanford University School of Medicine
Stanford, CA
Newborn Care and Delivery Room Management

Brian F Herbst Jr, MD
Medical Director, Hospital Medicine Adult Care
Division of Hospital Medicine
Cincinnati Children’s Hospital Medical Center
Assistant Professor of Internal Medicine and Pediatrics
University of Cincinnati College of Medicine
Cincinnati, OH
Adolescent and Young Adult Medicine

Daniel Hershey, MD, SFHM
Rady Children’s Hospital
Clinical Professor of Pediatrics
University of California, San Diego
San Diego, CA
Non-invasive Monitoring

Kim Hoang, MD, FAAP
Lucile Packard Children’s Hospital
Clinical Assistant Professor
Stanford University School of Medicine
Stanford, CA
Education

Alison Volpe Holmes, MD, MPH
Children’s Hospital at Dartmouth-Hitchcock
Associate Dean for Student Affairs, Career Advising
Vice-Chair for Education, Department of Pediatrics
Associate Professor of Pediatrics and of The Dartmouth Institute
Geisel School of Medicine at Dartmouth
Hanover, NH
Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome

Akshata Hopkins, MD, FAAP, FHM
Director, Pediatric Residency Program
Johns Hopkins All Children’s Hospital
Assistant Professor of Pediatrics
Johns Hopkins University School of Medicine
St. Petersburg, FL
High Value Care

Yemisi Jones, MD, FAAP, FHM
Co-Medical Director, Continuing Medical Education
Co-Director Liberty Simulation Education
Cincinnati Children’s Hospital Medical Center
Assistant Professor of Clinical Pediatrics
University of Cincinnati College of Medicine
Cincinnati, OH
Intravenous Access and Phlebotomy

Alisa Khan, MD, MPH
Health Services Researcher
Division of General Pediatrics, Boston Children’s Hospital
Clinical Instructor in Pediatrics
Harvard Medical School
Boston, MA
Family Centered Care

Vivian Lee, MD
Children’s Hospital Los Angeles
Clinical Assistant Professor of Pediatrics
University of Southern California Keck School of Medicine
Los Angeles, CA
Altered Mental Status

Su-Ting T. Li, MD, MPH
Associate Vice Chair of Education
Pediatric Residency Program Director
University of California Davis Children’s Hospital
Professor of Pediatrics
University of California, Davis
Sacramento, CA
Skin and Soft Tissue Infections

Patricia S. Lye, MD, MEd, FAAP
Children’s Hospital of Wisconsin
Professor of Pediatrics, Retired
Medical College of Wisconsin
Milwaukee, WI
Handoffs and Transitions of Care

Tamara Maginot, PhD
Pediatric Psychologist
Program Director, Medical Behavioral Unit
Rady Children’s Hospital San Diego
Assistant Professor, Department of Psychiatry
UC San Diego Eating Disorders Center for Treatment and Research Behavioral Medicine
San Diego, CA
Chronic Behavioral and Psychiatric Conditions

Christopher Maloney, MD, PhD, FAAP
Chief Medical Officer and Senior Vice President
Children’s Hospital & Medical Center
Professor of Pediatrics and Pediatric Critical Care
Department of Pediatrics
University of Nebraska Medical Center College of Medicine
Omaha, NE 
Pediatric Advanced Life Support

Jennifer Maniscalco, MD, MPH, MAcM, FAAP
Designated Institutional Official
Johns Hopkins All Children’s Hospital
Assistant Professor
Department of Pediatrics
Johns Hopkins University School of Medicine
St. Petersburg, FL
Failure to Thrive

Elizabeth Mannino Avila, MD
Rady Children’s Hospital
Assistant Clinical Professor of Pediatrics
University of California, San Diego
San Diego, CA
Kawasaki Disease

Alison Markowsky, MD, MSHS, FAAP
Medical Director
Children’s National Pediatric Hospitalist Program at Mary Washington Healthcare
Children’s National Health System
Assistant Professor of Pediatrics
The George Washington University School of Medicine & Health Sciences
Washington, DC
Newborn Care and Delivery Room Management

Michelle Marks, DO, FAAP, SFHM
Chair, Pediatric Hospital Medicine
Cleveland Clinic Children’s Hospital
Clinical Associate Professor
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University
Cleveland, OH
Nutrition

Armand H. Matheny Antommaria, MD, PhD, FAAP
Lee Ault Carter Chair Pediatric Ethics and Pediatric Hospitalist
Cincinnati Children’s Hospital
Associate Professor of Clinical-Affiliated
University of Cincinnati School of Medicine
Cincinnati, OH
Ethics

Erich Maul, MD
Division Chief, Hospital Medicine
Medical Director, Acute Care and Progressive Care
Kentucky Children’s Hospital
Professor of Pediatrics
University of Kentucky School of Medicine
Lexington, KY
Electrocardiogram Interpretation

Rusty McCulloh, MD
Chief, Division of Hospital Medicine
Children’s Hospital & Medical Center
Associate Professor, Division of Hospital Medicine
University of Nebraska College of Medicine
Omaha, NE
Infection Control and Antimicrobial Stewardship

Anjna Melwani, MD
Director, Preoperative Care Clinic
Children’s National Medical Center
Associate Professor of Pediatrics
George Washington University School of Medicine and Health Sciences
Washington, DC
Consultation and Co-management

Christopher Miller, MD
Pediatric Allergist
Children’s Mercy Hospitals and Clinics
Assistant Professor of Pediatrics
Section of Allergy and Immunology
University of Missouri-Kansas City School of Medicine
Kansas City, MO
Asthma

Vineeta Mittal, MD, MBA
Imm. Past President of the Medical/Dental Staff
Children’s Medical Center
Associate Professor of Pediatrics
Director of Pediatric Hospital Medicine
Department of Pediatrics
UT Southwestern Medical Center & Children’s Health System Dallas
Dallas, TX
Acute Respiratory Failure

Beth Natt, MD, MPH, FAAP, SFHM
Director, Pediatric Hospital Medicine, Regional Programs
Connecticut Children’s Medical Center
Associate Professor of Pediatrics
University of Connecticut School of Medicine
Farmington, CT
Bladder Catheterization and Interpretation of Urinalysis

Jennifer O’Toole, MD, MEd, FAAP, SFHM
Program Director, Internal Medicine – Pediatrics Residency
Director of Education, Division of Hospital Medicine
Cincinnati Children’s Hospital Medical Center
Associate Professor of Pediatrics and Internal Medicine
University of Cincinnati College of Medicine
Cincinnati, OH
Adolescent and Young Adult Medicine

Mary Ottolini, MD, MPH, MEd, FAAP
George W. Hallett Chair of Pediatrics
Barbara Bush Children’s Hospital at Maine Medical Center
Professor of Pediatrics
Tufts University School of Medicine
Portland, ME
Fluid and Electrolyte Management

Jack Percelay, MD, MPH, FAAP, MHM
Stanford Lucile Packard Children’s Hospital
Clinical Associate Professor of Pediatrics
Stanford University School of Medicine
Stanford, CA
Advocacy
Seizures

Shannon Phillips, MD, MPH
Chief Patient Safety and Experience Officer
Primary Children’s Medical Center
Intermountain Healthcare, Inc.
Adjunct Associate Professor of Pediatrics
University of Utah Health Sciences
Salt Lake City, UT
Patient Safety

David Pressel, MD, PhD, FAAP, FHM
Medical Director, Pediatric Hospitalist Program
Capital Health Medical Center- Hopewell
Pennington, NJ
Acute Behavioral and Psychiatric Conditions
Child Abuse and Neglect

Ricardo Quinonez, MD, FAAP
Chief, Pediatric Hospital Medicine
Texas Children’s Hospital
Associate Professor of Pediatrics
Baylor College of Medicine
Houston, TX
High Value Care

Shawn Ralston, MA, MD, MS
Johns Hopkins Children’s Center
Editor, Hospital Pediatrics, American Academy of Pediatrics
Associate Professor of Pediatrics
Division of Pediatric Quality and Safety
The Johns Hopkins Hospital University School of Medicine
Baltimore, MD
Evidence Based Medicine

David I. Rappaport, MD, FAAP, FHM
Associate Residency Program Director
Division of General Pediatrics
Nemours/AI duPont Hospital for Children
Wilmington, DE
Associate Professor of Pediatrics
Sidney Kimmel Medical College at Jefferson
Philadelphia, PA
Consultation and Co-management

Daniel Rauch, MD, FAAP, SFHM
Chief, Pediatric Hospital Medicine
The Floating Hospital for Children at Tufts Medical Center.
Professor of Pediatrics
Tufts University School of Medicine
Boston, MA
Preventive Care Services

Kyung (Kay) Rhee, MD, MSc, MA
Director of Research, Division of Pediatric Hospital Medicine
Medical Director, Medical Behavioral Unit
Rady Children’s Hospital San Diego
Professor of Clinical Pediatrics
Department of Pediatrics, Division of General Academic Pediatrics, Developmental Pediatrics, and Center for Community Health
University of San Diego School of Medicine
San Diego, CA
Chronic Behavioral and Psychiatric Conditions

Jeffrey Riese, MD
Associate Pediatric Residency Program Director
Hasbro Children’s Hospital
Associate Professor of Pediatrics
Warren Alpert School of Medicine at Brown University
Providence, RI
Neonatal Fever

Ken Roberts, MD, FAAP
Professor Emeritus of Pediatrics
University of North Carolina School of Medicine
Chapel Hill, NC
Urinary Tract Infections

Amanda Rogers, MD
Associate Pediatric Residency Program Director
Children’s Hospital of Wisconsin
Assistant Professor, Section of Hospital Medicine
Medical College of Wisconsin
Milwaukee, WI
Lumbar Puncture

Rebecca E. Rosenberg, MD, MPH
Chief, Section of Hospital Medicine, Division of General Pediatrics
Hassenfeld Children’s Hospital at NYU Langone Health
Associate Professor of Pediatrics
NYU School of Medicine
New York, NY
Peri-procedural Care

Michael Ruhlen, MD, MHCM, FHM, FACHE
Vice President, Division of Medical Education
Vice Chair, RRC ACGME
Atrium Health System
Charlotte, NC
Legal Issues and Risk Management

Christopher J. Russell, MD, MS, FAAP
Research Director, Division of Hospital Medicine
Children’s Hospital Los Angeles
Assistant Professor of Clinical Pediatrics
Keck School of Medicine, University of Southern California
Los Angeles, CA
Child with Medical Complexity

Christopher Russo, MD
Director of Pediatrics
Central Lynchburg General Hospital
Assistant Professor of Pediatrics
Liberty University College of Osteopathic Medicine
Lynchburg, VA
Advocacy

Klint M. Schwenk, MD, MBA, FAAP, FHM
Associate Division Chief, Pediatric Hospital Medicine
Norton Children’s Hospital
Associate Professor of Pediatrics
University of Louisville
Louisville, KY
Acute Gastroenteritis
Gastrointestinal and Digestive Disorders

Anand Sekaran, MD, FAAP
Associate Chair of Pediatrics, Clinical Affairs
Division Chief, Hospital Medicine
Connecticut Children’s Medical Center
Associate Professor of Pediatrics
University of Connecticut School of Medicine
Hartford, CT
Diagnostic Imaging

Kristin A. Shadman, MD, FAAP
American Family Children’s Hospital
Associate Professor of Pediatrics
Division of Hospital Medicine
University of Wisconsin School of Medicine and Public Health
Madison, WI
Oxygen Delivery and Airway Management

Samir S. Shah, MD, MSCE
Director, Division of Hospital Medicine
James M. Ewell Endowed Chair
Attending Physician in Hospital Medicine & Infectious Diseases
Chief Metrics Officer
Cincinnati Children’s Hospital Medical Center
Professor, Department of Pediatrics
University of Cincinnati College of Medicine
Cincinnati, OH
Bone and Joint Infections

Mark Shen, MD, MBA, FAAP, SFHM
Associate Professor of Pediatrics
Dell Medical School at the University of Texas at Austin
Austin, TX
Leadership in Healthcare

Tamara Simon, MD, MSPH, FAAP
Principal Investigator, Center for Clinical and Translational Research
Seattle Children’s Research Institute
Associate Professor of Pediatrics
Divisions of Hospital Medicine and General Pediatrics, Department of Pediatrics
University of Washington
Seattle, WA
Child with Medical Complexity

Amit Singh, MD, FAAP
Lucile Packard Children’s Hospital
Clinical Assistant Professor
Division of Pediatric Hospital Medicine, Department of Pediatrics
Stanford University School of Medicine
Stanford, CA
Communication

Karen Smith, MD, MEd, SFHM, FAAP
Chief, Division of Pediatric Hospital Medicine
Children’s National Medical Center
Associate Professor of Pediatrics
The George Washington School of Medicine and Health Sciences
Washington, DC
Business Practices

Nita Srinivas, MD
Pediatric Hospitalist and Infectious Disease Specialist
Fellowship Director, Pediatric Hospital Medicine
Lucile Packard Children’s Hospital
Clinical Assistant Professor
Stanford University School of Medicine
Stanford, CA
Fever of Unknown Origin

Rajendu Srivastava, MD, FRCP(C), MPH
Primary Children’s Medical Center
Assistant Vice President of Research and Medical Director of the Office of Research
Intermountain Healthcare Inc.
Professor of Pediatrics
University of Utah Health Sciences
Salt Lake City, UT
Research

Lynne Sterni, MD
Pediatric Anesthesiology and Pain Medicine
Naval Medical Center San Diego
Assistant Professor
Uniformed Services University School of Health Sciences
San Diego, CA
Pain Management

E. Douglas Thompson Jr, MD, FAAP
Chief, Section of Hospital Medicine
Associate Chair, Access and Partnerships
St. Christopher’s Hospital for Children
Associate Professor of Pediatrics
Drexel University School of Medicine and Health Sciences
Philadelphia, PA
Sickle Cell Disease

Joanna Thomson, MD, MPH, FAAP
Associate Fellowship Program Director, Pediatric Hospital Medicine
Cincinnati Children’s Hospital Medical Center
Assistant Professor, Department of Pediatrics
University of Cincinnati School of Medicine
Cincinnati, OH
Acute Respiratory Failure

Joel Tieder, MD, MPH
Seattle Children’s Hospital
Associate Professor of Pediatrics, Division of Hospital Medicine
University of Washington School of Medicine
Seattle, WA
Brief Resolved Unexplained Event

Adriana Tremoulet, MD, MAS
Associate Director, Kawasaki Disease Research Center
Division of Host-Microbe Systems and Therapeutics
Pediatric Infectious Diseases and Kawasaki Disease
Associate Professor of Pediatrics, University of California San Diego
San Diego, CA
Kawasaki Disease

Marie E. Wang, MD, MPH, FAAP
Associate Fellowship Program Director, Pediatric Hospital Medicine
Lucile Packard Children’s Hospital
Clinical Assistant Professor 
Stanford University School of Medicine
Stanford, CA
Central Nervous System Infections

Ronald Williams, MD, FAAP, FACP
Director, Combined Internal Medicine/Pediatrics Residency Program
Penn State Hershey Children’s Hospital
Professor of Pediatrics and Medicine
Penn State College of Medicine
Hershey, PA
Head and Neck Disorders

Susan Wu, MD, FAAP
Children’s Hospital Los Angeles
Associate Professor of Clinical Pediatrics
Division of Hospital Medicine, Department of Pediatrics
USC Keck School of Medicine
Los Angeles, CA
Bronchiolitis

Sandra Gage, MD, PhD, FAAP, SFHM
Associate Division Chief and Associate Fellowship Director
Division of Hospital Medicine
Phoenix Children’s Hospital
Clinical Associate Professor
University of Arizona College of Medicine – Phoenix
Department of Child Health
Phoenix, AZ

Jennifer Maniscalco, MD, MPH, MAcM, FAAP
Designated Institutional Official
Johns Hopkins All Children’s Hospital
Assistant Professor
Department of Pediatrics
Johns Hopkins University School of Medicine
St. Petersburg, FL

Erin Fisher, MD, MHM, FAAP
Medical Director Quality Improvement
Rady Children’s Hospital
Professor of Clinical Pediatrics
Director of Pediatric Quality and Safety Graduate Medical Education
Fellowship Director and Division Director, Pediatric Hospital Medicine
University of California San Diego School of Medicine
Department of Pediatrics
San Diego, CA

Sofia Teferi, MD, FAAP, SFHM
Physician Executive
Richmond, VA

ASSOCIATE EDITORS

Francisco Alvarez, MD, FAAP
Associate Chief, Regional Pediatric Hospital Medicine Programs
Lucile Packard Children’s Hospital
Clinical Associate Professor
Stanford School of Medicine
Stanford, CA 

Michael Burke, MD (1957 – 2019)
In memory: Chairman of Pediatrics
Saint Agnes Hospital
Associate Professor of Pediatrics
Johns Hopkins University School of Medicine
Baltimore, MD

Weijen Chang, MD
Division Chief, Pediatric Hospital Medicine
Vice Chair for Clinical Affairs, Department of Pediatrics
Baystate Children’s Hospital
Associate Professor of Pediatrics
University of Massachusetts Medical School-Baystate
Springfield, MA

Vineeta Mittal, MD, MBA
Imm. Past President of the Medical/Dental Staff
Children’s Medical Center
Associate Professor of Pediatrics
Director of Pediatric Hospital Medicine
Department of Pediatrics
UT Southwestern Medical Center & Children’s Health System, Dallas
Dallas, TX

Anand Sekaran, MD
Associate Chair of Pediatrics, Clinical Affairs
Division Chief, Hospital Medicine
Connecticut Children’s Medical Center
Associate Professor of Pediatrics
University of Connecticut School of Medicine
Hartford, CT

Amit Singh, MD, FAAP
Lucile Packard Children’s Hospital
Clinical Assistant Professor
Division of Pediatric Hospital Medicine
Department of Pediatrics
Stanford University School of Medicine
Stanford, CA

Academic Pediatric Association Hospital Medicine Special Interest Group

American Academy of Pediatrics

• Committee on Psychological Aspects of Child and Family Health
• Council on Children with Disabilities
• Council on Community Pediatrics
• Disaster Preparedness Advisory Council
• Family Partnerships Network
• Section on Anesthesiology and Pain Medicine
• Section on Breastfeeding
• Section on Cardiology and Cardiac Surgery
• Section on Critical Care
• Section on Hematology/Oncology
• Section on Hospice and Palliative Medicine
• Section on Hospital Medicine
• Section on LGBT Health and Wellness
• Section on Medicine-Pediatrics
• Section on Nephrology
• Section on Neurology
• Section on Pediatric Trainees
• Section on Surgery
• Section on Transport Medicine
• Section on Urology

Association of Pediatric Program Directors Curriculum Committee

Society of Hospital Medicine Pediatrics Special Interest Group

Society of Hospital Medicine Medicine-Pediatrics Special Interest Group