Harriet Lane Handbook: Pediatric Insights from The Johns Hopkins Hospital

Episoade

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  Episode 20: Pediatric Musculoskeletal (MSK) Injuries and Exam 04.09.2026 25min

  A child won't bear weight after a tumble on the playground. Sprain, strain, or fracture? In this episode, join Dr. Eva Seligman, a pediatric emergency medicine and sports medicine specialist at Johns Hopkins Hospital, with host, Dr. Luisa Costa to unpack the evaluation of pediatric ankle and knee injuries. They explore why open growth plates change the game in kids, whether the Ottawa ankle rules really hold up in young patients, and which exam maneuvers separate a stable joint from an unstable one. Dr. Seligman breaks down when imaging is truly warranted, how to decide between sports medicine and orthopedic referral, and what families need to hear about return-to-play timelines. Whether you'refacing a swollen knee in the ED or a worried parent in clinic, this conversation offers a practical framework you'll reach for again and again. Tune in for the pearls every trainee needs before the next limping patient walks in.Why the Ottawa ankle rules don't behave quite the sameway in kids — and how that should shift your threshold for ordering an X-ray.       The single biomechanical concept (hint: it involves growth plates) that explains almost every injury pattern unique to pediatric patients.A rapid rundown of the exam maneuvers for kneeinstability — and the one pitfall that can make them unreliable in kids.How to tell when a "simple sprain" is something more, and when to loop in sports medicine versus orthopedics.The return-to-play framework Dr. Seligman uses tocounsel families — simpler than you'd think, but easy to get wrong.Get more must-know information in The Harriet Lane Handbook, 24th edition, available now.
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  Episode 19: Signs of Abuse 10.08.2026 39min

  A three-month-old arrives in the ED with irritability,decreased feeding, and a story that doesn't quite add up: he "rolled off the bed." Is this an accident, or something more? In this episode, Dr. Brian Schultz, Dr. Mitchell Goldstein, Dr. Gabrielle Pollack, and Dr. Samantha Waslewski from Johns Hopkins Hospital walk through a real-world case to teach clinicians how to spot the subtle, often non-specific signs of physical child abuse — before it's too late. They cover red flags in history and exam, the sentinel injuries doctors miss, how implicit bias shapes who gets scrutinized, and exactly which imaging and labs to order. Whether you're in the ED or a pediatrician's office, this conversation will change how carefully you listen to every history you take. A must-listen for any provider who cares for children. The story doesn't match the injury — why a "three-month-old rolled off the bed" should immediately raise red flags, and how to spot developmental inconsistencies in any history.The 2/3 statistic that changes everything — most kids with abusive head trauma have no other physicalfindings. Learn why a normal exam doesn't mean you're in the clear.Sentinel injuries you might be missing — subtle signs like a torn frenulum or subconjunctival hemorrhagethat can be the only clue before a fatal injury occurs.Bias is invisible until it isn't — how implicit assumptions about "who abuses children" cause providers to miss cases in higher socioeconomic, two-parent households.CT vs. MRI — practical, concrete guidance on imaging choices, skeletal surveys, and how to start aworkup even without a trauma center's resources.
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  Episode 18: Episode Primary and Secondary Trauma 13.07.2026 1h 4min

  When a critically injured child arrives in the emergency department, every second counts — and every decision matters. In this episode of the Harriet Lane Handbook Audio Companion, pediatric residents Dr. Sarah-Thérèse Curtis Welling and Dr. Peyton Russell sit down with Dr. Keith Kleinman, a pediatric emergency medicine physician and researcher at Johns Hopkins, to break down what it really takes to assess and stabilize a child in trauma. From the moment EMS calls ahead to the last step of the secondary survey, Dr. Kleinman walks through the ABCDE framework, the unique physiologic challenges of treating pediatric patients,and the leadership skills that keep a trauma bay from descending into chaos. Whether you're a trainee stepping into the trauma bay for the first time or a seasoned provider looking to sharpen your approach, this episode deliverspractical, expert guidance on one of medicine's highest-stakes scenarios.Master the ABCDE primary survey framework andknow exactly when to intervene at each step Learn why children are not small adults — andhow their physiology can fool even experienced providers Understand the early warning signs of shockin kids before blood pressure tells you it's too late Get a step-by-step guide to pediatricintubation, including how to handle a difficult or failed airway Discover how to communicate with nonverbaland developmentally delayed patients during high-stakes trauma Hear expert advice on leading a trauma teamwith calm, clarity, and control when the pressure is on
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  Episode 17: Rheumatology: A systematic approach to differentiating the various childhood arthritic conditions 22.04.2026 26min

  Tolulope Fatola, MD and Julia F. Shalen, MD from Johns Hopkins Hospital discuss Rheumatology: A systematic approach to differentiating the various childhood arthritic conditions. Key takeaways:Core diagnostic cues and red flags for common pediatricrheumatic diseases discussed, with quick signs you can check on exam.Key physical exam findings and how to differentiateinflammatory vs. noninflammatory presentations in children (joints, skin, mucosal) to guide when to escalate.Initial workup steps and criteria for urgent rheumatology referral, including when to order imaging or labs.First-line treatment principles in pediatrics: NSAIDs,steroid-sparing approaches, and DMARDs/biologics, with pediatric dosing caveats and vaccine considerations.Monitoring and safety considerations for children onimmunomodulatory therapy (growth, infections, lab monitoring, long-term risks).Controversies or debated points raised in the episode (e.g., sequencing of DMARDs/biologics, use of steroids, steroid-sparing strategies) with succinct takeaways or guidelines mentioned.Practical clinical pearls and common pitfalls for residents(how to simplify complex cases, how to communicate with families, and what to document consistently).
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  Episode 16: End of life decision making in the adolescent palliative care patient 16.03.2026 29min

  Juliet A. Joseph, MD and Emily Johnson, CRNP from Johns Hopkins Hospital discuss end of life decision makingin the adolescent palliative care patient.Key takeaways:Proactively include PPC in routine care for serious pediatric illnesses.Use structured, family-centered conversations to clarify goals, preferences, and trade-offs.Leverage a multidisciplinary team to support complex decisions.Emphasize clear communication, cultural sensitivity, and ongoing family support.Address adolescent autonomy and ethically challenging situations.
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  Episode 15: Initial presentation and workup of acute lymphoblastic leukemia 11.02.2026 20min

  Katelyn Williams, MD and Nathaniel J. Silvestri, MD fromJohns Hopkins Hospital discuss the initial presentation and workup of acute lymphoblastic leukemia.  Acute lymphoblastic leukemia (ALL) is the most commonpediatric cancer. Early recognition and prompt workup are critical for improvedoutcomes.A case-based conversation featuring a 5-year-old withfatigue, bone pain, pallor, and reduced activity, guided by pediatric hematology/oncology expert input. The discussion outlines red flags, initial laboratory tests, imaging, differential diagnoses, and referral pathways. Key points:Red flags for ALL in children include persistent bone/backpain, refusal to bear weight, unexplained bruising, pallor, and diminishedactivity.Comprehensive physical exam should assess forhepatosplenomegaly, lymphadenopathy, and, in boys, testicular involvement.Initial laboratory workup (if malignancy is suspected) centers on CBC with differential and reticulocyte count, with attention to red cell indices (MCV, iron studies), hemoglobin, platelets, and neutrophils; LDH and uric acid; CMP and coag studies; and peripheral smear.WBC counts can be normal, low, or high at presentation;imaging (e.g., chest X-ray) is considered to evaluate potential mediastinal mass, particularly with risk for T‑cell leukemia.Differential includes infectious diseases and rheumatologicconditions; neuroblastoma should be considered in the differential of bone pain.Referral to pediatric oncology or the emergency departmentis advised when alarm features or concerning labs are present.Management considerations in the ED/outpatient settinginclude non-emergent procedures planning, NPO status when needed, and cautious use of steroids due to risks such as tumor lysis and diagnostic masking.Resources and collaboration with oncology, vaccinationconsiderations during therapy, and family education are emphasized.Implications: The talk reinforces recognizing early ALLsigns, initiating appropriate labs and imaging, timely referrals, and coordinated care to optimize outcomes.
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  Episode 14: Pediatric Food Insecurity Nutrition and Growth 05.11.2025 13min

  Edward Corty, MD and Melissa Lutz, MD from Johns Hopkins Hospital discuss pediatric food insecurity.This podcast features a discussion on childhood foodinsecurity, emphasizing its significance as a health and social issue in the United States. Hosted by Edward Corty, MD and Melissa Lutz, MD from Johns Hopkins Hospital, the conversation begins with a case study of a four-year-oldboy, illustrating how food insecurity can affect families even when children appear well.Key points include:Definition and importance: Food insecurity is the lack of consistent access to enough food for an active,healthy life, affecting about 15% of U.S. households with children. It can lead to nutritional deficiencies, physical illnesses, behavioral health issues, developmental delays, and long-term health risks like diabetes and heart disease.Screening practices: Pediatricians are recommended to routinely screen for food insecurity using tools like theHunger Vital Signs, which involve simple questions about food access over the past year. Sensitive, private conversations and permission are essential.Interventions and resources: Multiple levels of intervention are available, including federal assistance programs (e.g., SNAP, WIC, school meal programs), healthcare-based resources (food vouchers, clinics), and community resources (food banks, churches,community organizations). Follow-up is crucial to ensure families connect with and benefit from these resources.Ongoing management: Continuous follow-up within the healthcare setting helps track progress and adapt support.
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  Episode 13: Seizure mimics: an age based approach 01.10.2025 24min

  Maria Molinaro, MD, Molly Himmelrich, MD, Alex Testino, MD, and Eric H. Kossoff, MD from Johns Hopkins Hospital discuss seizure mimics and an age-based approach.   
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  Episode 12: Ventilation strategies in the neonatal ICU 05.09.2025 26min

  Megan Gates, MD and Kartikeya Makker, MBBS from Johns Hopkins Hospital discuss ventilation strategies in theneonatal ICU.
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  Episode 11: Resistance mechanisms in Gram Negative Rods 06.08.2025 16min

  Ashley Wallace Wu, MD, Amali Gunawardana, MD, and John McAteer, DO, MPH from Johns Hopkins Hospital discussresistance mechanisms in gram negative rods    
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  Episode 10: Hemophilia/Emicizumab 02.07.2025 32min

  Anna Bitners, MD and Courtney Lawrence, MD from Johns Hopkins Hospital discuss Hemophilia/Emicizumab.
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  Episode 9: Newborn Screening 05.05.2025 20min

  Nadav Weinstock, MD, PhD and Shira G. Ziegler, MD, PhD from Johns Hopkins Hospital discuss the newborn screening.
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  Episode 8: Framework of Gastrointestinal Bleeding by Age 11.04.2025 26min

  Kaysha Henry, MD, MPH and Steven Miller, MD from Johns Hopkins Hospital discuss the framework for gastrointestinal bleeding by age.
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  Episode 7: Tetralogy of Fallot: Review of the congenital heart disease and accompanying cardiac surgeries 04.03.2025 50min

  Fred Lam, MD and W. Reid Thompson III, MD from Johns Hopkins Hospital discuss tetralogy of fallot: review of the congenital heart disease and accompanying cardiac surgeries.
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  Episode 6: Auscultation and heart sounds 03.02.2025 29min

  Kyla Cordrey, MD, Rebecca Dryer, MD, and W. ReidThompson III, MD discuss auscultation and heart sounds.
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  Episode 5: Medications for analgesia and sedation 08.01.2025 25min

  Matthew Kosasih, MD and Sapna Kudchadkar, MD, PhD from Johns Hopkins Hospital discuss medications for analgesia and sedation.
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  Episode 4: An interactive walk through the HEADSS assessment, and next steps 01.11.2024 29min

  Andrea Silvas, MD and Errol Fields, MD, PhD, MPHfrom Johns Hopkins Hospital discuss an interactive walk through the HEADSS assessment, and next steps.
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  Episode 3: Pediatric Ingestions, Workup, and Management 08.10.2024 29min

  Zainab Khan, MD and Roselyn Appenteng, MD from Johns Hopkins Hospital discuss pediatric toxicology ingestions, workup, and management.
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  Episode 2: Advocacy, gun violence, and healthcare utilization 23.08.2024 22min

  Rachel Darko, MD and Katherine E. Hoops, MD, MPH from Johns Hopkins Hospital discuss advocacy, gun violence, and healthcare utilization.
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  Episode 1: Introduction 23.08.2024 1min

  Camille C. Anderson, MD, Sunaina Kapoor, MD, and Tiffany E. Mark, MD were the Chief Residents of Pediatrics for The Johns Hopkins Hospital. As Editors of the 23rd edition of The Harriet Lane Handbook, they introduce the new discussions with residents and faculty on case studies and healthcare disparities.