Virtual Curbside

This month, we begin a new series on Polycystic Ovary Syndrome (PCOS), including the discussion surrounding a potential name change to Polycystic Metabolic Ovary Syndrome (PMOS) and evolving diagnostic criteria, particularly for adolescents. Our Paul Wirkus, MD, FAAP, and expert Katherine Hayes, MD, explore how our understanding of the condition continues to change and why diagnosing adolescents requires special consideration.

The conversation covers updated diagnostic criteria, the role of hyperandrogenism, and how oral contraceptive pills (OCPs) can affect evaluation and diagnosis. They also discuss the importance of excluding other conditions that may present with similar...

In this Q&A episode, we wrap up our series on vitamin K deficiency bleeding by answering common questions about newborn prophylaxis and ongoing protection. Our host Paul Wirkus, MD, FAAP, and Sarah Coggins, MD, MSCE discuss whether infants ever need additional supplementation or a second dose after the initial birth dose, how long protection lasts, and whether there is a point at which it is too late to administer intramuscular (IM) vitamin K.

The conversation also explores whether early antibiotic exposure can affect an infant’s risk of bleeding complications and why standardized, FDA-approved al...

In Episode 3 of our series on vitamin K deficiency bleeding, we focus on one of the most challenging aspects of newborn care: talking with parents who are hesitant about vitamin K prophylaxis. Our host Paul Wirkus, MD, FAAP, and two experts, Kristan Scott, MD, MSHP, and Sarah Coggins, MD, MSCE, explore three key factors that shape parental decisions: personal beliefs, concerns about infant welfare, and outside influences. Throughout the conversation, they emphasize that parents genuinely want what is best for their babies and that listening with empathy is essential to building trust.

The discussion addresses...

In Episode 2 of our series on vitamin K deficiency bleeding (VKDB), our host Paul Wirkus, MD, FAAP and two experts, Kristan Scott, MD, MSHP and Sarah Coggins, MD, MSCE explore why intramuscular (IM) vitamin K is recommended for newborns, how current supplementation guidelines were established, and what the evidence tells us about its effectiveness. We compare oral and IM administration, discuss why recommendations vary between countries, and review findings from studies in Denmark, Sweden, and Australia.

The conversation also addresses common questions and misinformation families may encounter online, including the risks of unregulated products and...

This month, we begin a new series on Vitamin K Deficiency with host Paul Wirkus, MD, FAAP and two experts,  Kristan Scott, MD, MSHP and Sarah Coggins, MD, MSCE joining us to explore why newborns are particularly vulnerable to vitamin K deficiency and how our approach to prevention has evolved over time.

In this first episode, we discuss the history and progression of vitamin K use in newborns and why breast milk alone does not provide enough vitamin K to meet an infant’s needs. We also explore the unique physiology of the newborn period, inc...

In this Q&A episode, we wrap up our series on psychosis by exploring the important role of family, relationships, and support systems in caring for children and adolescents experiencing psychosis. Our host Paul Wirkus, MD, FAAP and guest Kristi Kleinschmit, MD discuss how household dynamics can influence recovery, including the importance of predictability, stability, and a supportive home environment. They also revisit the concept of low expressed emotion and whether it remains a recommended approach for families.

The conversation addresses support following a first episode of psychosis, including the importance of recognizing and treating...

This week, we take a brief detour from our series on psychosis for a special Book Club episode. Our host and guest discuss Stephen Covey’s classic The 7 Habits of Highly Effective People, exploring the seven habits and the ideas behind them.

The conversation also considers how some of Covey’s principles can apply to pediatric practice and the everyday work of caring for patients and families.

Next week, we’ll return to our series on psychosis with the Q&A episode.

The Virtual Curbside is a podcast of the Am...

This week on The Virtual Curbside, we take a closer look at hallucinations and delusions in children and adolescents. Our host Paul Wirkus, MD, FAAP and guest Kristi Kleinschmit, MD discuss how to approach the diagnosis while keeping safety at the forefront. A thorough history is essential, including the patient’s family history, recent illnesses or infections, travel, changes in function, confusion, and the nature and timing of delusions or hallucinations. The conversation emphasizes the importance of considering both psychiatric and medical causes when a child presents with new or concerning symptoms.

We also discuss th...

In Episode 2 of our series on psychosis, we take a closer look at schizophrenia in children and adolescents, including the typical onset of symptoms, the role of genetics, and the relationship between cannabis use and psychosis. Our host Paul Paul Wirkus, MD, FAAP and guest Kristi Kleinschmit, MD review the disorders and conditions that commonly overlap with schizophrenia or occur at higher rates, including autism, major depressive disorder, bipolar disorder, schizoaffective disorder, anxiety, and substance use disorders.

The conversation also explores how schizophrenia can progress over time and what clinicians can expect as the illness...

This month we turn to psychiatric topics, beginning with an important clinical question: when a child or adolescent presents with unusual thoughts, perceptions, or behaviors, how do we distinguish psychosis from other psychiatric or medical conditions?

In this episode, our host Paul Wirkus, MD and guest Kristi Kleinschmit, MD discuss psychotic experiences and how they can occur in conditions including major depression, bipolar disorder, and OCD, as well as with substance use and trauma or PTSD. We explore how to think about experiences such as imaginary friends and vivid imagination, and when symptoms such as...

This week we wrap up our series on supporting children’s social, emotional, and relational health with a conversation focused on what pediatricians and other clinicians can take from the series and put into practice. Our host Paul Wirkus, MD and guests Neal Davis, MD and Quang-Tuyen "Q" Nguyen join us to reflect on the key messages from the previous episodes and explore how clinicians can incorporate relational health into everyday pediatric care, particularly when working with families facing additional challenges.

The discussion emphasizes that supporting children’s mental and relational health doesn’t always requir...

This week, we turn to one of the most common parenting questions in pediatric practice: screen time and digital wellness. Our host Paul Wirkus, MD, FAAP and guest Mark Witt, MD, discuss the unique role pediatricians have in helping families navigate technology use, while recognizing the challenge of addressing an increasingly complex topic within the limited time of a well-child visit.

Rather than focusing only on a specific number of screen-time hours, the conversation emphasizes an age-specific approach and encourages pediatricians to consider what screen use may be displacing. We explore how increased screen time...

In Episode 2 of our quality improvement series on parenting advice in pediatric practice, we focus on the role pediatricians can play in supporting emotional resilience for both children and their parents. Host Paul Wirkus, MD, FAAP and guest Ryan Gottfredson, DO begin by discussing why quality improvement matters in clinical practice and how small, intentional changes can help pediatricians incorporate meaningful parenting guidance into routine care.

The conversation explores modern parenting challenges, including stress, toxic levels of stress, and strategies for building resilience. We discuss how parents can teach resilience by modeling healthy behaviors, while...

This month, we begin a new series on quality improvement initiatives that pediatric practices can implement to support families. Our first episode focuses on promoting social and emotional health by equipping pediatricians with practical strategies to help parents foster resilience, healthy relationships, and emotional well-being in their children.

Our host Paul Wirkus, MD, FAAP and Cindy Brough, MD discuss the importance of building awareness, empathy, effective communication, problem-solving skills, self-confidence, and a strong sense of self from an early age. The conversation introduces a simple framework for coaching families through emotions: "notice, name, normalize, and...

In this Q&A episode of our Postural Orthostatic Tachycardia Syndrome (POTS) series, host Paul Wirkus, MD, FAAP and guest Kirti Sivakoti, MD, answer listener questions about diagnosing and managing POTS in pediatric patients. The discussion explores how to distinguish POTS from conditions with overlapping symptoms, including Mast Cell Activation Syndrome (MCAS) and other common POTS mimics, and when referral to an immunologist may be appropriate.

We also review commonly used medications for symptom management, including practical considerations for initiating and tapering therapy as patients improve. Additional topics include the effects of caffeine, stimulant medications...

In this episode of our Postural Orthostatic Tachycardia Syndrome (POTS) series, we look beyond diagnosis and treatment to discuss what the future holds for children and adolescents living with POTS. Host Paul Wirkus, MD, FAAP and guest Kirti Sivakoti, MD, review the long-term prognosis, highlighting what is currently known about recovery, symptom progression, and functional outcomes over time.

The conversation also explores the complex relationship between POTS and other conditions, including the impact of COVID-19, eating disorders, chronic pain syndromes, and functional neurologic disorders. We discuss how these overlapping conditions can influence diagnosis, management, and...

In Episode 2 of our series on Postural Orthostatic Tachycardia Syndrome (POTS), we focus on evidence-based treatment strategies to help children and adolescents manage symptoms and improve daily functioning. Host Paul Wirkus, MD, FAAP and guest Kirti Sivakoti, MD, review the foundation of POTS management, emphasizing lifestyle interventions such as maintaining adequate hydration, increasing salt intake when appropriate, establishing healthy sleep habits, and implementing a gradual, structured exercise program.

The discussion also explores the role of nutrition, compression garments, and heat avoidance in reducing symptom burden, along with practical accommodations that can support patients at school...

This month we begin a new series on Postural Orthostatic Tachycardia Syndrome (POTS), exploring the diagnosis and management of this increasingly recognized condition in pediatric patients. In this episode, host Paul Wirkus, MD, FAAP and guest Kirti Sivakoti, MD, provide an overview of POTS before discussing current approaches to diagnosis and recent updates in the field. We review the diagnostic criteria, including orthostatic symptoms and the degree of functional impairment, and consider how these factors help guide clinical evaluation and management.

The conversation also examines the growing understanding of POTS as a spectrum disorder, with...

In months with five weeks, The Virtual Curbside takes a break from clinical topics for a pediatric book club discussion. This month, host Paul Wirkus, MD, FAAP, is joined by regular book club guest Angelo Giardino, MD, FAAP, and a special guest, fifth-grader Harry Thatcher, to discuss The Anxious Generation: A Graphic Novel by Jonathan Haidt.

Together, they explore the book's central themes through the lens of two very different childhoods, comparing the play-based experiences of previous generations with today's phone-based childhoods. Harry offers a unique perspective as a member of the generation at the...

In this Q&A episode of our pediatric neurology series, we answer listener questions about some of the most rapidly evolving areas in neurology and genetics. The discussion begins with the relationship between child abuse evaluations and Brief Resolved Unexplained Events (BRUE), including important considerations when assessing infants with unexplained symptoms.

Host Paul Wirkus, MD, FAAP and guest Josh Bonkowsky, MD then explore the neurologic basis of developmental disorders and the growing role of advanced diagnostics such as genome sequencing and MRI. Our guests discuss how these tools can provide valuable insights into underlying conditions...

In this episode of our pediatric neurology series, host Paul Wirkus, MD, FAAP and guest Josh Bonkowsky, MD explore the rapidly evolving field of gene therapy and its potential to transform the care of children with neurologic disorders. Our guest explains the science behind gene therapy, including how these treatments work to target the underlying causes of genetic disease.

The conversation also examines emerging approaches to gene editing and the exciting possibilities these technologies hold for the future of pediatric medicine. Alongside the promise of these innovations, we discuss the challenges, ethical considerations, and unanswered...

In Episode 2 of our pediatric neurology series, we explore how advances in diagnostic technology have transformed the field of neurology. Our guests discuss the evolution of neurologic evaluation - from early ultrasound imaging to CT and MRI - and how modern imaging has revolutionized the ability to diagnose and understand neurologic disease in children.

Host Paul Wirkus, MD, FAAP and guest Josh Bonkowsky, MD also examine the growing role of genomic testing, which is increasingly available in clinical practice and providing families with greater diagnostic clarity. Alongside these advances come important philosophical and ethical questions...

This month we begin a new series on pediatric neurology issues, starting with a discussion with Josh Bonkowsky, MD, PhD, about his book Dancing Eyes, Dancing Feet. In this episode, our host Paul Wirkus, MD, FAAP and Dr. Bonkowsky trace the evolution of how clinicians understand and approach unexplained events in infants and children - from Sudden Infant Death Syndrome (SIDS) to Apparent Life-Threatening Events (ALTE), and more recently, Brief Resolved Unexplained Events (BRUE) and Functional Neurological Disorder (FND).

The conversation explores how terminology, diagnostic approaches, and clinical thinking have changed over time, as well...

In this Q&A episode of our infant formula and nutrition series, host Paul Wirkus, MD, FAAP and guest Steve Abrams, MD address common questions pediatricians hear from families during the newborn period. The discussion explores the role of lactose in infant formula, including when lactose-free options may - or may not - be appropriate. We also talk about normal newborn fussiness in the first weeks of life and how clinicians can help families distinguish typical infant behavior from signs that warrant further evaluation.

The episode also reviews formula fortification, with a focus on preterm...

In this episode of our infant formula and nutrition series, host Paul Wirkus, MD, FAAP and guest Steve Abrams, MD take a closer look at formula regulation, importation, and the growing influence of social media on infant feeding decisions. Our guests discuss the FDA registration process for infant formulas, what it means when products are not FDA registered, and the potential benefits and limitations of imported formulas. The conversation also explores how manufacturing and safety standards differ across countries and whether imported formulas are necessarily “cleaner” or safer.

We also address the powerful role social medi...

In Episode 2 of our infant formula and nutrition series, host Paul Wirkus, MD, FAAP and guest Steve Abrams, MD explore the question many families ask: how closely should infant formula resemble breast milk, and does it matter? Our guests discuss the science behind common formula ingredients, including oligosaccharides, prebiotics, postbiotics, and lactose, and review what evidence currently tells us about their role in infant nutrition and gut health.

The conversation also compares different protein sources - including cow’s milk, goat’s milk, and plant-based formulas - and addresses common parent questions about specialty, premium, and...

This month we turn our focus to infant formula and nutrition, beginning with a discussion of formula safety and supply. In this episode, our host Paul Wirkus, MD, FAAP and guest Steve Abrams, MD revisit Operation Fly Formula and the broader challenges of maintaining a safe and reliable formula supply in the U.S. We review safety concerns related to contamination - including bacteria, viruses, and rare but serious risks such as botulism - and discuss why recalls, while essential, can be complex for both families and providers to navigate.

The conversation also explores differences...

In this Q&A episode of our psychiatric “grab bag” series, host Paul Wirkus, MD, FAAP and Jeremy Kendrick, MD tackle common and challenging scenarios related to panic and anxiety in pediatric patients. The discussion clarifies how panic disorders differ from OCD, helping clinicians distinguish overlapping symptoms and guide appropriate treatment.

We also address school refusal, exploring how anxiety and panic can manifest in avoidance behaviors and how to support families in getting children back to school. The panel shares practical, real-time strategies for managing panic in the clinic setting - including in the office, hall...

In the third episode of our psychiatric “grab bag” series, we focus on the “angry adolescent” and the complex factors that can drive irritability and behavioral outbursts. Host Paul Wirkus, MD, FAAP and Jeremy Kendrick, MD discuss Disruptive Mood Dysregulation Disorder (DMDD) and how it differs from other mood and behavioral conditions. We explore how coexisting factors—such as substance use, trauma, and ADHD—can influence presentation, severity, and treatment outcomes.

The conversation emphasizes the importance of identifying the underlying cause of a teen’s anger to guide appropriate, individualized treatment. Evidence-based approaches, including cognitive behavioral the...

In this episode of our psychiatric “grab bag” series, we focus on panic disorders and how they present in pediatric patients. Host Paul Wirkus, MD, FAAP and Jeremy Kendrick, MD discuss the differences between panic and general anxiety, helping clinicians recognize key features that distinguish acute panic episodes from broader anxiety conditions.

The conversation also explores the role of family dynamics in both the development and management of symptoms, along with evidence-based treatment approaches. These include cognitive behavioral therapy (CBT), the use of rescue and maintenance medications, and practical strategies such as deep breathing exercises to h...

This month we shift to a psychiatric “grab bag” series, beginning with a focused discussion on suicide risk assessment in pediatric practice. Host Paul Wirkus, MD, FAAP and Jeremy Kendrick, MD review how to ask about suicide in a direct, developmentally appropriate way and explore the differences between passive thoughts and active risk. The conversation also addresses the limits of risk prediction, emphasizing the importance of ongoing assessment rather than relying on a single point in time.

We conclude with practical guidance on creating safety action plans, including how to engage patients and families, reduce imme...

In months with five weeks, The Virtual Curbside steps away from clinical topics for a pediatric book club discussion.

In this month’s book club episode, we explore Humbitious: The Power of Low-Ego, High-Drive Leadership by Amer Kaissi. Our hosts Paul Wirkus, MD, FAAP and Angelo Giardino, MD, FAAP reflect on the concept of “humbition” - balancing humility with ambition - and discuss how these leadership principles apply to pediatric practice. The conversation highlights how low-ego, high-drive leadership can strengthen team dynamics, improve patient care, and support more collaborative, compassionate healthcare environments. 

No credit availab...

In this Q&A episode of our Poison Control series, Host Paul Wirkus, MD, FAAP and guest Michael Moss, MD address emerging trends and high-risk behaviors contributing to pediatric and adolescent poison exposures. Our experts discuss substances sometimes used in social media challenges - including diphenhydramine, combination cold medications like NyQuil, and household items such as salt, nutmeg, cinnamon, and detergent pods - and the real dangers associated with these ingestions.

The conversation also highlights serious risks tied to everyday household products, including tiki torch fuel and inhalant (“huffing”) exposures. Throughout the episode, we emphasize earl...

In recognition of Poison Prevention Week, this episode of our Poison Control series focuses on practical strategies to prevent pediatric poison exposures. Host Paul Wirkus, MD, FAAP and guest Michael Moss, MD, discuss the importance of safe medication and household product storage, correct medication dosing, and how tools such as pill imprint codes can help identify unknown medications. The conversation also highlights common pitfalls, including the risks of relying on internet searches or AI tools for guidance during a potential poisoning event. Instead, clinicians and families are encouraged to use trusted, expert resources when questions arise.

In this episode of our Poison Control series, host, Paul Wirkus, MD, FAAP and guest Michael Moss, MD, focus on several high-risk exposures commonly encountered in pediatrics. Our guests review toxic thresholds for medications such as acetaminophen, discuss the dangers of prescription medication ingestions, and highlight particularly hazardous household items, including button batteries, magnets, hydrocarbons, and cleaning agents. The conversation emphasizes early recognition, appropriate initial management, and when to seek expert guidance. Listeners will gain practical insights to help prevent serious injury and respond effectively when exposures occur.

If there is ever a concern about...

This month we turn our attention to Poison Control, beginning with an overview of why children are uniquely vulnerable to toxic exposures. In this episode, our host, Paul Wirkus, MD, FAAP and guest Michael Moss, MD review common pediatric ingestions, household risks, and explain factors that increase children's vulnerabilities.

We also take a behind-the-scenes look at how the nation’s poison control system works - how calls are triaged, who provides guidance, and how centers collaborate across the country to deliver real-time, evidence-based recommendations. Most importantly, we emphasize when and how to use this invaluable re...

In this Q&A episode of our neonatal opioid withdrawal syndrome (NOWS) series, we address challenging and nuanced clinical questions surrounding withdrawal, toxicology testing, and newborn exposures. Our host, Paul Wirkus, MD, FAAP, and guest Camille Fung, MD, review the early signs of withdrawal and discuss the process of obtaining consent for neonatal toxicology screening, clarifying when testing is considered diagnostic and how results may have reporting implications.

We also explore common clinical scenarios, including the impact of maternal fentanyl administered via epidural on newborn toxicology results, and how in utero SSRI exposure may present...

In this episode, we continue our series on neonatal opioid withdrawal syndrome (NOWS) with a discussion of substance exposure in the perinatal period and the practical considerations surrounding testing and discharge planning. Our host, Paul Wirkus, MD, FAAP and guest Camille Fung, MD review the fundamentals of prenatal substance exposure and the rationale for testing, including what different methods - such as urine, meconium, and umbilical cord testing - can and cannot tell us. The conversation explores the limitations of testing and how results should be interpreted in the clinical and social context of each family.

In this episode, we continue our series on neonatal opioid withdrawal syndrome (NOWS) with a discussion of substance exposure in the perinatal period and the practical considerations surrounding testing and discharge planning. Our host, Paul Wirkus, MD, FAAP and guest Camille Fung, MD review the fundamentals of prenatal substance exposure and the rationale for testing, including what different methods - such as urine, meconium, and umbilical cord testing - can and cannot tell us. The conversation explores the limitations of testing and how results should be interpreted in the clinical and social context of each family.

In this episode, we continue our discussion of neonatal opioid withdrawal syndrome (NOWS), focusing on clinical features, treatment, and care after discharge. Our host, Paul Wirkus, MD, FAAP and guest Camille Fung, MD review the signs and symptoms clinicians use to recognize and assess withdrawal, along with current approaches to medication management and supportive care in the hospital setting. The conversation also addresses discharge planning, including criteria for safe transition home and coordination with caregivers. Finally, we explore the important role of the primary care pediatrician in follow-up—monitoring growth and development, supporting families, and coordinating ongoing services to pr...