Virtual Curbside

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 maintaining balanced boundaries that provide children with both structure and support. Additional topics include helping children navigate failure, fostering independence, and finding the balance between parental authority and recognizing the humanity of both parents and children.Finally, we address a practical challenge familiar to every pediatrici

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 navigate." We also explore how pediatricians can help parents provide consistent guidance, model healthy emotional regulation, and tailor expectations to a child's developmental stage.Additional topics include teaching conflict resolution, supporting positive peer relationships, recognizing when social withdrawal or changes in friendshi

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, ADHD treatments, and vasoconstrictors on orthostatic symptoms, helping clinicians navigate treatment decisions in children and adolescents with complex presentations.Throughout the episode, Dr. Sivakoti emphasizes the importance of individualized care, careful assessment, and ongoing follow-up to optimize outcomes for patients living with

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 quality of life, and examine where current research is headed as our understanding of POTS continues to evolve.Finally, our Dr. Sivakoti shares what they believe is the most misunderstood aspect of POTS and identifies one of the most undervalued interventions that can make a meaningful difference for patients. This episode offers practic

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. Our guest reviews 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 and in everyday activities. Finally, we review pharmacologic treatment options, discussing when medications may be appropriate and how they fit into an individualized care plan. Throughout the episode, the emphasis is on developing a comprehensive, patient-centered approach that helps children and adolescents regain function and improve their quality of life.H

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 many patients experiencing overlapping symptoms and contributing conditions. Finally, we discuss how to distinguish POTS from vasovagal syncope and review current thinking on the underlying causes and pathophysiology of POTS. This episode provides pediatricians with a practical framework for recognizing and evaluating children and adolescents with orthostatic intoleran

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 center of the discussion, while Drs. Wirkus and Giardino reflect on how growing up in a different era shaped their own experiences. The conversation examines the impact of technology, social connection, and unstructured play on child development, mental health, and what these changes mean for pediatricians and the families they serve.No credit available for this episode. See vcurb.com for additional episodes

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 and increasingly influence treatment decisions and long-term care planning.The conversation also examines the complex relationship between genes, brain development, and the symptoms children experience. As genetic testing becomes more widely available, we consider the promise of gene therapy, the emerging field of precision medicine, and realistic timelines for tran

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 questions that accompany this new era of precision medicine.Throughout the episode, our guest emphasizes the importance of helping patients and families understand complex treatment options so they can make informed decisions as the landscape of genetic diagnosis and therapy continues to evolve.Have a question? Email questions@vcurb.com. Listener questions will be answered in

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: What is the value of diagnosing a condition when no cure exists? How much information do families want, and how should that information be shared?Our guest discusses a “leveled results” approach to genomic testing, emphasizing shared decision-making and giving families meaningful input into how much information they receive. Throughout the episode, the focus remains on help

This month we begin a new series on pediatric neurology issues, starting with a discussion with Josh Bonkowsky, MD, PhD, about his book Dancing Eyes, Dancing Feet. In this episode, our host Paul Wirkus, MD, FAAP and Dr. Bonkowsky trace the evolution of how clinicians understand and approach unexplained events in infants and children - from Sudden Infant Death Syndrome (SIDS) to Apparent Life-Threatening Events (ALTE), and more recently, Brief Resolved Unexplained Events (BRUE) and Functional Neurological Disorder (FND).The conversation explores how terminology, diagnostic approaches, and clinical thinking have changed over time, as well as the challenges providers face when balancing reassurance, evaluation, and uncertainty. We also discuss the important roles of the child’s pediatrician and pediatric hospitalists in coordinating care, supporting families, and guiding follow-up after these often frightening events.Have a question? Email questions@vcurb.com. Listener questions will be answered in episode four.

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 and NICU infants who may require additional nutritional support for growth and development. Our guests discuss when fortification is indicated, practical considerations for outpatient follow-up, and how pediatricians can guide families through feeding decisions with clear, evidence-based counseling.Have a question? Email questions@vcurb.com. For more information about available credit, visit vCurb.com.ACCME Accreditation

In this episode of our infant formula and nutrition series, host Paul Wirkus, MD, FAAP and guest Steve Abrams, MD take a closer look at formula regulation, importation, and the growing influence of social media on infant feeding decisions. Our guests discuss the FDA registration process for infant formulas, what it means when products are not FDA registered, and the potential benefits and limitations of imported formulas. The conversation also explores how manufacturing and safety standards differ across countries and whether imported formulas are necessarily “cleaner” or safer.We also address the powerful role social media plays in shaping parent perceptions, including marketing claims that certain formulas can “cure” common infant concerns such as reflux, colic, or fussiness. Finally, the episode emphasizes the significant dangers of homemade formula and provides guidance on how pediatricians can counsel families using clear, evidence-based information while acknowledging the pressures and confusion many pa

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 organic products. We examine whether higher-cost formulas offer meaningful advantages and how pediatricians can help families make informed, practical decisions without unnecessary pressure or confusion. Throughout the episode, the emphasis remains on evidence-based guidance and supporting families in choosing safe, nutritionally appropriate options for their infants.Have a que

This month we turn our focus to infant formula and nutrition, beginning with a discussion of formula safety and supply. In this episode, our host Paul Wirkus, MD, FAAP and guest Steve Abrams, MD revisit Operation Fly Formula and the broader challenges of maintaining a safe and reliable formula supply in the U.S. We review safety concerns related to contamination - including bacteria, viruses, and rare but serious risks such as botulism - and discuss why recalls, while essential, can be complex for both families and providers to navigate.The conversation also explores differences between liquid and powdered formulas, with an emphasis on preparation practices and how improper bottle hygiene can increase contamination risk. We highlight current FDA guidance on boiling and cooling water for formula preparation and provide practical tips for counseling families. Importantly, our guests strongly caution against homemade formula and offer strategies for pediatricians to have clear, supportive conversations with care

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, hallway, or waiting room - so providers can respond effectively in the moment.Additional topics include medication selection based on specific clinical presentations and when to consider higher levels of care, including the role and value of inpatient services. This episode offers actionable insights to help clinicians confidently assess and manage complex anxiety-related concerns.Utah Psy

In the third episode of our psychiatric “grab bag” series, we focus on the “angry adolescent” and the complex factors that can drive irritability and behavioral outbursts. Host Paul Wirkus, MD, FAAP and Jeremy Kendrick, MD discuss Disruptive Mood Dysregulation Disorder (DMDD) and how it differs from other mood and behavioral conditions. We explore how coexisting factors—such as substance use, trauma, and ADHD—can influence presentation, severity, and treatment outcomes.The conversation emphasizes the importance of identifying the underlying cause of a teen’s anger to guide appropriate, individualized treatment. Evidence-based approaches, including cognitive behavioral therapy (CBT), are reviewed alongside practical considerations for management in primary care. We also discuss when it’s appropriate to refer to a specialist or seek additional support, including use of the Utah Psychiatric Consultation Line (801-587-3636) for real-time guidance.Have a question? Email questions@vcurb.com. They will be answered n

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 help patients manage symptoms in real time.We also highlight an important local resource for clinicians: the Utah Psychiatric Consultation Line at 801-587-3636, which provides support for managing pediatric mental health concerns in practice.Have a question? Email questions@vcurb.com. They will be answered in week four.For more information about available c

This month we shift to a psychiatric “grab bag” series, beginning with a focused discussion on suicide risk assessment in pediatric practice. Host Paul Wirkus, MD, FAAP and Jeremy Kendrick, MD review how to ask about suicide in a direct, developmentally appropriate way and explore the differences between passive thoughts and active risk. The conversation also addresses the limits of risk prediction, emphasizing the importance of ongoing assessment rather than relying on a single point in time.We conclude with practical guidance on creating safety action plans, including how to engage patients and families, reduce immediate risk, and connect to appropriate resources. This episode equips clinicians with clear, compassionate strategies to navigate one of the most critical aspects of pediatric mental health care.Utah Psychiatric Call Up Line: 801.587.3636Have a question? Email questions@vcurb.com. They will be answered in week four.For more information about available credit, visit vCurb.com.ACCME Accreditation S

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 available for this episode. See vcurb.com for additional episodes.