Virtual Curbside

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.

In this Q&A episode of our Poison Control series, Host Paul Wirkus, MD, FAAP and guest Michael Moss, MD address emerging trends and high-risk behaviors contributing to pediatric and adolescent poison exposures. Our experts discuss substances sometimes used in social media challenges - including diphenhydramine, combination cold medications like NyQuil, and household items such as salt, nutmeg, cinnamon, and detergent pods - and the real dangers associated with these ingestions.The conversation also highlights serious risks tied to everyday household products, including tiki torch fuel and inhalant (“huffing”) exposures. Throughout the episode, we emphasize early recognition of concerning symptoms, proactive counseling for families and adolescents, and the importance of open, nonjudgmental conversations about risk-taking behaviors.If there is ever a concern about a possible poisoning, contact Poison Control at 1-800-222-1222 for immediate guidance anywhere in the United States.Have a question? Email questi

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.If there is ever a concern about a possible poisoning, contact Poison Control at 1-800-222-1222 for immediate guidance anywhere in the United States.Have a question? Email questions@vcurb.com. They will be answered next week.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in acco

In this episode of our Poison Control series, host, Paul Wirkus, MD, FAAP and guest Michael Moss, MD, focus on several high-risk exposures commonly encountered in pediatrics. Our guests review toxic thresholds for medications such as acetaminophen, discuss the dangers of prescription medication ingestions, and highlight particularly hazardous household items, including button batteries, magnets, hydrocarbons, and cleaning agents. The conversation emphasizes early recognition, appropriate initial management, and when to seek expert guidance. Listeners will gain practical insights to help prevent serious injury and respond effectively when exposures occur.If there is ever a concern about a possible poisoning, contact Poison Control at 1-800-222-1222 for immediate guidance anywhere in the United States.Have a question? Email questions@vcurb.com. They will be answered in week four.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implement

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 resource.If you have a concern about a possible poisoning, call 1-800-222-1222 to reach your local poison control center anywhere in the United States.Have a question? Email questions@vcurb.com. They will be answered in week four.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the acc

In this Q&A episode of our neonatal opioid withdrawal syndrome (NOWS) series, we address challenging and nuanced clinical questions surrounding withdrawal, toxicology testing, and newborn exposures. Our host, Paul Wirkus, MD, FAAP, and guest Camille Fung, MD, review the early signs of withdrawal and discuss the process of obtaining consent for neonatal toxicology screening, clarifying when testing is considered diagnostic and how results may have reporting implications.We also explore common clinical scenarios, including the impact of maternal fentanyl administered via epidural on newborn toxicology results, and how in utero SSRI exposure may present with symptoms such as apnea, posturing, or seizure-like activity. The conversation further examines the effects of prenatal THC exposure, addressing common misconceptions, potential neonatal impacts, and the persistence of THC in breastmilk.Throughout the discussion, the emphasis remains on careful clinical assessment, clear communication with families, and a

In this episode, we continue our series on neonatal opioid withdrawal syndrome (NOWS) with a discussion of substance exposure in the perinatal period and the practical considerations surrounding testing and discharge planning. Our host, Paul Wirkus, MD, FAAP and guest Camille Fung, MD review the fundamentals of prenatal substance exposure and the rationale for testing, including what different methods - such as urine, meconium, and umbilical cord testing - can and cannot tell us. The conversation explores the limitations of testing and how results should be interpreted in the clinical and social context of each family.We also discuss discharge planning, including referrals to primary care pediatricians and child welfare agencies when appropriate, and what clinicians and families can expect regarding developmental follow-up. Throughout the episode, Dr. Fung emphasizes the importance of a nonjudgmental, supportive approach that fosters trust and promotes the best outcomes for infants and their caregivers.Have a

In this episode, we continue our series on neonatal opioid withdrawal syndrome (NOWS) with a discussion of substance exposure in the perinatal period and the practical considerations surrounding testing and discharge planning. Our host, Paul Wirkus, MD, FAAP and guest Camille Fung, MD review the fundamentals of prenatal substance exposure and the rationale for testing, including what different methods - such as urine, meconium, and umbilical cord testing - can and cannot tell us. The conversation explores the limitations of testing and how results should be interpreted in the clinical and social context of each family.We also discuss discharge planning, including referrals to primary care pediatricians and child welfare agencies when appropriate, and what clinicians and families can expect regarding developmental follow-up. Throughout the episode, Dr. Fung emphasizes the importance of a nonjudgmental, supportive approach that fosters trust and promotes the best outcomes for infants and their caregivers.Have a

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 promote the best possible outcomes for these infants. Have a question? Email questions@vcurb.com. They will be answered in week four.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requiremen

This month we are focusing on neonatal opioid withdrawal syndrome (NOWS), with an emphasis on the underlying physiology and clinical presentation. Our host, Paul Wirkus, MD, FAAP and guest Camille Fung, MD review the mechanisms of opioid exposure and withdrawal, including neuroexcitability and the gastrointestinal and autonomic manifestations commonly seen in affected newborns. The discussion also highlights the role of specialized clinics and coordinated care models that support mothers during pregnancy and the postpartum period. Together, this episode provides a foundational understanding of NOWS to help clinicians recognize symptoms early and deliver informed, compassionate care to both infants and their families. Have a question? Email questions@vcurb.com. They will be answered in week four.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Me

In this Q&A episode, Host Paul Wirkus, MD, FAAP and Ophthalmologist Mitchell Strominger, MD address common clinical questions related to pediatric red eye presentations. The discussion covers key elements of the differential diagnosis, including how to approach cloudy corneas and other concerning findings. We also review practical questions pediatricians frequently encounter, such as whether massage is effective for clearing duct obstruction and important considerations for contact lens use in children and adolescents. This episode offers clear, practical guidance to support safe evaluation, counseling, and management of pediatric eye concerns. Have a question? Email questions@vcurb.com. We will have a new topic next week.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, Americ

In this episode, we turn our focus to allergic conjunctivitis. Host Paul Wirkus, MD, FAAP and Ophthalmologist Mitchell Strominger, MD guests review the clinical features of ocular allergy and discuss how characteristics such as discharge and symptom patterns can help distinguish allergic conjunctivitis from viral, bacterial, and other etiologies. The conversation also covers important mimics and red flags, including chemical conjunctivitis, corneal abrasions, and foreign bodies, with guidance on evaluation and management. This episode equips pediatricians with practical tools to accurately assess red eye complaints and determine when further intervention is needed. Have a question? Email questions@vcurb.com. They will be answered next week.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas C