Gastroesophageal Reflux Disease (GERD) in Babies – PediaCast 574

Show Notes

Description

  • Dr Sudarshan Jadcherla visits the studio as we consider gastroesophageal reflux disease (GERD) in babies. When is spitting up normal… and when might it be a sign of something serious? Where should parents turn for advice? And what can be done (if anything) to stop the vomiting? Tune in to find out!

Topic

  • Gastroesophageal Reflux Disease (GERD)

Guests

Links

 

Episode Transcript

[Dr Mike Patrick]
This episode of PediaCast is brought to you by the Division of Neonatology at Nationwide Children's Hospital.

Hello, everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads.

This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 574.

We're calling this one Gastroesophageal Reflux Disease or GERD in Babies. I want to welcome all of you to the program. So, in a nutshell, because that's a lot of words, gastroesophageal reflux disease.

We're talking about babies spitting up, which is a very common problem. But is it a serious problem or is it more of a laundry problem? And that's a legitimate question because spitting up before the age of a year can be normal with a best approach of simply watching and waiting and cleaning up the mess as it occurs, knowing that it is going to resolve itself.

On the other hand, spitting up can also cause symptoms and be a sign of something more serious, perhaps even life threatening, especially if there's blood in the spitting up or bile. So, if there's a green or yellow to the to the spit ups, then that could be a problem. So, it's important to know when it's normal and when it's not normal.

But as a parent, how can you tell the difference? You know, when do you worry? Who do you turn to for advice?

What can you do about it, if anything? And of course, you know, the simple answer there is to talk to your doctor. You know, if you're concerned about your child spitting up, you definitely talk to them.

But if your doctor is telling you that, you know, your baby's growing OK, they're not having any symptoms that we're worried about, then, you know, watching and waiting is a real thing. And just given baby some time and looking at it as a laundry problem instead of a baby problem, as we will discuss more in the course of this podcast. So, we're going to take a deep dive today into gastroesophageal reflux and gastroesophageal reflux disease.

So, when is reflux sort of normal and expected? And when is reflux a problem? And to help us answer these questions and lots more, we have a terrific studio guest joining us, Dr. Sudarshan Jadcherla. He is a neonatologist and a principal investigator with the Center for Perinatal Research at Nationwide Children's Hospital. He will be joining us soon. But before we get him in the studio, I do want to remind you that the information presented in this podcast is for general educational purposes only.

We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you are concerned about your child's health, be sure to call your health care provider. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org.

So, let's take a quick break. We'll get Dr. Sudarshan Jadcherla settled into the studio, and then we will be back to talk about gastroesophageal reflux disease in babies. It's coming up right after this.

Dr. Sudarshan Jadcherla is a neonatologist and the Nationwide Foundation Endowed Chair in Neonatology Research at Nationwide Children's Hospital and a professor of pediatrics at the Ohio State University College of Medicine. He has a passion for supporting young babies and their families, and that includes diagnosing and managing gastroesophageal reflux disease, also known as GERD. And that is our topic.

But before we get into it, let's provide a warm PediaCast welcome to our guest, Dr. Sudarshan Jadcherla. Thank you so much for visiting the studio today.

[Dr Sudarshan Jadcherla]
Thank you for inviting.

[Dr Mike Patrick]
Yeah, really, really glad to have you here. Let's just start with some definitions. You know, what exactly is it that we mean by gastroesophageal reflux or GERD and then the disease?

So, we hear about reflux, you know, is it is it a disease? Is it not a disease? What's the what's the difference there?

[Dr Sudarshan Jadcherla]
Yes. First, let us understand what gastroesophageal reflux means. It's a very common condition wherein stomach contents move up into the esophagus, also known as foot pipe.

This happens before or after eating when the junction between the stomach and the esophagus is very active. This is a very normal process. Many babies have even adults have these at all times.

On the other hand, in GERD, also known as gastroesophageal reflux disease, eating difficulties are present along with airway, digestive symptoms, cardiorespiratory symptoms, some of which can be troublesome. Some of these troublesome symptoms may then be due to the movement of stomach contents into the esophagus. Then it is called GERD.

However, reflux contents can be acidic, weakly acidic or ingested food or even gas. And symptoms may result from any of such events. Commonly, acid suppressive medications are used, but acid is equally important for the digestion of food.

So how best to diagnose and how best to treat and how long to treat GERD remains a big puzzle.

[Dr Mike Patrick]
Yeah. Yeah, absolutely. And I just want to make sure that I have this straight.

So, I'm going to kind of sum up what I think you just said. But please stop me at any point with it that this is not correct. But a lot of times babies are born with the valve that's on top of their stomach kind of loose.

And so, when their stomach squeezes, that valve can pop open and instead of the food going down, it comes back up. And that's a normal thing for a lot of babies. But as they get older and mature, that valve sort of matures as well and is able to close and the reflux goes away.

But we don't really call that a disease since it happens to so many babies. However, if in the course of their spitting up, they're losing weight, they're having difficulty breathing because maybe they're aspirating or some of the food is coming up and then wants to go down into toward their lungs. And so, they're choking and gagging on it.

Then when there's those sorts of bad symptoms, then we would start to say, oh, this is a disease. So now we would call it GERD. Is that a good summary?

[Dr Sudarshan Jadcherla]
I think that's fair, but there's no structural valve per se. It is a junction. It is a weakness of the muscle.

There's no structure as a valve, but it is the gastroesophageal junction is a muscular entity.

[Dr Mike Patrick]
Yes. Yes. So, it's not a valve that like with a flap, but it closes by the muscle being constricted or tight and so that the food can't come back up.

And then when that muscle relaxes, then that's when it can come up. So, it's functioning like a valve, but may not have a like a flap or a cusp or something on it. Okay.

And then, so how do we know if it really is a disease? Like, you know, cause some babies can still sort of, you know, cough when they spit up, but it's not necessarily causing a problem. How do we know when we need to do something about it and when it's okay just to watch it and with the idea that it's going to go away here soon?

Well, you know, in a few months anyway.

[Dr Sudarshan Jadcherla]
Yeah. Well, it's a great question. You know, gastroesophageal reflux can be very physiologic, first of all.

And if the baby is eating well and thriving well, you know, all the parents need to look into is, you know, take care of the laundry, you know, because of the spit ups. And as long as the baby is thriving well, happy and eating well, these minimal symptoms will go away with time, with growth and maturation of the gastroesophageal junction. Yes.

On the other hand, GERD is a pathologic entity, can be problematic because the symptoms are recurrent, they are troublesome, they involve airway symptoms, digestive symptoms, and sometimes all of these may impact growth.

[Dr Mike Patrick]
Yes.

[Dr Sudarshan Jadcherla]
When the growth is impacted, that's when they need attention. You know, that's when they need some kind of involvement by the physicians to figure out how to recognize this pathological entity. Yeah.

[Dr Mike Patrick]
So really it comes down to, are they gaining weight, okay? And if they are choking on it, is that an issue or is it not significant? And so, asking those questions, looking at their growth chart is really going to help us differentiate between physiologic or sort of normal gastroesophageal reflux and pathologic or when there's more of a disease process that's going along with it.

[Dr Sudarshan Jadcherla]
That's correct. Generally, the symptoms are very nonspecific. There's a problem of treating pathological entity based on symptoms only.

[Dr Mike Patrick]
Yes, yes. And you know, the other thing too is this is the same age when we often see colic. And so, we can have some babies who are fussy and maybe they're not fussy because of acid in their spit ups, but maybe they're fussy because they have colic, and they just happen to be occurring at the same time.

Is that something that's a possibility as well?

[Dr Sudarshan Jadcherla]
Absolutely. You know, the causes of fussiness can be so many. Babies are irritable from multiple reasons, whether it is the swallowing issues or reflux issues or colic issues or stooling issues, you know, there's so many reasons are there for fussiness and cannot be attributed to GERD or reflux disease per se.

[Dr Mike Patrick]
Yeah. If only they came out talking and they could let us know exactly what's going on, but they can't. And so, we have to just sort of guess how common are these conditions?

So, both the physiologic reflux and then the disease state, how common are these things in babies?

[Dr Sudarshan Jadcherla]
Yes, it's having these symptoms is very common. These spit ups or airway digestive symptoms. Now, about 50 percent of those present with troublesome symptoms that have undergone testing for GERD have physiological reflux.

But not all of these need treatment because it may be milder and not acid related. On the other hand, some of these symptoms will improve with optimal nutrition and growth. The remaining infants may need therapeutic interventions.

So, this is where instrumental diagnosis needs to happen. Testing needs to happen to make a precision diagnosis. In a study of 33 freestanding children's hospitals in the United States involving over 18,000 preterm infants, we have noted that the concern for GERD was about 10 percent.

So just think about it, 18,000 babies, 10 percent, quite a big number.

[Dr Mike Patrick]
Yeah, yeah.

[Dr Sudarshan Jadcherla]
And importantly, there is a big variation in this prevalence across these institutions and it is a 13-fold variation. What it means is that there isn't a standard of care for between institutions and simple diagnosis of GERD can increase the hospitalization by a month and additional health care costs by over $70,000. Because of the increased length of stay and involving other issues.

[Dr Mike Patrick]
Yeah, yeah. Yeah. And so, it really is important to sort of differentiate, is this physiologic?

Are we going to say that this particular baby spitting up is normal for them and hopefully they're going to outgrow it in a few months versus, hey, this really is causing a problem. But maybe we need to take a look at more than just symptoms and their growth chart but actually diagnose if this is happening or not based on perhaps some tests. Because a lot of times parents want to know, like, yes or no, is this a disease state or is this not a disease state?

And that can be really challenging to diagnose, but it is also nice to give parents an answer and then you have a better idea of which kids you are going to treat and which ones you are not. So how do we go about actually diagnosing the disease state?

[Dr Sudarshan Jadcherla]
Absolutely. Diagnosing GERD in infants is very challenging. For example, an adult or a communicating child can complain, oh, I have burning pain.

I have throat pain. I have some discomfort in the belly or something like that. But whereas infants, you know, it's all science.

They don't communicate with a particular way. So, the best way to do a recognition of these symptoms, if they are attributed to GERD, is by a test and those are objective tests. And then these tests involve recognizing the reflux in the esophagus.

And we use a technique called pH impedance testing, which helps us to recognize the degree of acidity in the esophagus. And if the reflux indeed happens, is it acid, weakly acid, non-acid or gas or mixed? And if so, is it associated with any symptoms?

Therefore, we are trying to establish a true, true correlation between reflux and symptoms. Or if a symptom is happening, and is that symptom because of reflux? These are the questions that will be addressed when we do the pH impedance study with symptom correlation.

[Dr Mike Patrick]
Yeah. So, this is a probe that goes down the throat to where the stomach and the esophagus meet each other, correct?

[Dr Sudarshan Jadcherla]
Yes. This is a probe that is placed from the nostrils into the esophagus. And the sensor is above the gastroesophageal junction.

Because in reflux, the material from the stomach comes into the esophagus. So, we want to measure the changes in the esophagus.

[Dr Mike Patrick]
And that's a continuous monitor so that then you can see what the baby's doing and what the pH is. And so, if every time the pH goes low, which is an indication of acid being present, then, and the baby is fussy every time that happens. But then, you know, when the pH is normal, then they're not fussy.

But then it goes down again, and they're fussy. Then you can start to say, well, maybe their fussiness is caused from the low pH or the acid burning. But if, on the other hand, they're just fussy, and it's more of a waxing and waning fussiness, and it doesn't necessarily correlate with when the pH drops, then maybe they're fussy for some other reason.

[Dr Sudarshan Jadcherla]
Absolutely. You're right on. Absolutely.

So, the, during symptom correlation, the presence of acidic nature of the reflux or non-acidic or chemical characteristics or physical characteristics, we correlate the findings. And then attribute it, whether it's reflux-related or non-reflux-related.

[Dr Mike Patrick]
Yeah, that makes sense. And then, so let's say that you do this, and you discover, yes, the symptoms do appear to be related to the actual reflux, because they're happening when the pH drops. And it's a child who might be gagging and choking on their feeds when it comes up.

And it might be a kid who has lost some weight, or they're not gaining weight as we would expect them to be gaining it. Then what do you do? Are there levels of severity with reflux that might dictate your approach?

[Dr Sudarshan Jadcherla]
Yes, absolutely. Currently, there are different levels of severity attributed to pathological GERD. For example, when the degree of esophageal acid exposure over a 24-hour period is greater than 7% of the time, it's considered acid GERD of severe degree.

Again, there isn't a big consensus there across the globe. However, some of these guidelines are applicable for bigger children, but there aren't any actual guidelines developed for ICU babies or infants. Yeah, yeah.

So, we chose a particular number here, more than 7% of the time, we can consider that as a severe degree. Anything between 3% to 7% is considered moderate. Anything less than 3% is normal.

[Dr Mike Patrick]
Okay. So, in addition to correlating the drop in pH with their symptoms, which is an important thing to do, we also then look at what percent of the time that the pH is low. So, we say what percent of the time is their acid present down there at the bottom of the esophagus.

As we're thinking about a 24-hour clock, if it's more than 7% of the time, it's dropped below a certain point, then you would say this is abnormal. Even if they don't have symptoms with that, I mean, they must have symptoms or you wouldn't have been doing the test, correct? That's right.

Okay. And then, so what do you do then for, let's say, you know, the kids who are over 7% of the time or they have a lot of fussiness, they're losing weight, obviously that's sort of a category. The kids who are spitting up, but they're happy spitters, and as you said, it's more of a laundry problem than a baby problem, but maybe they did find their way to get a pH probe because, you know, parents are very concerned about this, and oftentimes they've gone through all the different formulas, you know, trying this and trying that, and of course, changing the formula doesn't help because it's not a formula problem, it is a plumbing problem, so to speak. And so, changing the formula doesn't really make a lot of difference, but they, you know, the parents are concerned about it, they found their way to get a pH probe, and maybe they're in that 3-7% category, but they're gaining weight okay.

So, you know, there are definitely different levels to this, how do you treat each of those levels, sort of the moderate versus the severe?

[Dr Sudarshan Jadcherla]
Yeah, it's a great question, there isn't a consensus about how best to manage, however, I'll explain a few concepts over here. In general, about 3-5 events, reflux events occur per hour, and some of these are acidic, and some of these are not acidic. You know, oftentimes the food neutralizes the gastric acid, and therefore makes it weakly acidic or non-acidic, and therefore, you know, what are we treating is a big question, because we need acid for food digestion in the stomach.

At the same time, we also do not want acid to be causing problems into the esophagus. So, these are some of the logical concerns because greater exposure of esophagus to acid and for prolonged durations can cause inflammation, and inflammation can cause hypomotility and problems with the reflexes that helps to protect the airway and the esophagus. So, these are real concerns.

So, there are three potential best practices. One of them is treat acidity with acid suppressive medications, but acid is also needed for gastric effects, digestion. Other approach is thickening the milk with added rice cereal formula, because adding the rice cereal will allow the milk to stay in the stomach for a little longer time, and therefore, less reflux.

However, babies that have eating difficulties, they find it difficult to extract. Other approach is giving the best possible nutrition and allow the baby to grow. Then with growth, what happens?

The sphincters become stronger, the muscle becomes stronger, maturation improves, mortality improves, airway protective mechanisms get better, clearance mechanisms get better, and therefore, baby can self-recover. Which of these three is better is not known. So, this is where we are conducting a NIH funded study, NIDDK funded study, which has been reviewed by scientists and experts in the field and approved by the IRB over here and the DSMB over here, and then we are conducting the clinical study.

Any of these three approaches is good, but which is better? Practice in a truly diagnosed GERD, not just by empiric GERD diagnosis based on the symptoms, because a diagnosis of GERD based on the symptoms is not correct.

[Dr Mike Patrick]
Yeah, yeah. So, because in that case, it's not a disease process. If a kiddo is growing just as would be expected, they're not choking on their food, and if they have the pH study done, and it's moderate, I suppose there's a lot of kids that would fit into that category, and this research at least would show, hopefully, I would suspect that your theory is that those moderate cases without severe symptoms, watching them and letting them spit up is absolutely fine to do without intervening, because the things that we intervene with can cause their own problems, which we would also be watching for in the study, and by that we mean that kids who are on the acid reducers, we don't know necessarily what other effects that those might have by decreasing the stomach acid, because as you said, we need that stomach acid there, and then adding the cereal to thicken the feeds.

Sure, the spitting up goes away, but in my experience, a lot of those kids start gaining quite a bit of weight, and then we know that obese babies can turn into obese toddlers, and then weight may be an issue down the road. Again, this is all in my mind. I don't have any research evidence that that is true, which is really what you guys are trying to get at, to actually show with data that these risks are present, and that it is safe to just kind of wait and see.

[Dr Sudarshan Jadcherla]
Absolutely, you're right on, thank you.

[Dr Mike Patrick]
Yeah, well, sometimes I need to break it down in my own mind, and then that helps everybody understand. It surprises me a little bit that it's taken this long to actually research this, because I've been a pediatrician for 30 years, and over that time, the treatment of baby spitting up was really quite different 30 years ago, and we've seen medicines come and go. We've seen really the thinking on how to do this has changed over time quite a bit, and so I think having a study to actually show what are the best practices based on data is really such a fantastic thing.

What kind of timeline are you on in terms of the study itself? When do you think you'll have results that are publishable?

[Dr Sudarshan Jadcherla]
Oh, this study has just started last year, so it is a five-year study, and we are actively recruiting babies who are admitted to the nurseries, the NICUs, and anyone who has got considerations for GERD based on clinical reasons is investigated, and those qualifying babies are enrolled depending on parental consent. Oftentimes, we run into the problem of parents asking for medications, parents asking for a particular approach, but that puts in a bias, and what is the right thing to do is to run a random allocation, randomization. Yes.

In that way, we will figure out which is the best practice among these three. All these three are good, like giving optimal nutrition for better growth, acid-suppressive medications in a controlled manner, not for a long period of time, limited time period, and added rice cereal formula, again, for a limited time period. Again, there are consequences for everything we do, and therefore, using evidence-based management will decrease ambiguity with the GERD diagnosis and treatment.

[Dr Mike Patrick]
Now, do you think, so from what I understand, you are recruiting infants from the neonatal intensive care unit. If that's the only places that you're recruiting infants, does that introduce bias that this is true for babies sick enough to be in an ICU versus those who go home, they're full-term, they're spitting up, what's their pediatrician to do? Do you think that the results that you get on the NICU babies will be applicable to term infants who go home?

[Dr Sudarshan Jadcherla]
Absolutely. We are making a diagnosis of the condition, not necessarily a baby. It is easier for us to perform these studies over a 24-hour time period if the baby is in the hospital.

[Dr Mike Patrick]
Yeah, yeah. And, you know, maybe it starts with your study, and then someone in primary care does a study on term infants to see if your results are replicable. And this is, for the listeners out there, this is how research happens, and how we learn things and build upon previous research.

So, all really cool. One thing we didn't talk about that I think is important in terms of treatment is positioning of the baby, and also the volume that's being fed. I see a lot of babies where parents come into the emergency department because their kiddo is spitting up a lot, and, you know, they're feeding them six ounces, and you hold up a six-ounce bottle to their belly, and it just doesn't fit.

And so, you know, sometimes I feel like we're overfeeding, and if we do smaller volumes, more frequently, then, you know, that'll at least, you know, cover their appetite, but still not, you know, be so much in there that they're spitting up as much. And, of course, you know, keeping them upright after they eat for, you know, 30 minutes or so, or an hour, if you can, can also help. So that, and again, these are more the moderate cases that we would be talking about where you might be able to get away with just sort of lifestyle changes, so to speak.

[Dr Sudarshan Jadcherla]
Absolutely. And lifestyle changes are equally important in the care of a neonate or infant.

[Dr Mike Patrick]
Yes, yes, absolutely. So are there other, well, let me ask you this, too. Do you just go through the NICU and just, and to recruit, just ask folks, do you, have you had anyone who's heard about this study, and maybe they ask if they can, their baby can be enrolled in it?

[Dr Sudarshan Jadcherla]
You know, most of the time, babies in the NICU are, parents of the babies in the NICUs ask, not outside the NICU.

[Dr Mike Patrick]
Yes, yes, yes. Because, you know, it's interesting because we really see a lot of babies who do come in the emergency room because of spitting up. And, you know, they've tried different formulas, they've tried this, they've tried that.

And I feel like my training at Nationwide Children's back when I was a resident, I remember in my primary care clinic, we had an attending who used to use the phrase, hey, this is a laundry problem, not a baby problem. And I kept that. I cannot even tell you how many times I have said that to parents.

And when you really take the time to explain the pathophysiology, so, you know, you talk about that sphincter, that muscle that's kind of loose, and you just sort of explain the whole process as we have done in the course of this episode, for so many parents, it's like an aha moment. Like if someone would just take the time to explain what is happening and why changing the formula often does not help, then I think parents can, you know, feel like it's okay to say this is a laundry problem and not a baby problem because they want to make sure we're not missing a baby problem, which is, you know, you can understand why that's really important for parents. So, we got this study going on.

What other studies are happening in the world of neonatology these days?

[Dr Sudarshan Jadcherla]
Yes, we are exploring new ways of diagnosis for why babies don't eat well by mouth and how to prevent gastrostomy, how to minimize chronic tube feeding, because our data shows that babies that go home on oral feeds have superior milestones, developmental milestones, and they have better motor function, better cognitive function, better intellectual abilities later on. And some of those babies who have feeding difficulties are at risk for chronic tube feeding because they're swallowing problems and oral eating problems. And then the question is, why are they not eating orally?

This is a major question we are addressing, looking into much more deeper detail of mechanisms and then targeting specific areas, how best we can modify the performance of those muscle groups with a view to improve oral intake. The mission is to minimize the chronic tube feeding dependence.

[Dr Mike Patrick]
Yeah, because once you start and they're growing well, and then you take the tube feedings away and then that same problem that they had has not really been addressed, and then they start losing weight or not gaining, and then suddenly we're putting the tube back down, and you can really get into a cycle of concern from everyone's viewpoint.

[Dr Sudarshan Jadcherla]
We are developing innovative methods and technologies that will enhance the development, testing, and implementation of diagnostics. That's where a lot of effort is going on right now, implementation of diagnostics and therapeutics. Both are important because this is a very high-risk group of patients in the ICU who are here for prolonged periods of time, and when it comes to how to take the baby home on chronic tube feeding, that's where the new problem comes.

[Dr Mike Patrick]
Yeah, yeah, absolutely. Well, we really appreciate you taking time today to explain the differences between gastroesophageal reflux and gastroesophageal reflux disease, GERD and GERD. We have a lot of links in the show notes for folks over at PediaCast.org.

This is episode 574, so just look for the show notes for this episode. And we will have links to Neonatology at Nationwide Children's, the Center for Perinatal Research at Nationwide Children's. We also have some interesting educational articles and blog posts that talk about GERD and what it is and what can be done.

There's a great article called, Does My Irritable Baby Have GERD? Is it GERD, or are they just, they have colic, or they're fussy for whatever other reason? And then we have some news reports on the study that finds that a GERD is less likely a cause of fussiness in irritable babies than maybe was previously thought.

So, lots of resources there in the show notes for you, again, over at PediaCast.org. So once again, Dr. Sudarshan Jadcherla, Neonatologist and a Principal Investigator in the Center for Perinatal Research at Nationwide Children's Hospital. Thank you so much for being here today.

[Dr Sudarshan Jadcherla]
Thank you for inviting me, Dr. Mike. And thanks a lot for giving this opportunity.

[Dr Mike Patrick]
We are back with just enough time to thank all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that. Also, thank you to our guests this week, Dr. Sudarshan Jadcherla, Neonatologist and Principal Investigator with the Center for Perinatal Research at Nationwide Children's Hospital. Don't forget, you can find us wherever podcasts are found. We're in the Apple podcast app, iHeartRadio, Spotify, Amazon Music, YouTube, and most other podcast apps for iOS and Android. Our landing site is PediaCast.org.

You'll find our entire archive of past programs there, along with show notes for each of the episodes, our terms of use agreement, and that handy contact page if you would like to suggest a future topic for the program. Reviews are helpful wherever you get your podcasts. We always appreciate when you share your thoughts about the show.

And we love connecting with you on social media. We are on Facebook, Instagram threads, LinkedIn, and X. Simply search for PediaCast.

Don't forget about our other podcasts. We do have a podcast for pediatric providers. It is similar to this program.

We call it PediaCast CME, which stands for Continuing Medical Education. We turn the science up a couple notches, and we do offer free Category 1 Continuing Medical Education credit for those who listen. And it's not just physicians.

It's also good for nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists. And since Nationwide Children's is jointly accredited by all of those professional organizations, it's likely we offer the exact credits you need to fulfill your state's Continuing Medical Education requirements. Shows and details are available at the landing site for that program, PediaCastcme.org.

You can also listen wherever podcasts are found. Simply search for PediaCast CME. And an additional podcast that I host starting this week.

So, our very first episode is actually going out at the same time that this episode is going out. And that podcast is called FAMEcast, F-A-M-E-C-A-S-T. It is a faculty development podcast from the Center for Faculty Advancement, Mentoring, and Engagement at The Ohio State University College of Medicine.

We do have a lot of pediatric faculty who listen to this podcast just because we are affiliated with Nationwide Children's Hospital. And it's a longstanding podcast that we've been doing since 2006. So, we have lots of providers who listen, even though our target audience is parents.

But if you are a pediatrician and or, you know, any medical provider with a faculty appointment and so you are on a career faculty track, then that is going to be a great podcast for you. So really the target audience is teachers in academic medicine or a faculty member in any of the health sciences. And you can find FAMEcast at famecast.org and also wherever podcasts are found. All you got to do is search for FAMEcast. What kind of topics do we have on there? Well, coming up, we have one on mentoring and coaching.

We're going to be talking about the professional mission statement and the importance and utility of that document. And then we're also going to be talking about work-life harmony, all coming up here in the near future. So again, please check out those podcasts at PediaCastcme.org and famecast.org.

Thanks again for stopping by here at PediaCast. And until next time, this is Dr. Mike saying, stay safe, stay healthy, and stay involved with your kids. So long, everybody.

Leave a Reply

Your email address will not be published. Required fields are marked *