The MCG Pediatric Podcast

Parents and clinicians are often faced with an important question: is anesthesia safe for young children? In this episode, medical student Kaavya Gudapati is joined by Dr. Maria Valeria Carrasquero and Dr. Ana Mavarez to review the current evidence on anesthesia exposure and the developing brain, and to provide practical guidance for clinical decision-making and family counseling. Specifically, they will:

Review the FDA warning regarding repeated or prolonged anesthesia exposure in children under 3 years of age

Compare key findings from animal studies and human clinical trials

Summarize major studies including PANDA, MASK, and GAS

Discuss strategies for counseling families and addressing parental concerns

Identify considerations for timing of elective versus urgent procedures

Review approaches to minimize exposure and explore potential neuroprotective strategies

Special thanks to Dr. Heather Byrd and Dr. Rebecca Yang for peer reviewing this episode.

CME available free with sign up: Link coming soon!

References:

1. Vinson AE, Houck CS. Neurotoxicity of Anesthesia in Children: Prevention and Treatment. Curr Treat Options Neurol 2018; 20:1–10. https://doi.org/10.1007/S11940-018-0536-Z/TABLES/1.

2. Hansen TG. Anesthesia-related neurotoxicity and the developing animal brain is not a significant problem in children. Pediatric Anesthesia 2015; 25:65–72. https://doi.org/10.1111/PAN.12548.

3. O’Leary JD. Human Studies of Anesthesia-Related Neurotoxicity in Children: A Narrative Review of Recent Additions to the Clinical Literature. Clin Perinatol 2019; 46:637–45. https://doi.org/10.1016/j.clp.2019.08.001.

4. FDA Drug Safety Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women | FDA n.d. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-review-results-new-warnings-about-using-general-anesthetics-and (accessed August 28, 2025).

5. FDA Drug Safety Communication: FDA approves label changes for use of general anesthetic and sedation drugs in young children | FDA n.d. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-approves-label-changes-use-general-anesthetic-and-sedation-drugs (accessed August 28, 2025).

6. SmartTots. SmartTots consensus statement on the use of anesthetic and sedative drugs in infants and toddlers.Published 2015. Updated 2017. Accessed September 17, 2025. https://smarttots.org

7. Sun LS, Li G, Miller TLK, Salorio C, Byrne MW, Bellinger DC, et al. Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood. JAMA - Journal of the American Medical Association 2016; 315:2312–20. https://doi.org/10.1001/JAMA.2016.6967.

8. Warner DO, Zaccariello MJ, Katusic SK, Schroeder DR, Hanson AC, Schulte PJ, et al. Neuropsychological and behavioral outcomes after exposure of young children to procedures requiring general anesthesia: The mayo anesthesia safety in kids (MASK) study. Anesthesiology 2018; 129:89–105. https://doi.org/10.1097/ALN.0000000000002232.

9. McCann ME, Berde C, Soriano S, Marmor J, Bellinger D, de Graaff JC, et al. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicenter, randomised controlled equivalence trial. Lancet 2019; 393:664. https://doi.org/10.1016/S0140-6736(18)32485-1.

10. Davidson AJ, Disma N, de Graaff JC, Withington DE, Dorris L, Bell G, et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): An international multicentre, randomised controlled trial. The Lancet 2016; 387:239–50. https://doi.org/10.1016/S0140-6736(15)00608-X.

11. Reighard C, Junaid S, Jackson WM, Arif A, Waddington H, Whitehouse AJO, et al. Anesthetic Exposure During Childhood and Neurodevelopmental Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open 2022;5: e2217427. https://doi.org/10.1001/JAMANETWORKOPEN.2022.17427.

12. Jadhav U, Bhanushali J, Sindhu A, Shiv Kiran Reddy B, Toshniwal A, Rashmika M. A Comprehensive Review of Pediatric Obstructive Sleep Apnea: From Assessment to Intervention 2025. https://doi.org/10.7759/cureus.78051.

13. Andropoulos DB. Neuroprotective strategies in anesthesia-induced neurotoxicity. Best Pract Res Clin Anaesthesiol 2023; 37:52–62. https://doi.org/10.1016/J.BPA.2022.11.005.

14. Ji F, Sun J, Sun L, et al. Effects of Dexmedetomidine and Remifentanil on Neurodevelopmental Outcomes After Sevoflurane Anesthesia in Infants: A Randomized Clinical Trial. Anesthesiology. 2025. 143(4), 827–834. https://doi.org/10.1097/ALN.0000000000005634

15. Saynhalath, R, Disma, N, Taverner, FJ et al. on behalf of the TREX (Trial Remifentanil DEXmedetomidine) Consortium. Short-term Outcomes in Infants after General Anesthesia with Low-dose Sevoflurane/Dexmedetomidine/Remifentanil versus Standard-dose Sevoflurane (the TREX Trial). Anesthesiology 141(6): p 1075-1085, December 2024. | DOI: 10.1097/ALN.0000000000005232

16. Ing C, Warner DO, Sun LS, Flick RP, Davidson AJ, Vutskits L, McCann ME, O'Leary J, Bellinger DC, Rauh V, Orser BA, Suresh S, Andropoulos DB. Anesthesia and Developing Brains: Unanswered Questions and Proposed Paths Forward. Anesthesiology. 2022 Mar 1;136(3):500-512. doi: 10.1097/ALN.0000000000004116. PMID: 35015802.

Did you know that a single crumb of bread is enough to cause an autoimmune response in children with celiac disease? Dr. Pankaj Vohra, Professor of Pediatrics and Board-Certified Pediatric Gastroenterologist, joins medical student Andrea Smith to discuss the evaluation and management of celiac disease, as well as essential guidance for following a gluten-free diet. Specifically, they will:

Review the epidemiology of celiac disease and identify common symptoms and presentations of celiac disease

Describe the pathophysiology of celiac disease including histopathological changes to the duodenum

Identify diagnostic tests and criteria for diagnosing celiac disease in the pediatric population

Identify common sources of gluten and the basics of identifying gluten on food labels

Discuss typical management of celiac disease including appropriate screening tests and managing accidental gluten ingestion

Special thanks to Dr. Rebecca Yang and Dr. Neeharika Bade for peer reviewing this episode.

CME available free with sign up:  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=25562

References:

Bolia, R., & Thapar, N. (2023). Celiac Disease in Children: A 2023 Update. In Indian Journal of Pediatrics. Springer. https://doi.org/10.1007/s12098-023-04659-w

Gidrewicz, D., Potter, K., Trevenen, C. L., Lyon, M., & Butzner, J. D. (2015). Evaluation of the ESPGHAN celiac guidelines in a North American pediatric population. American Journal of Gastroenterology, 110(5), 760–767. https://doi.org/10.1038/ajg.2015.87

Hill, I. D., Fasano, A., Guandalini, S., Hoffenberg, E., Levy, J., Reilly, N., & Verma, R. (2016). NASPGHAN clinical report on the diagnosis and treatment of gluten-related disorders. Journal of Pediatric Gastroenterology and Nutrition, 63(1), 156–165. https://doi.org/10.1097/MPG.0000000000001216

Husby, S., Koletzko, S., Korponay-Szabó, I., Kurppa, K., Mearin, M. L., Ribes-Koninckx, C., Shamir, R., Troncone, R., Auricchio, R., Castillejo, G., Christensen, R., Dolinsek, J., Gillett, P., Hróbjartsson, A., Koltai, T., Maki, M., Nielsen, S. M., Popp, A., Størdal, K., … Wessels, M. (2020). European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. In Journal of Pediatric Gastroenterology and Nutrition (Vol. 70, Issue 1, pp. 141–156). Lippincott Williams and Wilkins. https://doi.org/10.1097/MPG.0000000000002497

Nenna, R., Tiberti, C., Petrarca, L., Lucantoni, F., Mennini, M., Luparia, R. P. L., Panimolle, F., Mastrogiorgio, G., Pietropaoli, N., Magliocca, F. M., & Bonamico, M. (2013). The celiac iceberg: Characterization of the disease in primary schoolchildren. Journal of Pediatric Gastroenterology and Nutrition, 56(4), 416–421. https://doi.org/10.1097/MPG.0b013e31827b7f64

Sahin, Y. (2021). Celiac disease in children: A review of the literature. In World Journal of Clinical Pediatrics (Vol. 10, Issue 4, pp. 53–71). Baishideng Publishing Group Co. https://doi.org/10.5409/wjcp.v10.i4.53

Salden, B. N., Monserrat, V., Troost, F. J., Bruins, M. J., Edens, L., Bartholomé, R., Haenen, G. R., Winkens, B., Koning, F., & Masclee, A. A. (2015). Randomised clinical study: Aspergillus niger-derived enzyme digests gluten in the stomach of healthy volunteers. Alimentary Pharmacology and Therapeutics, 42(3), 273–285. https://doi.org/10.1111/apt.13266

Schuppan, D., Mäki, M., Lundin, K. E. A., Isola, J., Friesing-Sosnik, T., Taavela, J., Popp, A., Koskenpato, J., Langhorst, J., Hovde, Ø., Lähdeaho, M.-L., Fusco, S., Schumann, M., Török, H. P., Kupcinskas, J., Zopf, Y., Lohse, A. W., Scheinin, M., Kull, K., … Greinwald, R. (2021). A Randomized Trial of a Transglutaminase 2 Inhibitor for Celiac Disease. New England Journal of Medicine, 385(1), 35–45. https://doi.org/10.1056/nejmoa2032441

Tack, G. J., van de Water, J. M. W., Bruins, M. J., Kooy-Winkelaar, E. M. C., van Bergen, J., Bonnet, P., Vreugdenhil, A. C. E., Korponay-Szabo, I., Edens, L., von Blomberg, B. M. E., Schreurs, M. W. J., Mulder, C. J., & Koning, F. (2013). Consumption of gluten with gluten-degrading enzyme by celiac patients: A pilot-study. World Journal of Gastroenterology, 19(35), 5837–5847. https://doi.org/10.3748/wjg.v19.i35.5837

Husby S, Koletzko S, Korponay-Szabó IR, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012; 54: 136–160

Did you know that congenital heart defects (CHDs) affect nearly 40,000 babies born in the United States every year?

On this episode, Pediatric Cardiologist Dr. Melissa Lefebvre and medical student Marina Hashim discuss the evaluation and management of common acyanotic congenital heart conditions. Specifically, they will:

Review the classification of CHDs as cyanotic versus acyanotic.

Discuss the pathophysiology of the three most common acyanotic CHDs – ASD, PDA, and VSD.

Describe early clinical findings and use of diagnostic tools.

Cover management options, ranging from spontaneous closure to surgical intervention.

Explore prognosis and long-term outcomes on physical activity, neurodevelopment, and overall health.

Special thanks to Dr. Rebecca Yang and Dr. Abeer Hamdy for peer reviewing this episode.

CME available free with sign up:  Click Here!

References:

Dimopoulos, K., Constantine, A., Clift, P., & Condliffe, R. (2023). Cardiovascular complications of down syndrome: Scoping review and expert consensus. Circulation, 147(5). https://doi.org/10.1161/CIRCULATIONAHA.122.059706   Dugdale, D. C. (Ed.). (n.d.). Pediatric heart surgery - discharge. Mount Sinai. Retrieved April 26, 2024, from https://www.mountsinai.org/health-library/discharge-instructions/pediatric-heart-surgery-discharge   Eckerström, F., Nyboe, C., Maagaard, M., Redington, A., & Hjortdal, V. (2023). Survival of patients with congenital ventricular septal defect. European Heart Journal,  44 (1,1), 54-61. https://doi.org/10.1093/eurheartj/ehac618  

Heart MRI. (2022, July 24). Cleveland Clinic. Retrieved April 19, 2024, from https://my.clevelandclinic.org/health/diagnostics/21961-heart-mri

Leihao, S., Yajiao, L., Yunwu, Z., Yusha, T., Yucheng, C., & Lei, C. (2023). Heart-brain axis: Association of congenital heart abnormality and brain diseases. Frontiers in Cardiovascular Medicine, 10. https://doi.org/10.3389/fcvm.2023.1071820

Meyer, K. (Ed.). (2022, May 1). What is a ventricular septal defect (VSD)? Cincinnati Children's. Retrieved March 12, 2024, from https://www.cincinnatichildrens.org/health/v/vsd

Minette, M. S., & Sahn, D. S. (2006). Ventricular septal defects. Circulation, 114(20). https://doi.org/10.1161/CIRCULATIONAHA.106.618124

Mussatto, K. A., Hoffmann, R. G., Hoffman, G. M., Tweddell, J. S., Bear, L., Cao, Y., & Brosig, C. (2014). Risk and prevalence of developmental delay in young children with congenital heart disease. Pediatrics, 133(3), e570–e577. https://doi.org/10.1542/peds.2013-2309

Pruthi, S. (Ed.). (2022, October 21). Ventricular septal defect (VSD). Mayo Clinic. Retrieved April 9, 2024, from https://www.mayoclinic.org/diseases-conditions/ventricular-septal-defect/symptoms-causes/syc-20353495    

Right heart catheterization. (2022, July 24). Cleveland Clinic. Retrieved April 19, 2024, from https://my.clevelandclinic.org/health/diagnostics/21045-right-heart-catheterization

Shah, S., Mohanty, S., Karande, T., Maheshwari, S., Kulkarni, S., & Saxena, A. (2022). Guidelines for physical activity in children with heart disease. Annals of pediatric cardiology, 15(5-6), 467–488. https://doi.org/10.4103/apc.apc_73_22

Sigmon, E., Kellman, M., Susi, A., Nylund, C., & Oster, M. (2019). Congenital heart disease and Autism: A case-control study. Pediatrics, 144(5). https://doi.org/10.1542/peds.2018-4114

Thacker, D. (Ed.). (2022, January 1). Ventricular septal defect (VSD). Nemours Kids Health. Retrieved April 10, 2024, from https://kidshealth.org/en/parents/vsd.html   Tierney, S., & Seda, E. (2020). The benefit of exercise in children with congenital heart disease. Current Opinion in Pediatrics, 32(5), 626-632. https://doi.org/10.1097/MOP.0000000000000942  Ventricular septal defects (VSD). (2021, November 9). Cleveland Clinic. Retrieved April 2, 2024,from https://my.clevelandclinic.org/health/diseases/17615-ventricular-septal-defects-vsd    Ventricular septal defect surgery for children. (n.d.). Johns Hopkins Medicine. Retrieved April 11,2024, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/ventricular-septal-defect-surgery-for-children#:~:text=During%20this%20surgery%2C%20a%20surgeon,the%20hole%20between%20the%20ventricles

Wernovsky, G., & Licht, D. J. (2016). Neurodevelopmental Outcomes in children with congenital heart disease - what can we impact?. Pediatric Critical Care Medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 17(8 Suppl 1), S232–S242. https://doi.org/10.1097/PCC.0000000000000800

Join medical students Binal Patel and Aashka Sheth as they discuss adolescent gynecology with pediatrician Dr. Shreeti Kapoor.  Specifically, they will discuss:

What exactly is adolescent gynecology.

The proper approach to taking a comprehensive history for a pediatric patient with a gynecologic chief complaint.

The various causes of dysmenorrhea in the early menarche period and its presentation.

The diagnostic approach to dysmenorrhea in adolescents.

The approach to treatment of dysmenorrhea in a pediatric population.

And how to approach addressing safe sex practices and sexually transmitted infections with adolescents.

References:

21 reasons to see a gynecologist before you turn 21. ACOG. (n.d.). https://www.acog.org/womens-health/infographics/21-reasons-to-see-a-gynecologist-before-you-turn-21  

Adams Hillard P. J. (2008). Menstruation in adolescents: what's normal?. Medscape journal of medicine, 10(12), 295. 

Breehl L, Caban O. Physiology, Puberty. [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534827/ 

Centers for Disease Control and Prevention. (n.d.). About heavy menstrual bleeding. Centers for Disease Control and Prevention. https://www.cdc.gov/female-blood-disorders/about/heavy-menstrual-bleeding.html 

Primary dysmenorrhea in adolescents. UpToDate. (n.d.). https://www.uptodate.com/contents/primary-dysmenorrhea-in-adolescents?search=Primary+Dysmenorrhea+&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 

professional, C. C. medical. (2024, September 20). Pediatric gynecology. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/24574-pediatric-gynecology 

professional, C. C. medical. (2025, February 18). Puberty. Cleveland Clinic. https://my.clevelandclinic.org/health/body/puberty  

Sachedin, A., & Todd, N. (2020). Dysmenorrhea, endometriosis and chronic pelvic pain in adolescents. Journal of Clinical Research in Pediatric Endocrinology, 12(1), 7–17. https://doi.org/10.4274/jcrpe.galenos.2019.2019.s0217  

Sexuality, Sexual Health, and Sexually Transmitted Infections in Adolescents and Young Adults. (2020). Topics in Antiviral Medicine, 28(2). https://pmc.ncbi.nlm.nih.gov/articles/PMC7482983/pdf/tam-28-459.pdf  

UpToDate. (n.d.). Abnormal uterine bleeding in adolescents. https://www.uptodate.com/contents/abnormal-uterine-bleeding-in-adolescents-evaluation-and-approach-to-diagnosis?search=heavy%2Bbleeding&usage_type=default&source=search_result&selectedTitle=3~150&display_rank=3

Did you know that Obsessive-Compulsive Disorder (OCD) affects approximately 1 in 200 children, with symptoms often emerging between the ages of 7 and 12? As pediatricians, you're likely the first to encounter these patients, making early recognition and intervention critical for achieving optimal outcomes. In this episode, we’ll provide you with the knowledge and tools nee ded to accurately diagnose and effectively manage OCD, laying the foundation for better long-term care.

Dr. Theresa Fiagbe, a second-year Child Psychiatry Fellow, Dr. Dale Peeples, Associate Professor of Child Psychiatry, and Alisha Patel, Medical Student at the Medical College of Georgia, join forces to unpack the complexities of OCD in children and adolescents.

Tune in as we:

Explore key diagnostic criteria and the most effective screening tools for identifying OCD in pediatric patients

Discuss evidence-based treatments such as Cognitive Behavioral Therapy (CBT) and SSRIs, and how to incorporate them into your practice

Review common comorbid conditions, like anxiety and PANDAS, that can complicate diagnosis and treatment

Examine the impact of OCD on school performance, social interactions, and family life

Share practical guidance on managing long-term care to prevent relapse and ensure successful outcomes

Whether you're encountering OCD symptoms in a patient for the first time or seeking to enhance your expertise, this episode will equip you with the essential tools to improve diagnosis and treatment. Special thanks to Dr. Yang for editing and Dr. Sarah Straka, and Dr. Baris Olten for peer reviewing this episode.

CME Credit Available: 

https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=25556

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

Berman, L., & Flessner, C. A. (2014). Pediatric obsessive-compulsive disorder: Diagnostic and treatment issues. Journal of the American Academy of Child and Adolescent Psychiatry, 53(2), 123-131. https://doi.org/10.1016/j.jaac.2013.10.003

Clark, C. A., & Scharf, R. (2020). Cognitive-behavioral therapy for obsessive-compulsive disorder in children and adolescents: Current trends and future directions. Journal of the American Academy of Child and Adolescent Psychiatry, 59(9), 971-979. https://doi.org/10.1016/j.jaac.2020.05.007

Fahrion, S., & Goodwin, G. M. (2019). Pharmacological treatment of pediatric obsessive-compulsive disorder: SSRIs, clomipramine, and beyond. Current Psychiatry Reports, 21(8), 58-66.

https://doi.org/10.1007/s11920-019-1040-3

Franklin, M. E., & March, J. S. (2015). Treatment of obsessive-compulsive disorder in children and adolescents.

Pediatric Clinics of North America, 62(3), 529-545. https://doi.org/10.1016/j.pcl.2015.02.004

March, J. S., & Mulle, K. (2017). OCD in children and adolescents: A review of treatments and practical guidance. The Psychiatric Clinics of North America, 40(2), 199-208. https://doi.org/10.1016/j.psc.2017.01.002

Murphy, T. K., & Pincus, D. B. (2019). Pediatric obsessive-compulsive disorder: Diagnosis, treatment, and future directions. Current Opinion in Pediatrics, 31(4), 517-524. https://doi.org/10.1097/MOP.0000000000000801

PANDA Study Group. (2017). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal

infections (PANDAS). Journal of the American Academy of Child and Adolescent Psychiatry, 56(11), 933-940. https://doi.org/10.1016/j.jaac.2017.07.866

Peris, T. S., & Piacentini, J. (2021). Pediatric obsessive-compulsive disorder: Treatment strategies and challenges. Journal of Clinical Child and Adolescent Psychology, 50(1), 32-43. https://doi.org/10.1080/15374416.2020.1831504

Reaven, J. (2018). Screening for pediatric obsessive-compulsive disorder: Tools, guidelines, and challenges.

Child and Adolescent Mental Health, 23(3), 133-139. https://doi.org/10.1111/camh.12267

Thienemann, M., & McGuire, L. (2019). Treating pediatric OCD with a focus on cognitive-behavioral therapy: Evidence and efficacy. Journal of Clinical Child and Adolescent Psychology, 48(4), 530-538. https://doi.org/10.1080/15374416.2019.1612851