Regional: Jon B. Tingelstad Conference: Practical Pediatrics 2025: Afternoon Sessions, Thu. June 5

The Baby BRUEs

Brief Resolved Unexplained Event (BRUE)
A brief resolved unexplained event (BRUE) happens quickly and can be scary for parents or caregivers. When a BRUE happens, your baby’s appearance may change, or their breathing may slow or stop, but then return to normal.

Source: https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/brief-resolved-unexplained-event-brue

Items 1-10 of 10 (Display the 10 citations in PubMed)

1.	Brief resolved unexplained event: Severity-associated factors at admission in the pediatric emergency ward. Denis M, Brulé C, Lauzier B, Brossier D, Porcheret F. Arch Pediatr. 2023 Aug;30(6):389-395. doi: 10.1016/j.arcped.2023.05.005. Epub 2023 Jun 17. PMID: 37330397
2.	Brief resolved unexplained event: New diagnosis in infants. Arane K, Claudius I, Goldman RD. Can Fam Physician. 2017 Jan;63(1):39-41. PMID: 28115439 Free PMC article.
3.	Brief Resolved Unexplained Event. Kondamudi NP, Virji M. 2023 Aug 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 28722926 Free Books & Documents.
4.	Intussusception Initially Diagnosed as a Brief Resolved Unexplained Event (BRUE). Atsumi Y, Kusama Y, Fukui S, Kamimura K. Cureus. 2023 May 15;15(5):e39054. doi: 10.7759/cureus.39054. eCollection 2023 May. PMID: 37323354 Free PMC article.
5.	Apparent life-threatening events and brief resolved unexplained events: management of children at a Swiss tertiary care center. Evers KS, Wellmann S, Donner BC, Ritz N. Swiss Med Wkly. 2021 Oct 22;151:w30026. doi: 10.4414/smw.2021.w30026. eCollection 2021 Oct 11. PMID: 34694101
6.	Home Cardiorespiratory Monitoring in Infants at Risk for Sudden Infant Death Syndrome (SIDS), Apparent Life-Threatening Event (ALTE) or Brief Resolved Unexplained Event (BRUE). Sodini C, Paglialonga L, Antoniol G, Perrone S, Principi N, Esposito S. Life (Basel). 2022 Jun 13;12(6):883. doi: 10.3390/life12060883. PMID: 35743914 Free PMC article. Review.
7.	Diagnostic Evaluation Low Yield for Patients with a Lower-Risk Brief Resolved Unexplained Event. Haddad R, Parker S, Farooqi A, DeLaroche AM. Glob Pediatr Health. 2021 Feb 1;8:2333794X20967586. doi: 10.1177/2333794X20967586. eCollection 2021. PMID: 33614835 Free PMC article.
8.	GASTROESOPHAGEAL REFLUX DISEASE IN INFANTS WHO PRESENTED BRIEF RESOLVED UNEXPLAINED EVENT (BRUE). Bellomo-Brandão MA, Stranguetti FM, Lopes IF, Peixoto AO, Marson FAL, Lomazi EA. Arq Gastroenterol. 2021 Oct-Dec;58(4):424-428. doi: 10.1590/S0004-2803.202100000-77. PMID: 34909844
9.	Infants' Feeding Habits and Brief Resolved Unexplained Events (BRUEs): A Prospective Observational Study. Quitadamo P, Mosca C, Verde A, De Marco G, Giorgio V, Valitutti F, Dolce P, Piccirillo M, Evangelisti M, Andreozzi M, Carangelo L, Di Nardo G. J Clin Med. 2025 Mar 12;14(6):1910. doi: 10.3390/jcm14061910. PMID: 40142716 Free PMC article.
10.	Gastro-oesophageal reflux is not a major cause of brief resolved unexplained events in infants. Jilani NZ, Hussain A, Al Ansari K, Powell CVE. Breathe (Sheff). 2019 Jun;15(2):e32-e39. doi: 10.1183/20734735.0174-2019. PMID: 31777563 Free PMC article.

Acute Pain Management in the Outpatient Setting

Here is a brief bullet point summary of acute pain management for pediatric outpatients:

Assess Pain: Use age-appropriate pain scales (self-report is key when possible). Observe behavior for non-verbal children. Get parent/caregiver input.

Multimodal Approach: Combine nonpharmacologic and pharmacologic strategies.

Nonpharmacologic (First-Line for Mild-Moderate Pain):

Comfort measures (swaddling, holding, positioning).
Distraction (toys, games, music, etc.).
Child life involvement.

Pharmacologic:

Non-Opioids (Mild-Moderate Pain): Acetaminophen, NSAIDs (weight-based dosing, be aware of combinations).
Opioids (Moderate-Severe Pain, Use Judiciously): Lowest effective dose, immediate-release, shortest duration (≤ 5 days typically), avoid codeine/tramadol in young children and certain adolescents, consider naloxone.

Outpatient Considerations: Age-appropriate formulations.

Comprehensive caregiver education (dosing, side effects, when to seek help, safe storage/disposal, teach-back).
Individualized pain plan.
Follow-up.
Clear home pain management plan.

Source: Google Gemini

Items 1-8 of 8 (Display the 8 citations in PubMed)

1.	Evidence for the Use of Opioid Medication for Pediatric Acute Pain in the Outpatient Setting: Technical Report. Raman SR, Smith MJ. Pediatrics. 2024 Sep 30:e2024068753. doi: 10.1542/peds.2024-068753. Online ahead of print. PMID: 39344446
2.	Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings: Clinical Practice Guideline. Hadland SE, Agarwal R, Raman SR, Smith MJ, Bryl A, Michel J, Kelley-Quon LI, Raval MV, Renny MH, Larson-Steckler B, Wexelblatt S, Wilder RT, Flinn SK. Pediatrics. 2024 Sep 30:e2024068752. doi: 10.1542/peds.2024-068752. Online ahead of print. PMID: 39344439
3.	Management of Acute Sickle Cell Disease Pain. Payne JN, Gee BE. Pediatr Rev. 2024 Jan 1;45(1):26-38. doi: 10.1542/pir.2022-005631. PMID: 38161155
4.	Management of Pediatric Persistent Asymptomatic Cervical Lymphadenopathy. Harris JE, Patel NN, Wai K, Rosbe KW. Otolaryngol Head Neck Surg. 2024 Jan;170(1):69-75. doi: 10.1002/ohn.420. Epub 2023 Jul 7. PMID: 37418178
5.	Outpatient administration of naxitamab in combination with granulocyte-macrophage colony-stimulating factor in patients with refractory and/or relapsed high-risk neuroblastoma: Management of adverse events. Mora J, Chan GC, Morgenstern DA, Nysom K, Bear MK, Tornøe K, Kushner BH. Cancer Rep (Hoboken). 2023 Jan;6(1):e1627. doi: 10.1002/cnr2.1627. Epub 2022 May 17. PMID: 35579862 Free PMC article. Review.
6.	Acute and Chronic Pain in Children and Adolescents With Cerebral Palsy: Prevalence, Interference, and Management. Ostojic K, Paget S, Kyriagis M, Morrow A. Arch Phys Med Rehabil. 2020 Feb;101(2):213-219. doi: 10.1016/j.apmr.2019.08.475. Epub 2019 Sep 12. PMID: 31521713
7.	Fentanyl Formulations in the Management of Pain: An Update. Schug SA, Ting S. Drugs. 2017 May;77(7):747-763. doi: 10.1007/s40265-017-0727-z. PMID: 28337672 Review.
8.	Chronic pain management as a barrier to pediatric palliative care. Thompson LA, Meinert E, Baker K, Knapp C. Am J Hosp Palliat Care. 2013 Dec;30(8):764-7. doi: 10.1177/1049909112473632. Epub 2013 Jan 16. PMID: 23329083

Somewhere Over the Counter: Counseling Caregivers on the Safety and Efficacy of OTC Medications

Here is a brief bullet point list for counseling caregivers on the safety and efficacy of over-the-counter (OTC) medications for children:

Read Labels Carefully: Emphasize checking active ingredients, dosages, warnings, and contraindications every time.
Age and Weight-Based Dosing: Highlight the importance of using the child's current weight for accurate dosing, not just age.
Use Measuring Devices Provided: Stress using the cups, spoons, or droppers that come with the medication, not household spoons.
Single-Ingredient Products Preferred: Advise choosing products that treat specific symptoms rather than multi-symptom cold/cough medications, especially in young children.
Avoid Duplication: Warn against giving multiple medications with the same active ingredient.
Know Potential Side Effects: Discuss common side effects and when to seek medical advice.
Storage Safety: Instruct on proper storage (out of reach and sight of children).
When to Call the Doctor: Outline red flags that warrant professional medical attention instead of relying solely on OTCs (e.g., high fever, difficulty breathing, persistent symptoms).
Not a Substitute for Medical Care: Remind caregivers that OTCs treat symptoms but don't address the underlying cause of illness.
Question the Pharmacist: Encourage caregivers to ask the pharmacist if they have any questions or concerns about OTC medications.

Source: Google Gemini

Items 1-8 of 8 (Display the 8 citations in PubMed)

1.	Over-the-Counter Ibuprofen-Induced Pre-Pyloric Gastric Perforation in a 28-Month-Old Child: A Rare Pediatric Case. Uddin W, Aylan Alshamsi M, Gupta V, Alblooshi M, Abdul Kader M. Cureus. 2025 Apr 23;17(4):e82821. doi: 10.7759/cureus.82821. eCollection 2025 Apr. PMID: 40271233 Free PMC article.
2.	Over-the-counter analgesic-related exposure and toxicity in pediatrics. Bentley S, Downs L, Oliver S, Pandy S, Rao S, Perry L. J Am Pharm Assoc (2003). 2024 Nov-Dec;64(6):102218. doi: 10.1016/j.japh.2024.102218. Epub 2024 Aug 19. PMID: 39168447
3.	Clinical Toxicology of OTC Cough and Cold Pediatric Medications: A Narrative Review. Diantini A, Alfaqeeh M, Permatasari LI, Nurfitriani M, Durotulailah L, Wulandari W, Sitorus TDR, Wilar G, Levita J. Pediatric Health Med Ther. 2024 Jul 11;15:243-255. doi: 10.2147/PHMT.S468314. eCollection 2024. PMID: 39011322 Free PMC article. Review.
4.	Parent-Directed use of Over-the-Counter Medications and Complementary and Alternative Medicine Therapies among Pediatric Patients: A Cross-Sectional Study. Seth S, Dubey AK, Maheshwari N. J Res Pharm Pract. 2023 Aug 29;11(4):151-161. doi: 10.4103/jrpp.jrpp_15_23. eCollection 2022 Oct-Dec. PMID: 37969617 Free PMC article.
5.	The Risk of Nonsteroidal Anti-Inflammatory Drugs in Pediatric Medicine: Listen Carefully to Children with Pain. Mboma O, Wirth S, Aydin M. Children (Basel). 2021 Nov 13;8(11):1048. doi: 10.3390/children8111048. PMID: 34828761 Free PMC article.
6.	US emergency department visits for acute harms from over-the-counter cough and cold medications, 2017-2019. Mital R, Lovegrove MC, Moro RN, Geller AI, Weidle NJ, Lind JN, Budnitz DS. Pharmacoepidemiol Drug Saf. 2022 Feb;31(2):225-234. doi: 10.1002/pds.5384. Epub 2021 Nov 24. PMID: 34757641 Free PMC article.
7.	Active Extraction of Experience of Adverse Drug Reactions in Children. Noda A, Obara T, Satoh M, Yagi N, Mano N, Kaneko K. J Pediatr Pharmacol Ther. 2021;26(4):352-360. doi: 10.5863/1551-6776-26.4.352. Epub 2021 May 19. PMID: 34035679 Free PMC article.
8.	Pancreatitis and Acute Liver Failure From Coricidin® HBP Intoxication. Medows M, Acosta C, Vega V. Cureus. 2020 Sep 2;12(9):e10202. doi: 10.7759/cureus.10202. PMID: 33033679 Free PMC article.

Lactation Matters: The Science, The Process, and How Pediatricians Can Lead Community Advocacy

Here's a brief bullet point list for "Lactation Matters: The Science, The Process, and How Pediatricians Can Lead Community Advocacy":

The Science:

Nutritional Superiority: Breast milk's unique and dynamic composition tailored to infant needs.
Immunological Benefits: Transfer of antibodies and bioactive factors protecting against infections.
Long-Term Health Outcomes: Reduced risk of asthma, allergies, obesity, diabetes, SIDS.
Maternal Health Benefits: Decreased risk of certain cancers, type 2 diabetes, postpartum depression.
Gut Microbiome Development: Breast milk fosters a healthy and diverse infant gut.

The Process:

Physiology of Milk Production: Hormonal influences (prolactin, oxytocin), supply-demand regulation.
Proper Latch and Positioning: Crucial for effective milk transfer and preventing nipple pain.
Frequency and Duration of Feeds: Responsive feeding cues, establishing milk supply.
Addressing Common Challenges: Sore nipples, engorgement, low milk supply, mastitis.
Support Systems: Importance of lactation consultants, peer support groups, family support.

Pediatrician Leadership in Community Advocacy:

Education and Counseling: Providing evidence-based information to families prenatally and postpartum.
Hospital Policies: Advocating for Baby-Friendly Hospital Initiatives (BFHI).
Community Partnerships: Collaborating with local health departments, WIC, and breastfeeding support organizations.
Policy Advocacy: Supporting legislation that protects and promotes breastfeeding (e.g., paid parental leave, workplace lactation support).
Addressing Disparities: Working to ensure equitable access to lactation support for all families.
Professional Development: Staying updated on lactation research and best practices.
Challenging Misinformation: Providing accurate information to counter myths and misconceptions about breastfeeding.
Promoting a Breastfeeding-Friendly Culture: Normalizing breastfeeding in public spaces and within the community.

Source: Google Gemini

Items 1-10 of 10 (Display the 10 citations in PubMed)

1.	Breastfeeding and Non-Communicable Diseases: A Narrative Review. Capra ME, Aliverti V, Bellani AM, Berzieri M, Montani AG, Pisseri G, Sguerso T, Esposito S, Biasucci G. Nutrients. 2025 Jan 30;17(3):511. doi: 10.3390/nu17030511. PMID: 39940369 Free PMC article. Review.
2.	A Directed Content Analysis of Discussions Between Mothers and Pediatricians Around Feeding and Growth Topics During Infant Well-Child Visits. Savidge MC, Bean MK, Caccavale LJ, Wijesooriya R, Adams EL. Clin Pediatr (Phila). 2025 Jun;64(5):665-674. doi: 10.1177/00099228241287629. Epub 2024 Oct 10. PMID: 39385592 Free PMC article.
3.	Complementary Feeding in the Clinical Practice: An Exploratory Survey among Italian Primary Care Pediatricians. Capra ME, Decarolis NM, Stanyevic B, Giudice A, Monopoli D, Neglia C, Ramundo G, Esposito S, Biasucci G; Italian Preventive and Social Pediatrics Society (SIPPS)—Emilia-Romagna Section. Nutrients. 2024 Sep 16;16(18):3127. doi: 10.3390/nu16183127. PMID: 39339727 Free PMC article.
4.	English Translation of the Breastfeeding Knowledge Survey for Pediatricians. Menéndez Orenga M, Porter D, Gómez Fernández-Vegue M. J Hum Lact. 2024 Aug;40(3):386-391. doi: 10.1177/08903344241254344. Epub 2024 Jun 3. PMID: 38826038 Free PMC article.
5.	Complementary Feeding: Tradition, Innovation and Pitfalls. Capra ME, Decarolis NM, Monopoli D, Laudisio SR, Giudice A, Stanyevic B, Esposito S, Biasucci G. Nutrients. 2024 Mar 4;16(5):737. doi: 10.3390/nu16050737. PMID: 38474864 Free PMC article. Review.
6.	Marketing and child feeding. Brandt KG, da Silva GAP. J Pediatr (Rio J). 2024 Mar-Apr;100 Suppl 1(Suppl 1):S57-S64. doi: 10.1016/j.jped.2023.09.013. Epub 2023 Oct 31. PMID: 37918811 Free PMC article. Review.
7.	Role of Pediatricians in Promoting and Supporting Breastfeeding: A Position Paper of the International Pediatric Association Strategic Advisory Group on Infant, Child, and Adolescent Nutrition. Fewtrell M, Bandsma RHJ, Baur L, Duggan CP, Dumrongwongsiri O, Hojsak I, Khatami K, Koletzko B, Kovalskys I, Li Z, Mouane N, Nel E, Sachdev HS, Spolidoro JV. Ann Nutr Metab. 2023;79(6):469-475. doi: 10.1159/000534004. Epub 2023 Sep 6. PMID: 37673040 Review.
8.	Innovative online care: A cross-sectional survey study of potential benefits and challenges of online lactation consultation service with paediatrician consultation. Hamid MA, Kumar A, Gunaseelan L, Arulchelvan A, Sinha A, Razi S, Subhan M, Subhan S, Kapoor S, Salim A. Paediatr Child Health. 2022 Aug 19;27(7):414-420. doi: 10.1093/pch/pxac074. eCollection 2022 Dec. PMID: 36524026 Free PMC article.
9.	Maternal Experiences with Discussing Complementary Feeding in Primary Care. Bouchard KL, Grigsby-Toussaint DS, Fox K, Amin S, Vadiveloo M, Greaney ML, Tovar A. Int J Environ Res Public Health. 2022 Sep 23;19(19):12061. doi: 10.3390/ijerph191912061. PMID: 36231363 Free PMC article.
10.	The weaning practices: A new challenge for pediatricians? Nuzzi G, Gerini C, Comberiati P, Peroni DG. Pediatr Allergy Immunol. 2022 Jan;33 Suppl 27(Suppl 27):44-46. doi: 10.1111/pai.13627. PMID: 35080314 Free PMC article.

Jon B. Tingelstad Conference: Practical Pediatrics 2025

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Conference Brochure

The Baby BRUEs

Acute Pain Management in the Outpatient Setting

Somewhere Over the Counter: Counseling Caregivers on the Safety and Efficacy of OTC Medications

Lactation Matters: The Science, The Process, and How Pediatricians Can Lead Community Advocacy