A monthly guide to the best new Pediatric Emergency Medicine FOAM
We’re changing up the Roundup a little this month. Instead of grouping resources by clinical topic, we’ve organized them around how you might use them. If you enjoy this format or have ideas for improving it, please leave a comment at the end of the post.
Read. Listen. Bring something back to your next shift. This month’s selection moves from a pneumonia evidence appraisal and a diagnostic safety case to procedures, neonatal presentations, adolescent care, and useful teaching material. Each link takes you to the original resource.
Overall Pearls from September’s PEM FOAM
- One examination finding should not carry the diagnosis. The pneumonia reliability review shows how differently clinicians may hear and describe the same lung findings. The diagnostic safety case reinforces the value of the full history, reassessment, and information from the rest of the team.
- Clot tools answer different questions. PERC-Peds can identify a very-low-risk group among selected children evaluated for pulmonary embolism; a nonnegative screen does not automatically mean CT. Suspected limb DVT requires its own evaluation and treatment discussion.
- A food reaction can look like gastroenteritis. FPIES may cause repetitive vomiting one to four hours after a trigger food, often without hives or respiratory symptoms. Ask about the timing of foods and whether the same pattern has happened before.
- Steroid decisions deserve a specific indication. The asthma dosing appraisal and steroid stewardship episode invite us to ask which children benefit, what course the evidence supports, and whether a prescription is being driven by habit.
- The plan does not end with the immediate intervention. Complete hair-tourniquet removal needs reassessment; laceration repair needs clear home-care instructions. Diagnostic uncertainty also calls for follow-up and return precautions that families can use.
⚡ This Month in 30 Seconds
🌐 External resources featured: 29
📝 Blog posts, cases, and journal-club resources: 14
🎧 Podcast episodes: 11
📊 One-page infographics: 4
🚀 Start Here: Three Picks
The evidence question. ALiEM’s pneumonia examination review separates clinician agreement from diagnostic accuracy.
The next shift skill. PEMBlog’s hair-tourniquet guide turns recognition into a removal and reassessment plan.
The listen. The Cribsiders’ FPIES episode gives you a memorable pattern for delayed vomiting after a trigger food.
🧐 The Evidence Worth Unpacking
Read or listen when the study design changes how the result should be used.
Pediatric Pneumonia Without Routine Chest X-Rays: How Much Weight Should We Give the Lung Exam?
📝 ALiEM | Evidence review | Published: September 25
An appraisal of PECARN PedCAPS data on interobserver agreement in children already diagnosed with pneumonia. No individual examination finding met the study’s prespecified reliability threshold; crackles and decreased breath sounds showed particularly low agreement. The post separates reliability from diagnostic accuracy and explains why one lung sound should not drive imaging or antibiotics in isolation.
Pulmonary Embolism in Children: BEEPER Study
📝 Pediatric EM Morsels | Evidence review | Published: September 4
BEEPER prospectively studied PERC-Peds in children ages 4–17 when pulmonary embolism was tested for or seriously considered. All eight criteria, including clinician gestalt under 15%, must be negative to identify a very-low-risk child; a nonnegative screen does not itself mean CT. Read the appraisal for the study’s high sensitivity, low specificity, and limits of an observational pediatric ED cohort.
PEAs on a Pod Episode 3: Two dose or not two dose?
🎙️ PEAs on a Pod | Podcast | Published: September 7
Drs. Seth Ball and Rusty Walker examine a study of one versus two dexamethasone doses for pediatric asthma exacerbations. Listen for the study design and whether the observed outcomes support changing a discharge steroid plan; the episode is an appraisal, not a universal dosing directive.
The 105th Bubble wrap: DFTB 26 BW Live -Gen Paeds
📝 Don’t Forget the Bubbles | Journal club | Published: September 1
A live journal-club review of five recent pediatric papers, opening with adjunctive prednisolone in Kawasaki disease. It brings trial methods, outcomes, and interpretive caveats into one teaching resource; follow the individual papers before applying a finding to a specific patient.
💼 For Your Next Shift
Practical moves and conversations to prepare before the next patient.
Management of Hair-Thread Tourniquet Syndrome
📝 PEMBlog | Procedure guide | Published: September 1
A practical approach to finding and completely removing a hair or fiber constricting an infant’s digit or appendage. The case moves from unsuccessful depilatory cream and forceps attempts to reassessment, escalation, and aftercare – useful when swelling or skin breakdown makes the band hard to see.
PEAs on a Pod Episode 4: Beyond the Stitch
🎙️ PEAs on a Pod | Podcast | Published: September 14
A review of what to tell families after laceration repair: moist versus dry care, whether to cover a wound, and practical discharge advice. Useful when a technically successful repair still needs a clear home-care plan.
PEAs on a Pod Episode 5: Stop, Valsalva & Drop
🎙️ PEAs on a Pod | Podcast | Published: September 21
An 11-minute look at standard versus modified Valsalva for supraventricular tachycardia, prompted by a 2026 systematic review and meta-analysis. Use it to revisit how to coach a stable patient through a vagal maneuver and consider how directly the underlying evidence applies to children.
Neonatal Conjunctivitis
📄 PedsCases | One-page infographic | Published: September 5
A one-page comparison of neonatal eye discharge in the first 30 days, including gonococcal, chlamydial, and HSV presentations. The key ED reason to save it is the reminder that gonococcal infection can threaten vision and requires prompt evaluation and treatment; check current local guidance for workup and management.
PEAs on a Pod Episode 6: Steroid Savvy
🎙️ PEAs on a Pod | Podcast | Published: September 28
A 19-minute discussion of steroid stewardship in common pediatric ED presentations: when treatment helps, where habit may outrun evidence, and the downsides of unnecessary prescribing. Pair it with the asthma episode when reviewing your department’s discharge practices.
MART in Childhood Asthma: One Inhaler, Simpler Care?
📝 Don’t Forget the Bubbles | Clinical review | Published: September 29
Maintenance and reliever therapy (MART) uses an inhaled corticosteroid–formoterol combination for both daily control and symptom relief. This review helps ED clinicians recognize a child’s one-inhaler regimen, assess inhaler technique, and clarify the discharge action plan.
#192: Live! The Clot Thickens: DVT and DOACs in Children
🎙️ The Cribsiders | Podcast | Published: September 23
Dr. Hope Wilson walks through pediatric DVT recognition, deep versus superficial veins, ultrasound, anticoagulant options, and treatment duration. The discussion includes the limits of shorter treatment for selected first provoked clots and practical counseling for children receiving anticoagulation.
Episode 140: Clinical Care Tips – When to Be More Worried
🎙️ PEM Rules | Podcast | Published: September 14
A short clinical tip about placing more weight on objective findings when a child’s presentation feels concerning. Use it as a prompt to revisit the examination, vital signs, and trajectory alongside the reported symptoms.
🔪 Sharpen Your Clinical Radar
Presentations that can be missed, misread, or mistaken for something more familiar.
Pulmonary haemorrhage in a toddler: when pneumonia isn’t pneumonia
📝 Don’t Forget the Bubbles | Clinical case | Published: September 22
A toddler with a presumed pneumonia and striking iron-deficiency anemia becomes a case in recognizing pulmonary hemorrhage. Hemoptysis may be absent because children swallow blood. The article covers the differential, early stabilization, and evaluation for diffuse alveolar hemorrhage; read it for the clue of infiltrates plus unexplained anemia.
Neonatal Seizures
📝 Don’t Forget the Bubbles | Clinical review | Published: September 15
A neonatal ward scenario reviews subtle seizure presentations, electrographic seizures that lack visible signs, common causes, and mimics such as jitteriness and sleep myoclonus. It is a useful refresher when an infant’s movements are ambiguous and a reminder to assess glucose and other reversible causes while arranging expert evaluation.
PEMPix 2026 Online Case 1: 60% of the Time, It Works Every Time
📝 PEMBlog | Visual Diagnosis case | Published: September 28
A visual diagnosis challenge featuring a 12-year-old with severe abdominal pain, nephrocalcinosis, short stature, and hypokalemia. Work through the imaging and laboratory clues before revealing the diagnosis; the case asks why a child is forming stones rather than stopping at renal colic.
PEMPix 2026 Online Case 2: I’m Not Even Mad, That’s Amazing!
📝 PEMBlog | Visual Diagnosis Case | Published: September 29
A well-appearing 6-year-old develops progressive clavicular pain and swelling after a minor fall. Imaging shows an aggressive-looking lesion, with additional findings elsewhere in the skeleton. Study the images and decide how the child’s reassuring appearance changes your differential before revealing the diagnosis.
PEMPix 2026 Online Case 3: Boy, That Escalated Quickly
📝 PEMBlog | Visual Diagnosis Case | Published: September 30
A 3-year-old’s enlarging lesion behind the ear initially appears consistent with cellulitis, but it keeps growing despite several antibiotic courses. Follow the serial photographs, imaging, and eventually striking laboratory results, then reconsider the diagnosis before clicking to reveal it.
Approach to Pancytopenia
🎙️ PedsCases | Podcast | Published: September 8
A structured approach to recognizing pancytopenia, its clinical manifestations, differential, and initial investigations. A useful teaching listen when an ED CBC shows reductions in more than one cell line.
#190: Trust Your Gut: It Might Be FPIES
🎙️ The Cribsiders | Podcast | Published: September 2
Pediatric allergist Dr. Jessica Macdougall discusses the infant with repetitive vomiting 1–4 hours after a trigger food, often without hives or respiratory symptoms. The episode distinguishes FPIES from immediate IgE-mediated allergy and allergic proctocolitis, then covers acute supportive care and specialist-guided food reintroduction.
#191: Vaccine Preventable Illnesses, TWO
🎙️ The Cribsiders | Podcast | Published: September 9
A clinical review of pertussis, pneumococcal disease, and Hib in children, with attention to presentations in infants and under-immunized patients. It is a prompt to revisit immunization history when an invasive or unusual infection enters the differential.
🔎 Beyond the Diagnosis
What changes when safety, systems, and the adolescent’s circumstances enter the clinical picture.
Barriers to Safe Diagnosis
📝 Don’t Forget the Bubbles | Clinical reasoning case | Published: September 8
A missed posterior fossa tumor illustrates how patient, clinician, and system factors can accumulate around a plausible diagnosis. The post highlights collateral history, handoffs, cognitive anchoring, and specific return precautions. A strong case for a team discussion about what information did not reach the bedside.
The APEM-PERUKI 2026 Mental Health PEM Adventure
📝 Don’t Forget the Bubbles | Simulation case | Published: September 15
An interactive case of a distressed adolescent with ligature marks explores immediate safety, neurodivergence, agitation, safeguarding, and trauma-informed care. Its legal discussion is specific to the UK; the transferable value is how the team adjusts the environment, reassesses risk, and looks beyond the initial account.
CPS Podcast: Considerations for Privacy and Confidentiality in Adolescent Health Care Service Delivery
🎙️ PedsCases | Podcast | Published: September 19
A discussion of the Canadian Paediatric Society’s guidance on adolescent privacy and confidentiality. It offers a prompt to examine how private conversation, documentation, and disclosure work in your own setting; legal requirements vary by jurisdiction.
Can a Paediatric Emergency Department Fit Inside a Laptop?
📝 Don’t Forget the Bubbles | Service evaluation | Published: September 10
A descriptive account of a large Australian pediatric virtual ED and more than 380,000 consultations. The authors frame video visits as risk stratification supported by experienced clinicians and safety-netting. Useful for thinking about access and ED flow; the observational service data do not prove that the model would perform the same way elsewhere.
💾 Save for Teaching
A literature map and compact teaching aids to use for your next journal club or learner session.
Bubble Wrap PLUS – September 2026
📝 Don’t Forget the Bubbles | Literature list | Published: September 1
A broad pediatric journal-club reading list drawn from 34 journals. Selected studies receive a design, finding, take-home point, and caveat. Save it for literature discovery rather than treating every highlighted paper as an immediate ED practice change.
SGEM Paper in a Pic #519
📄 The Skeptics’ Guide to Emergency Medicine | One-page infographic | Published: September 3
A visual teaching companion to SGEM #519 on the pediatric PERC-Peds/BEEPER evidence. It revisits the same study as this month’s Pediatric EM Morsels review, so use the graphic as a quick discussion starter and return to the full appraisals for the details.
Eosinophilic Esophagitis
📄 PedsCases | One-page infographic | Published: September 22
A one-page overview of presentation, pathophysiology, diagnosis, and management of eosinophilic esophagitis. Useful as a differential refresher for a child with dysphagia or recurrent food impaction.
Type 2 Diabetes Mellitus
📄 PedsCases | One-page infographic | Published: September 7
A visual overview of pediatric type 2 diabetes and its distinction from autoimmune type 1 diabetes. Keep it as a teaching aid when working through hyperglycemia in an adolescent; use local protocols for acute metabolic emergencies.
Episode 141: PEM Education, Beyond the Classroom and The Bedside, with Emily Rose
🎙️ PEM Rules | Podcast | Published: September 28
A conversation with Dr. Emily Rose about the work of educating the next generation of PEM clinicians beyond formal classroom and bedside teaching. Save it for an educator or team-development listen.
🗓️ Bring It to a Team Discussion
After reading the diagnostic safety case, ask: Which observations from families, nurses, play specialists, or outside clinicians are easiest for our team to miss during a crowded shift?
🏛️ New on HipPEMcrates
The PEM Podcast: Vaccines, Trust, and the Unvaccinated Child with Dr. Paul Offit
🎙️ The PEM Podcast | Podcast | Published: September 29
Dr. Bob Belfer and Dr. Paul Offit discuss vaccine confidence, how safety signals are investigated, and the return of vaccine-preventable illness. They bring the conversation back to the ED with a practical question: how should an unimmunized toddler with fever and no clear source affect concern for invasive bacterial infection?
The 3: What You Need to Know Before Reaching for TXA in Post-Tonsillectomy Hemorrhage
📝 HipPEMcrates | Clinical review | Published: September 30
Dr. Anum Mitha reviews why a well-appearing child may still have substantial blood loss, what the limited evidence suggests about nebulized TXA, and why improvement after TXA is not definitive hemostasis. Prioritize suction, airway and hemodynamic assessment, resuscitation, and early ENT involvement; TXA may serve as an adjunct while definitive care is arranged.
Rapid Rounds with HBD: Chest Pain
📝 HipPEMcrates | Clinical case | Published: September 4
Dr. Hannah Barber Doucet walks learners through an adolescent chest-pain case, emphasizing the history, red flags, differential, and targeted workup for uncommon but serious causes.
❤️ Thank You to This Month’s PEM FOAM Contributors
This month’s roundup featured work from:
- Academic Life in Emergency Medicine
- Don’t Forget the Bubbles
- PEMBlog
- Pediatric EM Morsels
- PedsCases
- PEAs on a Pod
- PEM Rules
- The Cribsiders
- The PEM Podcast
- The Skeptics’ Guide to Emergency Medicine
Thank you to everyone creating and sharing free, high-quality Pediatric Emergency Medicine education. Please support these educators by reading, listening, sharing, and engaging with the original content.
Dr. Joshua Belfer, MD, is a Pediatric Emergency Medicine physician at the Children’s Hospital of Philadelphia, and is the Founder and Editor-in-Chief of HipPEMcrates. He can be reached at HipPEMcrates@gmail.com.
