Pediatric Meltdown

250. Hand in Hand Parenting

Wed, 11 Jun 2025 09:00:00 +0000

Is the true heart of pediatrics found in the connection between practitioner and family?

In this powerful episode of Pediatric Meltdown, Dr. Lia Gaggino sits down with physician, educator, and hand-in-hand parenting advocate Dr. Pam Oatis, who brings decades of primary care and hospital experience to the forefront. Together, they explore how listening, humility, and authentic relationships transform patient outcomes far beyond medical treatments alone.

From the challenges of working in high-need communities to navigating tense family moments and exploring ethics in end-of-life care, this episode delves into the artistry that makes pediatric medicine so uniquely soul-filling. If you’ve ever questioned whether technical skill is enough—or wondered what truly heals—this conversation will invite you to see the science of medicine through the eyes of connection and compassion. Don’t miss the life-changing insights you’ll carry into every patient encounter.

Be sure to catch the special announcement in the Takeaways.

[0:01 - 07:59] Leaning Into Pediatrics: Beginnings, Inspiration, and Learning From Families

Understand why primary care pediatrics is infinitely rewarding—not just for the broad medical knowledge it demands, but for the lifelong learning about people, relationships, and cultures it provides.
Learn the importance of setting parents at ease through open-ended questions and authentic appreciation, establishing trust and safety from the very first visit.
Explore how humility and willingness to learn from families reveal the limitations of one-size-fits-all approaches and fuel long-term, mutually respectful relationships.
Hear personal stories illustrating the deep impact of simple listening skills, such as appreciating each parent and seeing profound transformation in both relationships and care outcomes.

[08:00 -16:40] The Power of Listening and Cultural Humility in Pediatric Care

Uncover how being attuned to parents’ fears and self-doubt allows physicians to connect deeply, providing reassurance and support that transcends medical advice.
Examine situations where cultural differences and past experiences inform parenting approaches, challenging providers to pause, listen, and reflect rather than judge.
Appreciate how open, honest dialogue about discipline and race can lead to decades-long partnerships founded on mutual respect and understanding.
Acknowledge that the wisdom and resilience of families, when honored, can lead to better outcomes than following protocols alone.

[16:41 - 26:01] Human Connection: Biology, Society, and the Foundation of Care

Investigate the deep human need for connection, acknowledging our social wiring and the essential role that physical and emotional closeness play from birth through adulthood.
Discover why the medical “team sport” approach leads to improved outcomes—not just for children, but for providers and families navigating medical complexity together.
Identify the under-recognized burdens society places on parents and why framing parental challenges as cultural rather than personal failures empower families.
Explore how respect, dignity, and honest collaboration form the backbone of effective care—and why accurate patient histories and trusting relationships matter as much as diagnostics.

[26:02 - 07:59] From Touch to Teamwork: Bioethics, Palliative Care, and Listening Partnerships

Learn how physical touch is not just diagnostic, but profoundly healing, fostering trust and well-being in children and families.
Understand the evolution of bioethics and palliative care as disciplines built on listening, respect, and honoring families’ definitions of meaning and...

249. The Pediatric Meltdown Podcast: Behind the Scenes

Wed, 04 Jun 2025 20:30:00 +0000

Are you curious about what really happens behind the microphones of a successful pediatric podcast—and the unconventional journeys that brought an incredible team together?

In this special milestone episode of Pediatric Meltdown, host Lia brings her entire production and strategy team on-air for an unfiltered, dynamic conversation. Discover the circuitous career paths that shaped a jazz singer-turned-podcast producer, a teacher turned ADHD coach and social media strategist, and a web developer with a nomadic spirit.

Uncover the highs, lows, and learning curves of building a polished show from the inside out—including struggles with self-promotion, harnessing social media, and the mounting pressures (and joys) of creative collaboration.

If you've ever wondered what it takes to sustain a podcast for (close to) 250 episodes, or you’re searching for inspiration to pivot in your own career, this story of grit and reinvention will leave you rethinking what’s possible.

[00:02 - 10:04] How the Team Came Together & Podcast Origins

The show’s launch was serendipitous, sparked by a leap of faith rather than a long-held ambition to podcast.
Early challenges with off-shore podcast management led to seeking more control and expertise locally.
The pivotal connection to a new producer happened via networking with Adam Schaeuble of Podcast Business School.
The team shares first impressions and mutual support, setting the collaborative tone for the episode.

[10:05 - 15:57 ] Creative Pivots, Building Skills, and Making Media

Team members discuss how their entertainment, teaching, and customer service backgrounds unexpectedly prepared them for podcasting and digital media.
D.R.’s “Mouthy Broad Media”company name was inspired by a personal family story, blending creativity with homage.
The learning curve of audio, websites, and social strategy is highlighted as an ongoing, shared challenge.
The importance of curiosity, open-mindedness, and adapting to unexpected opportunities is emphasized.

[15:58 - 34:30 ] The Rewards and Hurdles of Content Creation & Promotion

Social media emerges as both an essential tool for growth and the greatest challenge for the host, who dislikes self-promotion.
Each team member brings different comfort levels and tactics for tackling visibility and audience engagement.
Discussion of burnout, professional transitions, and how the pandemic prompted new career directions.
Strategies for supporting each other (and listeners) through ADHD, workflow experimentation, and honest dialogue about what works (or doesn’t).

[34:31 - 43:14 ] Leveraging Team Strengths: Services, Resources & Lessons for Listeners

The team shares their current services: web design, social media strategy, podcast production, ADHD coaching, and consulting.
Emphasis on collaboration (“it’s all right here”)—listeners are encouraged to reach out for services or to get started themselves.
Honest reflections on the tricky pursuit of monetization and the value of creative fulfillment.
Recommendations for further learning, including Colleen Cullinan’s ADHD series and Peter Jensen’s adult ADHD episode.

[43:15 - 48:49] Dr. G’s TakeAways

Resources Mentioned in the Episode:

D.R. Fay - MouthyBroadMedia.com

Margaret Faucella -

248. Conversation with My Daughter: Soft Body Baddie

Wed, 28 May 2025 12:30:00 +0000

How do we help kids and teens when social media is fueling a resurgence of body image issues and eating disorders? In this special conversation, Lia’s daughter, Julia Parzyck shares her personal and professional journey navigating the tumultuous landscape of body acceptance in a world obsessed with appearance. The episode explores the influence of social media platforms, like TikTok and Instagram, and the impact they have on pediatric mental health and body positivity. Listeners will discover practical parenting strategies rooted in empathy, compassion, and my own past mistakes. Body acceptance is an ongoing journey, not a destination. Are we ready to support the next generation in building resilience against the ever-present pressures of body image issues?

[00:01 - 06:22] The Shifting Landscape of Body Image and Social Media

Explores how diet culture and body expectations have worsened for teenagers in the age of TikTok and “skinny talk,” surpassing early 2000s pressures.
The proliferation of pro-eating disorder content, now openly accessible through social media, and how it’s masked as harmless tips.
Contrasts curated body-positive environments with the harsher realities faced by today’s youth on unchecked platforms.
Highlights the rise of the “skinny talk” hashtag/movement and its troubling normalization of disordered behaviors and comparison.

[06:23 - 11:39]Owning Softness: From Childhood Stories to Social Advocacy

Julia redefines “softness” as a source of strength, both in body and emotions, coining the phrase “soft body baddie” for her community.
Childhood anecdotes—ranging from fashion flair to forming the hilariously named "labia band"—remind listeners of the roots of self-expression.
Explores how embracing personal quirks and struggles, like anxiety and neurodivergence, leads to greater empathy in work with children and coaching.
Reflects on how family dynamics and navigating outspoken personalities shape resilience, communication, and mutual growth.

[11:40 -19:47]Healing, Boundaries, and Building a Modern Identity

Discusses the transformative impact of family therapy, learning emotional independence, and accepting that parents can’t always “fix” pain.
Julia’s journey through heartbreak (a called-off wedding) reveals the non-linear, ongoing process of healing and redefining self-worth.
Explores the leap of faith required to pursue a career in body-positive coaching and online content, with all its uncertainties.
Highlights the value of embracing risk, letting go of the need to “do it all over,” and recognizing how adversity can fuel growth and new purpose.

[19:48 - 29:22] Compassion, Societal Pressures, and Looking Forward

Shares insights on how political landscapes influence fashion, body ideals, and the subtle ways women are controlled through image and expectation.
Resist setting rigid future goals, focus instead on finding joy, balance, and meaning in work and life, post-trauma.
Stresses that body image work is lifelong, and that society will likely never “fix” its obsessions—progress is about grace, not perfection.
Leaves listeners with the message that taking up space, nurturing empathy, and living for personal fulfillment, not external approval, is an act of quiet revolution.

[29:23 - 35:21] Dr. G’s TakeAways

Connect with Julia Parzyck

Instagram: Fit Fat and All That

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247. Human Trafficking: What Pediatric Clinicians Must Know

Wed, 21 May 2025 09:00:00 +0000

Have you ever considered that victims of human trafficking might be walking into your clinic, hidden in plain sight, longing for someone to notice their silent signals?
In this episode of Pediatric Meltdown, host Dr. Lia Gaggino sits down with Dr. Dena Nazer , a leading child abuse pediatrician, to dispel widespread myths and expose the heartbreaking realities of child trafficking. They dive deeply into what human trafficking truly looks like, why language and empathy shape outcomes, and how pediatricians can recognize and respond to red flags—even when victims don’t or can’t ask for help. If you’ve ever wondered how to protect the most vulnerable or questioned your own role in advocacy, this conversation mixes expertise and actionable strategies you can use today.
Don’t miss this essential episode—sometimes the most critical intervention is simply being prepared to see what others overlook.
[00:00 - 06:25] Beyond Kidnapping: The Everyday Reality of Child Trafficking
Media Myths: trafficking is not always dramatic kidnappings—many victims are exploited by someone they know, sometimes in their own homes.
Defining human trafficking per US federal law: for children under 18, any commercial sexual act (anything exchanged for perceived value) is trafficking, regardless of force, fraud, or coercion.
Labor trafficking in children does require proof of force, fraud, or coercion, unlike sex trafficking.
Children cannot legally consent to commercial sexual acts, a fact often misunderstood by practitioners.

[06:26 - 18:33] Recognizing Vulnerability: Victims, Prevalence, and Persistent Myths
All children, regardless of socioeconomic status or geography, can be victimized; not just those from impoverished or unstable backgrounds.
Adolescents are particularly vulnerable due to developmental, social, and neurological factors—especially girls, though all genders are at risk.
The covert nature and underreporting of trafficking, with true prevalence grossly underestimated—actual victims far exceed documented cases.
Practitioners should avoid assumptions about victim profiles and recognize that trafficking does not discriminate by background or location.

[18:34 -24:41] Language, Reporting, and the Power of Empathy
There is an impact of language, advocating against terms like "prostitute" or "modern day slavery," as they distort public perception and can harm survivors.
There are nuanced preferences between “victim” and “survivor,” emphasizing respect for self-identification.
Addresses mandated reporting: outlines state-by-state differences, reminds clinicians to know their local laws, and suggests erring on the side of caution when in doubt.
Discusses the complexities of reporting and intervention with 18+ patients, promoting support over “rescue,” and collaboration over dictating solutions.

[24:42 - 47:58] Identification, Patient Support, and Multi-Agency Collaboration
Red flags in clinical settings: domineering non-parental adults accompanying children, delayed care-seeking, lack of address knowledge, repeated STIs, or signs of fear and withdrawal.
Ways to build trust and elicit disclosures: prioritize safety, establish boundaries about reporting, and use risk-factor-based screening questions.
Trauma-informed care—responding with empathy, validation, and minimal dramatization—to avoid re-traumatizing patients.
Connect with local Child Advocacy Centers and understanding local resources and procedures before a crisis arises.

[47:59 - 59:59] Dr. G’s TakeAways

Additional Resources Mentioned

246. Pediatric Psychopharmacology: Tips for Prescribers

Thu, 15 May 2025 01:30:00 +0000

Can medication truly transform the landscape of pediatric mental health, or are we oversimplifying the complexities of growing minds?
In this episode of Pediatric Meltdown, Dr. Lia Gaggino welcomes Dr. Jess Pierce, a hospital-based child psychiatrist whose expertise bridges the worlds of pediatrics and mental health, especially for children in rural areas. Unraveling the fascinating history of psychopharmacology and delving into the mechanisms of action for the antidepressants, this episode offers a roadmap for pediatricians navigating the maze of SSRIs, SNRIs, risks like serotonin syndrome, and difficult conversations about side effects. The nuances matter and Dr. Pierce guides us skillfully.
Discover why family history, patient buy-in, and transparent communications are pivotal to successful treatment—and why prescribing for young people demands a delicate blend of science, art, and empathy. This conversation will change the way you see—and approach—medication and the treatment of kids' mental health.
[00:08:51] Exploring Pediatric Psychopharmacology’s Roots
Tracing the unexpected origins of antidepressants, including how tuberculosis and hypertension treatments led to modern psychopharmacology
The monoamine hypothesis: understanding the neurotransmitter focus in early depression treatments
The move beyond serotonin, dopamine, and norepinephrine: new research on neurobiology, neurogenesis, and stress response
Prozac’s arrival and its impact in reshaping the treatment landscape for pediatric mental health

[08:52- 18:06 ] SSRIs in Practice: Similarities, Differences, and Selection
All SSRIs share rapid absorption, high protein binding, and similar side effect profiles—but key differences can matter
Important reasons to avoid Paxil and to use Lexapro over Celexa, particularly due to side effect burdens
Nuanced considerations: matching specific SSRIs to individual patient needs, such as Prozac’s activating profile for low-energy depression
Practical dosing strategies: the art of balancing “start low and go slow” with the urgency to help suffering children

[18:07- 27:59] Navigating Risks, Side Effects, and Patient Monitoring
The truth behind the Black Box Warning: clarifying risks of suicidal ideation vs. the dangers of untreated depression
Why regular, open conversations with families about medication side effects—especially sexual side effects in teens—build trust and adherence
Recognizing and managing serotonin syndrome: how to spot symptoms and when emergency intervention is needed
Identifying high-risk drug interactions, including situations with migraine or neurology medications

[28:00-45:19 ] From SNRIs to the Five-Step Prescribing Approach and Beyond
How SNRIs differ from SSRIs in action, side effects, and indication—especially in pain syndromes or where activating effects are desired
The use of Wellbutrin as an alternative with fewer sexual side effects, and cautions for seizure-prone populations
Strategic guidelines: the five-step approach to medication choice, considering patient history, family response, symptoms, buy-in, and comorbidities
Critical cautions with genetic testing and the limitations of using these results to guide first-line medication choices

[45:20-1:00:00] Dr Lia’s TakeAways

Resources Mentioned:
Dr. Pierce’s PPT on Pediatric Psychopharmacology Hello! Here's the link to the slides: Psychopharm...

245. When Sadness Looks Like Anger: Rethinking Pediatric Depression and Behavioral Activation

Wed, 07 May 2025 09:00:00 +0000

Are you struggling to support young patients—and maybe even yourself—with the emotional aftermath of our “new normal”?
In this compelling episode of Pediatric Meltdown, Dr. Colleen Cullinan returns to unpack the reality of pediatric depression in a world rocked by uncertainty. Discover why traditional approaches, like focusing solely on symptoms, may actually miss the bigger picture when kids are faced with unprecedented stress. Learn how changing the narrative, adopting techniques such as Acceptance and Commitment Therapy (ACT), and making small, values-driven changes can help children—and parents—find hope, function, and connection again. This episode isn’t just about treating depression; it’s about transforming how we relate to struggle and building resilience against the tide of ongoing adversity.
Tune in for real stories, actionable tools, and a refreshing reminder: even the heaviest feelings can be given a name, a shape, and ultimately, a little less power.
[00:00 - 08:40] The Impact: Symptom Overload, and Functional Impairment
The pandemic has significantly amplified youth mental health issues, leading to increased rates and severity of pediatric depression and anxiety.
Symptom checklists like the PHQ-9 now reveal almost universal distress—so much so that a "normal" score is rare.
Chronic uncertainty and prolonged stress (for both kids and adults) exacerbate feelings of hopelessness, helplessness, and irritability.
The primary care challenge: shifting from symptom identification to understanding the real-life impact on activities, relationships, and overall well-being.

[08:41 - 28:29] Rethinking Depression in Pediatrics: Connection, and Therapy Approaches
Connection—not just checking PHQ-9 scores—is a critical protective factor for youth mental health and should be the heart of clinical encounters.
Traditional Cognitive Behavioral Therapy (CBT) and newer Acceptance and Commitment Therapy (ACT) are compared — with ACT focusing on accepting thoughts and changing relationships with them, not just “fixing” or disputing them.
Dr. Cullinan explains how ACT techniques, including physicalizing and naming despair, help kids distance from and better manage their feelings.
The “beach ball” metaphor illustrates how fighting negative thoughts can cause you to miss life’s joys—and how letting them coexist with living can restore function and hope.

[28:30 -58:59] Strategies: Playful Experiments, Values-Based Goals, Motivational Tools
Practical examples include using humor, metaphor, and even quick physical challenges (like the “lemon” exercise) to help kids gain distance from distressing thoughts.
Naming depressive feelings or thoughts (e.g., “pathetic,” “Bob”) can help externalize and reduce their influence, making them easier to talk about and manage.
Motivational Interviewing is highlighted as a powerful tool—but only if it genuinely centers each child’s unique values and interests, not the provider’s agenda.
Avoidance, not just the presence of sadness or fear, is flagged as the true engine of suffering; the focus shifts to acceptance and gentle behavioral activation.

[59:00-1:06:47] Building Resilience: Safety, Nurture, New Frames, and Practical Pearls
Children’s beliefs and “frames” about themselves and the world are shaped by repeated messages—caregivers can help reframe these with new, nurturing narratives.
Safe, stable, nurturing relationships offer the strongest protection and resilience against depression and trauma, as explored through frameworks like toxic stress and child transformation health.
Providers can make meaningful impact in just minutes with new language, metaphors, and reframing exercises—even in a busy primary care setting.

[1:06:48 -...

244. Taming Pediatric Anxiety with Brain-Body-Behavior Strategies

Wed, 30 Apr 2025 09:00:00 +0000

Have you ever wondered why anxiety in children can look and feel so physical—and what we as pediatricians, parents, or caregivers can do about it?
We’re visiting a fan favorite from Episode #26 of Pediatric Meltdown, Dr. Lia Gaggino sits down with Dr. Colleen Cullinan, a leading pediatric psychologist, to dissect the powerful 3 B’s approach: Brain, Body, and Behavior. Together, they reveal eye-opening truths about integrated behavioral health, the ways anxiety manifests in kids, and practical, actionable strategies for managing emotional meltdowns in real-time. This is not just about recognizing anxiety—it's about transforming how we support kids inside and outside the exam room. If you want to empower families, level up your clinical skills, and make a tangible difference, don’t miss this conversation.
This episode could change the way you think about pediatric care—forever.
[00:00 - 11:35] Integrated Care Foundations: Building Partnerships in Pediatric Practice
Integrated behavioral health bridges the gap between physical and mental health, creating seamless care experiences for families.
Primary care is often the first—and sometimes only—entry point for children facing emotional or behavioral challenges.
Partnerships between pediatricians and behavioral health providers increase accessibility, reduce stigma, and foster earlier intervention.
The synergy and trust between pediatricians and psychology professionals leads to holistic, effective patient care.

[11:36 - 15:49] The Role of Primary Care in Managing Anxiety and Emotional Health
Primary care providers serve as trusted anchors, introducing mental health as an essential component of overall health.
Familiarity with a child's history allows pediatricians to recognize subtle behavior changes and collaborate meaningfully with behavioral specialists.
Normalizing physical symptoms of anxiety (like stomachaches and headaches) helps bridge conversations from medical to emotional concerns.
Educating families on the inseparability of physical and emotional health empowers them to seek support without shame.

[15:50 - 28:55] Anxiety Explained: The 3 B’s and Practical Strategies for Kids
The "3 B’s": Brain, Body, and Behavior, are interlinked—anxiety in the brain triggers body sensations, which guide behavior, often leading to avoidance.
Psychoeducation is key: Emphasizing to families and youth that everyone experiences anxiety validates their feelings and reduces shame.
Simple, actionable distress tolerance tools—breathing exercises, grounding techniques (like the “five senses” method), and focusing attention—can be taught in minutes during a regular visit.
Providers can help children recognize “worry thoughts” and redirect their response before anxiety spirals into withdrawal or meltdown.

[28:56 - 49:20] When to Escalate: Distress Tolerance, Prevention, and Team-Based Solutions
Distress tolerance techniques can bridge the gap until a child can access specialized behavioral care—or be sufficient for milder cases.
Functional impairment is the marker for when anxiety moves from “manageable” to requiring traditional CBT or higher-level intervention.
Exposure therapy explained: At its core, CBT for anxiety involves identifying fears and encouraging gradual, manageable exposure to them, with improvement through repetition.
Advocacy for integrated behavioral health, resource sharing, and ongoing partnerships with community therapists are essential for sustainable, high-impact child mental health care.

[49:21- 53:34] Dr. Lia’s...

243. The Child Mental Health Podcast: Expert Insights from Child Psychiatry

Wed, 23 Apr 2025 09:00:00 +0000

Are pediatricians prepared for the mental health crisis that’s impacting so many of our children today?
In this episode of Pediatric Meltdown, host Dr. Lia Gaggino sits down with nationally recognized child psychiatrist and podcast host Dr. Elise Fallucco to uncover the urgent realities facing pediatric practice. From understanding why a simple podcast name change can transform the reach of critical mental health education, to exploring the real-world, stepwise journey pediatricians navigate when facing complex child anxiety and medication management, this episode is a masterclass in practical empowerment. Listeners will discover actionable strategies for burnout, the evolving landscape of pediatric mental health treatment, and authentic stories of resilience, support, and resourcefulness. The stakes have never been higher—and the need to equip pediatric clinicians with the right knowledge and mindset is more critical than ever.
Don’t miss this invigorating roadmap for providing exceptional care in panicked times.
[00:02 - 05:46] Branding, Access, and Reaching Pediatric Clinicians
Pediatric mental health education is increasingly being disseminated beyond in-person local trainings, leveraging digital platforms like podcasts to amplify access and reach.
Clear, descriptive branding ensures the right clinicians can find mental health resources at the exact moment they need support in practice.
The main driver in choosing content is what pediatricians most urgently seek: practical, actionable advice about managing medications for anxiety and ADHD.
Making specialized knowledge accessible via on-demand, digestible podcast episodes empowers clinicians to feel less isolated and more competent.

[05:47 - 13:30] The Ongoing Challenge of Anxiety, Burnout, and Self-Care
Anxiety has emerged as the most common and burdensome mental health concern for children, exacerbated by societal stress and recent global events.
Differentiating normal anxiety from clinical anxiety is crucial: functional impairment and life disruption are key markers for escalated intervention.
Coping strategies for clinicians are vital; the “three pillars” are staying busy with purposeful activity, reaffirming personal/professional mission, and prioritizing self-care.
Peer connection, exercise, and carving out time for meaningful relationships are highlighted as essential personal de-stressors.

[13:31 - 25:00] Building Skill, Facing Complexity, and the Realities of Care
Pediatricians experience a four-stage progression from fear and avoidance to high-confidence care in managing pediatric mental health—each with unique challenges and rewards.
Access limitations to child psychiatry have forced primary care clinicians to expand their skillsets and comfort zones, often out of necessity.
Collaborative consultation programs, like psychiatric access hotlines, accelerate learning, build confidence, and foster an environment where sharing expertise is normalized.
Developing fluency with diagnoses and medication management leads to more effective and streamlined care; “herd immunity” and practice culture shifts increase collective capacity.

[25:01 - 36:05] Pain Points, Solutions, and Sustaining Progress in Pediatric Mental Health
Barriers to therapy—including logistics, family skepticism, and stigma—limit effective care, even as access improves; motivational interviewing is a partial solution but not a panacea.
Integrated behavioral health models and school-based clinics offer promising solutions by reducing friction and meeting children and families where they are.
Time constraints and misaligned incentives remain top frustrations; procedures are often reimbursed more than complex mental health care, despite the latter’s intensity and impact.
Empathy,...

242. Making Sense of a Mess: My Giant To-Do List

Wed, 16 Apr 2025 09:00:00 +0000

Can one person truly make a difference in the complex world of pediatric healthcare?
In this episode of Pediatric Meltdown, host Dr. Lia Gaggino explores how primary care pediatricians can step up amidst the chaos in Washington DC and stand as the trusted advocates children need. While Lia prepares for the pediatric academic society PAS in Honolulu, she is wrestling with the disastrous current health policy challenges and calls for local action. Lia pleads with her peers to organize and cause “good trouble”. This episode underscores that our most vulnerable population — children — deserves the unwavering dedication of empowered and informed advocates.
In pursuit of crafting a brighter future for children's health, will you rise to meet the challenge?
[00:00:04 - 00:01:21] Preparing for Change and Connection
Pediatric Meltdown is dedicated to children's mental health and emotional well-being.
Dr. Lia Gaggino shares her passion for facilitating thoughtful conversations with experts.
New and creative medical approaches are thriving and contributing to community upliftment.
Enjoying family time and Hawaii's scenic beauty is part of Lia’s plan to recharge.

[00:01:21 - 00:04:19] The Chaos in D.C. - A Call to Action
The state of national politics is concerning, described as a "dumpster fire."
Staying informed plays a crucial role despite the overwhelming current events.
Balancing leisure with staying critically aware of policy changes affecting pediatrics.
Connecting with pediatric colleagues to brainstorm actionable steps.

[00:04:19 - 00:08:39] Advocacy for Children’s Needs
Emphasizing the trust placed in pediatricians and the responsibility that comes with it.
Safe health practices are under threat from misinformation spreading rapidly.
Vital programs and advisory committees crucial for child safety are being dismantled.
Highlighting the unnecessary and detrimental effects of defunding health initiatives.

[00:08:39 - 00:12:39] Empower Your Voice and Community
Highlighting real stories as powerful tools for advocacy.
Breaking down scientific data into relatable family narratives aids understanding.
Demystifying Medicaid's role as crucial support for countless families.
Urging listeners to take definitive action, whether through social media or community forums.

Resources Mentioned:
AAP Advocacy Guide Member log-in required to access
On Tyranny Timothy Snyder
AAP MMR Vaccine Information
AAP Medicaid State Fact Sheets

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186. Immigrant Children and Families
158. Preventing Youth Suicide
100. The Art of Medicine

Tweetable Quotes:
"We've witnessed chaos, unprecedented and relentless. The landscape of Washington DC is reflective of a larger societal unrest, a crucible that now must forge strength and

241. Fighting Untruths and Chaos: The Power of the Pen and A Little Therapy

Wed, 09 Apr 2025 09:00:00 +0000

Are you feeling overwhelmed by the world's chaos and seeking hope amidst uncertainty?
In this moving episode of Pediatric Meltdown, host Dr. Lia welcomes Dr. Robert Saul to discuss the powerful principles guiding his commitment to advocacy and change. Dr. Saul introduces the transformative 12 words that have anchored his life's work and how these principles can propel communities forward. Together, they examine the impact of truth, trust, and the little-known role of the communal aspect in tackling societal issues. As Dr. Saul passionately delves into historical and modern-day examples of lying within power structures and challenges us to confront uncomfortable truths. Discover where the true power of change lies and how understanding our roles can lead to actionable advocacy.
This episode isn't just a conversation—it's a call to action for those yearning to make a difference.
[00:00 - 05:09] The Art of Medicine and the Value of Listening
Discussing the importance of comprehensive clinical encounters beyond quick checkups
Stressing that empathy and genuine presence build deeper connections in healthcare
Highlighting the responsibility to offer hope and guidance, not merely prescriptions
Suggesting that professionals and caregivers must pause to recalibrate when stress levels rise

[05:10 - 12:31] Accepting Responsibility: “I Am the Problem, I Am the Solution”
Exploring the idea that acknowledging our collective part in societal problems is the first step
Underlining the distinction between culpability and willingness to engage in solutions
Discussing how seeing oneself as part of the issue spurs commitment to meaningful action
Reminding listeners that we are interconnected in every community concern

[12:32 -31:06] Truth, Trust, and Social Fabric
Defining trust as the “currency” of relationships and community life
Arguing that telling the truth consistently is essential for building and preserving trust
Noting that children thrive when caregivers, professionals, and policymakers work together with integrity
Suggesting that widespread misinformation undermines the health and wellbeing of communities

[31:07 - 42:06] Looking Ahead: Ongoing Work and Hope
Encouraging continued involvement in committees, local boards, and mentorship roles
Highlighting the drive to create community programs focused on healing and trauma-informed care
Planning future projects that address truth, trust, science, diversity, and civility
Ending with an affirmation that sustained efforts at all levels can foster a more promising future

[42:07 - 55:46] Dr. G’s TakeAways

Additional Resources Mentioned
https://mychildrenschildren.com/my-childrens-children-name/
https://mychildrenschildren.com/better-is-good-incremental-steps-forward/
Power S. The Education of an Idealist: A Memoir. Dey St. 2019; 580 pp. (p. 282)
Snyder T. On Freedom. Crown, New York; 2024. 345 pp.
https://mychildrenschildren.com/infant-mental-health-part-i/

240. Independent Pediatric Practice: Can It Survive?

Wed, 02 Apr 2025 08:30:00 +0000

Have you ever wondered how pediatricians balance autonomy, mentorship, and the pressing demands of modern healthcare?
In this episode of “Pediatric Meltdown,” host Dr. Lia Gaggino welcomes Dr. Chris Peltier, MD, FAAP, who describes the rewards and hurdles of serving children through private practice, collaborative initiatives, and academic roles. He underscores the power of supportive peer networks to tackle shifting hospital structures, financial complexities, and the mental health needs of growing populations. His reflections reveal how advocacy, teaching, and flexibility can sustain a genuine passion for pediatrics.
Will these strategies ensure a vibrant future for the next generation of caregivers?
[00:00 - 22:18] Autonomy and Private vs. Hospital-Owned Practices
Shifts toward hospital system acquisitions reduce physician independence.
Succession planning gaps leave practices vulnerable to buyouts or closures.
Administrative decisions can feel distant from day-to-day patient care.
Becoming an employed physician can alleviate the stress of business management.

[22:19 - 37:04] Collective Approaches to Independent Practice Success
Collaborating across independent practices can reduce expenses, such as vaccine costs.
Sharing vendors and resources fosters a supportive rather than competitive environment.
Group quality improvement projects tackle issues like asthma or anxiety in children.
Large networks can negotiate better insurance contracts on behalf of multiple practices.

[37:05 -51:42] Preceptor Support and Compensation Strategies
Intrinsic motivation—such as the joy of mentoring—often drives physicians to teach.
Efficient time management (e.g., scribing during patient visits) enables bedside teaching.
Chapters and national organizations collaborate to advocate for preceptor stipends.
Small but meaningful policy changes (like state tax incentives) can bolster teaching efforts.

[51:43 - 1:07:43] Local Chapters and Advocacy for Child Health Initiatives
Mental health screenings, including suicide risk assessments, become embedded in well visits.
Working with community partners and even firearm ownership groups promotes harm reduction.
Coordinated action with lawmakers helps defend programs that protect vulnerable populations.
Sharing successful programs across state lines broadens the reach of proven solutions.

[1:07:44 - 1:19:52] Dr. G’s TakeAways

Contacting Dr.Peltier
FaceBook:: https://www.facebook.com/cpeltier007
X:@cpeltier007
INstagram:: https://www.instagram.com/cpeltier007/

Additional Resources Mentioned
The Pediatric Management Institute https://pediatricsupport.com
AAP Section on Administration and Practice Management SOAPM
AAP Council on Community Pediatrics COCP
AAP Advocacy...

239. Autism Spectrum Disorders: Parent Navigation Through the Teen Years

Wed, 26 Mar 2025 09:00:00 +0000

What does it really take to guide a teenager toward independence in an ever-changing world?
From managing IEPs and beginning transition planning at 14 to fostering self-awareness and skills for adult life, the journey is layered with challenges and growth. Parents like today’s guest, Natasha Robertson grapple with teaching social media safety, addressing emotional needs, and balancing day-to-day struggles with long-term goals. The process is both exhausting and inspiring, requiring patience, persistence, and firm advocacy. While the tools like coaching, therapies, and community support help, the weight often falls on families to navigate complex systems, such as educational frameworks and disability services. For teens, building independence means developing judgment, learning routines, and understanding boundaries in a digital age. For parents, like Natasha, it means preparing them for emotional, financial, and social self-reliance while ensuring basic skills are mastered.
Are we as a society truly equipping these families and teens with the tools they need, or are we still leaving them to figure it out in isolation?
[00:00 - 08:34] Evolving Services and Self-Advocacy
Realizing that past trial-and-error with therapies informs current decisions
The child’s ability to describe symptoms (e.g., stomach pain, insomnia) guides interventions
Emphasizing the shift from purely parent-led advocacy to incorporating the teen’s direct feedback
Preparing for ongoing changes in support needs as the child advances academically and socially

[08:35 - 15:47] Navigating the Teen Years
Addressing the impact of puberty and hormonal shifts on behavior
Considering new social interactions and the need for structured support
Implementing coaching strategies for everyday routines (e.g., chores, picking out clothes)
Recognizing that independent living skills build gradually through guided practice

[15:48 -28:40] Managing Digital Boundaries
Establishing phone usage restrictions (e.g., set times) to protect against late-night browsing
Finding monitoring tools (apps that flag concerning words) to balance privacy and safety
Realizing that direct honesty about monitoring builds trust with teens
Coaching the teen on responsible online communication and the risks of oversharing personal data

[28:41 - 53:19] Caregiver Self-Care and Resilience
Carving out small daily moments for personal relaxation (e.g., a movie break or foot soak)
Relieving stress by connecting regularly with supportive friends
Observing that the teen’s increased coping skills allow the caregiver to pause before intervening
Trusting the cumulative impact of years of therapies and interventions

[53:20 - 1:01:50] Dr. G’s TakeAways
Contact Natasha Robertson
n.robinson8@gmail.com.
Additional Resources Mentioned
Community Living Supports: Services that assist with daily living skills and social engagement.

Individualized Education Program (IEP) & Transition Planning: Formal educational plans that outline services and future goals for adolescents.

Career-Connect Programs: Local agencies or initiatives that help teens explore job training, résumé building, and employment opportunities.

Book: A teen parenting guide by Dr. Ken Ginsburg, titled Congrats, You’re Having a Teen, referenced for positive perspectives on adolescence.

238. Dr. Gaggino Goes to Washington: Advocacy for Kids

Wed, 19 Mar 2025 09:00:00 +0000

Have you ever wondered what happens when children's healthcare programs like Medicaid and CHIP face cuts?
In this episode of Pediatric Meltdown, Dr. Lia Gaggino emphasizes the urgent need to stand up for kids, who are disproportionately impacted by shifts in policy and funding. She highlights the power of sharing real-life stories and forging unexpected partnerships to protect essential resources. Advocacy takes perseverance and creativity, as complacency only enables political and social obstacles to harm children. Pediatricians and other advocates must unite, use their voices effectively, and push for healthier, safer lives for all kids.
So now the only question is….. Will you help safeguard the well-being of the next generation?
[00:00 - 05:07] Advocacy Conference Insights for Child Health
A large percentage of children rely on public insurance programs, underscoring the high stakes of legislative decisions.
Some decision-makers do not fully grasp the consequences of cutting critical services.
Hope fuels long-term efforts and energizes those championing children’s well-being.
An “advocacy wave,” highlights the need for a strong, collective push for change.

[05:07 - 12:32] Medicaid Challenges and Coverage Gaps
Public health emergency rollbacks led to reductions in child enrollment due to procedural missteps.
Many children lost insurance coverage not because of ineligibility, but because of bureaucratic hurdles.
70% of youth are deemed unfit for certain national service due to physical or mental health issues.
Call to safeguard essential child services (such as preventive care and immunizations) from budget cuts

[12:32 - 21:07] Immunization and Food Security Concerns
Renewed challenges to routine childhood vaccinations, with instances of preventable diseases appearing again.
Politicians downplaying vaccines, prompting greater vigilance in safeguarding public health.
Proposals to cut school meal provisions, raising ethical questions about denying basic nutrition to children.
Caring for children’s fundamental needs (like food and healthcare) should not be up for debate.

[21:07 - end] The Urgent Call to Protect Future Generations
Rejecting indifference and uniting for children’s rights and well-being.
Communities where basic resources, such as clean air, safe neighborhoods, and equitable opportunities, are universal.
Use every possible platform—professional and community-based—to champion the needs of children.
Final rallying cry to stay focused, gather supportive voices, and take concrete steps to safeguard the next generation.

Connect with Dr. Gaggino
website at www.lifeaftercorporatepodcast.com LinkedIn; https://www.linkedin.com/groups/12656341/

Resources mentioned in the show:
AAP Advocacy Guide: Located at aap.org/advocacyguide (helpful for step-by-step approaches to policy engagement).
Store It Safe Program: https://ohioaap.org/storeitsafe A collaborative initiative addressing firearm...

237. Physician Wellness: Needed Now More Than Ever

Wed, 12 Mar 2025 09:00:00 +0000

Could coaching be the key to overcoming burnout and moral injury that plagues the medical profession?
In this episode of Pediatric Meltdown, Dr. Lia Gaggino welcomes back Dr. Adrienne Mann and Dr. Tyra Fainstad, pioneers in physician well-being research, as they unpack the results from their studies on the impact of group coaching on physicians. Drs. Mann and Fainstad share their journey from a "cute little study" to a groundbreaking national program that offers a lifeline to medical students, residents, and faculty. As they study the struggles and triumphs of physicians battling burnout, moral injury, and self-compassion deficits, they reveal a whole new approach to healing and growth.
Hear how their innovative program is providing solace to thousands and lighting a path to flourishing in medicine.
[00:05 - 01:17] Transforming Physician Wellness through Coaching
Explore the origins of a simple idea during the pandemic that blossomed into a renowned coaching program
Understand how pivoting to online platforms expanded their coaching reach significantly beyond initial expectations
Discover the importance of addressing burnout, moral injury, and imposter syndrome in healthcare professionals
Learn about the innovative group coaching model and its profound impacts versus traditional one-on-one methods

[01:18 - 03:54] Impactful Outcomes of Group Coaching
Recognize the need for a targeted approach focusing initially on women due to higher burnout representation
Evaluate the coaching methodology's evolution from novice trials to thousands of residents in randomized control settings
Appreciate insights into baseline distress levels and how these reveal prevailing systemic issues
Analyze how group coaching effectively elevated self-compassion, reduced moral injury, and tackled burnout

[03:55 - 06:06] Inclusivity and Institutional Partnerships
Grasp the expanding scope to now include men and diverse genders, enhancing coaching accessibility
Reveal the collaboration with institutions to democratize coaching, offering programs at low costs per participant
Examine how privacy and anonymity are maintained to encourage participation without stigma
Recognize the structural evolution from restricted groups to open participation for trainees at all career stages

[06:07 - 8:52] The Future Direction of Physician Coaching Programs
Investigate the ongoing research into why and how coaching uniquely benefits medical professionals
The potential restructuring of medical leadership to address autonomy and eradicate systemic burnout
Appreciate the continuous refinement and adaptation of the coaching model based on participant feedback
Fact-check how empirical evidence supports the coaching method's resilience against challenges posed by modern healthcare

[48:51-32:50] Dr. Lia’s TakeAways
Connect with Dr. Adrienne Mann
Instagram: @amw1983

Connect with Dr. Tyra Fainstad
Instagram: @Tyraindenver

Resources Mentioned in the Episode
Better Together Coaching https://bettertogetherphysiciancoaching.com/
-Major updates: You can see our website here for research and peer-reviewed evidence updates.
Of high interest is our most

236. Mental Health Advocacy: The Youth Power Project

Wed, 05 Mar 2025 18:00:00 +0000

Are today's youth the missing voice in mental health advocacy?
In this episode of Pediatric Meltdown, host Dr. Lia Gaggino invites passionate mental health advocate Ria Babaria to talk about the unique struggles and strengths of today's youth. In her journey from high school advocate to college policy specialist, Ria emphasizes the need for youth representation in mental health decisions. She discusses the Youth Power Project's initiatives, access to mental health resources, and the importance of bridging societal and systemic gaps. From personal challenges to state-wide advocacy, Ria highlights the transformative power of youth voices in policy-making. Join us as we explore the potential changes when youth are given a platform to be heard.
The future of mental health is their future— but are we ready to listen?
[00:05 -15:21] The Birth of Youth Advocacy
The significance of amplifying youth voices in education and policy through advocacy organizations
Importance of bridging education gaps and providing resources for low-income and vulnerable youth
Empowering youth to assert confidence and influence in advocacy spaces
The transformative impact of including diverse backgrounds in policy discussions

[15:12 -22:22] Mental Health Advocacy and Cultural Challenges
Addressing mental health struggles within POC households and breaking cultural taboos
The importance of emotion integration for personal growth and social interactions
Building confidence to engage in mental health advocacy at a young age
Shaping policy through lived experiences and peer discussions

[22:23 -38:50] Expanding the Youth Power Project Reach
The national evolution from initial state-focused youth groups to broader advocacy at YPP
Strategizing for impactful health reform through youth collaboration and legislative work
Navigating peer-to-peer networks to bolster the youth advocacy movement
Tailoring mental health and educational policies around authentic youth voices

[38:51-48:50] Enhancing Access and System Reforms
Addressing consistency and discrepancies in mental health resource access nationwide
Innovative strategies to demystify access and eliminate stigma around mental health support
Strengthening first aid mental health training to improve communication and support
Developing legislative frameworks to integrate youth insights within mental health policy

48:51-32:50] Dr. Lia’s TakeAways

Connect with Ria ria@youthpowerproject.org

Resources Mentioned:
PHQ-9 Screening Tool for Depression:
PHQ-9 Questionnaire
Youth Power Project Website:
Youth Power Project
Mental Health First Aid Training:
Mental Health First Aid

Youth Power Project

235. Managing Chronic Pain: Creative Healing for Youth in Pain

Wed, 26 Feb 2025 09:00:00 +0000

Have you ever wondered what to do when traditional treatments for chronic pain in children don’t seem to help?
In this episode of Pediatric Meltdown, Dr. Lia Gaggino chats with Dr. Lonnie Zeltzer and Kim Poston Miller about innovative ways to address pediatric chronic pain. They discuss CHYP (Creative Healing for Youth in Pain), an organization offering hope to families through a creative, holistic approach to healing. Kim shares her personal story of supporting her son Grant’s remarkable recovery, showing how creativity can play a powerful role in pain management.
Tune in to learn how these approaches are opening new doors for children and families. Could creativity be the missing piece in chronic pain care?
[00:02 - 08:46] From Suffering to Hope – Introduction to CHYP
Kim talks about her personal journey as an advocate for CHYP, and the pivotal role creative arts played in her child's recovery.
Unpack the story behind Dr. Zeltzer’s influence in reshaping pediatric pain management.
Learn about the resourcefulness of a mother navigating her child's illness in a segmented medical landscape.
Understand CHYP’s role as a free, accessible solution to complex chronic pain issues for any child worldwide.

[08:47 - 14:53] Kim’s Inspiring Journey: Transforming Tragedy into Triumph
See the power of combining modern medicine with creative healing arts.
Examine the interconnected struggles of family members often overlooked in medical treatments.
Discover how social engagement became a lifeline for healing and improved quality of life.
Find out how a mother's intuition and creative willingness conquered skepticism in professional medical advice.

[14:54 - 23:30] The Creative System: Dr.Zeltzer's Vision and CHYP’s Foundation
Explore Dr.Zeltzer's 30-year journey of treating kids with chronic pain and the birth of the CHYP initiative.
Appreciate the need for an online platform providing holistic, no-cost care to children globally.
Grasp the significance of the biopsychosocial model in comprehending pediatric pain.
Understand the empowerment and education process for both children and parents under the CHYP program.

[23:31 - 54:36] Creating Magic: Camp as a Vessel for Change and Connection
Highlight the access to interactive platforms and workshops designed to enhance creative healing for youth.
Recognize the significance of larger social networks in managing pain through shared lived experiences.
Celebrate the impactful break-through of barriers, from timidity to friends on social platforms.
Appreciate CHYP’s strategic growth with events uniquely catering to different age brackets for maximal impact.

[54:37 - 1:00:53] Dr. Lia’s Takeaways

Connect with Lonnie Zeltzer
https://linktr.ee/mychyp
https://www.instagram.com/my_chyp/
https://www.linkedin.com/company/creative-healing-for-youth-in-pain/
https://www.facebook.com/creativehealingforyouthinpain

Connect with Kimberly Miller
LI Kimberly Miller, MBA
FB

234. Chronic Pain in Kids: An Innovative Approach

Wed, 19 Feb 2025 09:00:00 +0000

Did you know that nearly twenty-five percent of adolescents suffer from chronic pain, and for some, it’s severe enough to impact daily life?
In this episode of Pediatric Meltdown, Dr. Lia Gaggino and guest Dr. Lonnie Zeltzer talk about the complexity of chronic pain in children and adolescents—a subject often misunderstood and inadequately addressed in pediatric medicine. Through personal anecdotes and expert insights, Dr. Zeltzer shares her journey from a curiosity about adolescent medicine to specializing in pediatric chronic pain using modern pain science. This conversation not only unravels the preconceived beliefs surrounding chronic pain but also offers potential pathways and methods to manage and reframe the experience of pain in young individuals.
The episode is an eye-opener for anyone seeking to understand and support children grappling with chronic pain.

[00:00 - 17:02] Prevalence and Challenges of Pediatric Chronic Pain
Chronic pain affects 15–30% of adolescents globally, with 15% experiencing severe impairment.
70% of adolescents with untreated chronic pain develop adult chronic pain.
Pediatricians often lack training in modern chronic pain management concepts.
Subspecialists frequently struggle to address chronic pain after ruling out organic causes.

[17:02 - 27:55] Neurobiological and Psychosocial Factors
Chronic pain correlates with limbic system hyperactivity and prefrontal cortex underdevelopment in adolescents.
Neurodiverse individuals may experience heightened sensory sensitivity, amplifying pain perception.
Hypnotherapy and cognitive behavioral therapy (CBT) retrain pain-related neural pathways.
POTS (postural orthostatic tachycardia syndrome) reflects autonomic nervous system dysregulation linked to chronic pain.

[27:56 - 21:06] Gastrointestinal and Autonomic Dysregulation
Irritable bowel syndrome (IBS) stems from brain-gut axis dysfunction, not structural gastrointestinal issues.
Autonomic dysregulation in POTS requires salt intake, hydration, and compression garments for management.
Acupuncture and acupressure offer nonpharmacologic relief, particularly for needle-tolerant patients.
Abdominal pain often involves muscular tension, addressed through targeted physical therapy.

[21:07 - 48:48 ] Practical Clinical Interventions
Brief in-office mindfulness exercises (e.g., guided breathing) provide immediate stress relief.
Motivational interviewing helps adolescents identify achievable goals, like gradual physical activity.
Parent-child dyads benefit from joint mindfulness apps (e.g., Insight Timer) to reduce household stress.
The "five golden minutes" of non-directed play or connection improve emotional regulation.

[48:49 - 54:23] Dr. Lia’s Takeaways
Connect with Lonnie Zeltzer

https://linktr.ee/mychyp
https://www.instagram.com/my_chyp/
https://www.linkedin.com/company/creative-healing-for-youth-in-pain/
https://www.facebook.com/creativehealingforyouthinpain

Resources mentioned in the...

233. Tackling Child Poverty: The Rx Kids Initiative

Wed, 12 Feb 2025 17:00:00 +0000

Could a simple cash transfer program hold the key to reducing child poverty?
In this episode of Pediatric Meltdown, host Dr. Lia Gaggino chats with pediatrician and advocate, Dr. Brittney Tayler, about an innovative program called Rx Kids. Together, they explore how cash transfers can improve child health and well-being, especially in communities facing deep poverty. Dr. Tayler shares her firsthand experience in Flint, Michigan, detailing the transformation she's witnessed through the Rx Kids program. From addressing housing issues to boosting educational outcomes, this episode uncovers the impact that a single initiative can have.
Connect with the importance of advocacy and how one person can drive significant change, leaving a lasting impression on the entire community.
[00:00 - 05:07] From Pediatrics to Advocacy: Dr. Tayler's Journey
Find out how an accidental advocacy led to Dr. Tayler’s increased involvement in health policy.
Understand the significance of Dr. Tayler’s meeting with a senator, and the impact it had on health legislation.
Learn about the challenges of navigating advocacy as a medical professional.
Appreciate the support Dr. Tayler received from experienced mentors to sharpen her advocacy skills.

[05:07 - 12:32] Understanding Poverty's Impact on Child Health
Explore the key aspects of poverty affecting child health, including housing and food security.
Recognize the critical role of parents' stress levels in influencing children's well-being.
Explore the widespread effects of poverty on all domains of health and life.
Analyze how poverty can deeply affect educational outcomes and opportunities for children.

[12:32 - 21:07] Rx Kids: Transforming Communities Through Direct Cash Transfers
The transition from expanded child tax credit to the creation of Rx Kids.
Discover the pivotal role of expanded child tax credits in reducing child poverty during the pandemic.
How small studies and data informed the large-scale development of Rx Kids.
Discover the impactful results seen so far in communities participating in direct cash transfer programs.

[21:07 - 30:21] Pioneering Change and Empowering Communities
Understand why Flint, Michigan, became the perfect place to pilot the Rx Kids program.
Uncover the logistical aspects and eligibility criteria of the Rx Kids cash transfer program.
The importance of dignity, trust, and community-wide benefits in program implementation.
Future aspirations: how Rx Kids aims to expand and sustain its impact in Flint and beyond.

[30:22 - 35:21] TakeAways

Connect with Dr. Brittney Tayler
Facebook – https://www.facebook.com/RxKidsUS
Instagram - https://www.instagram.com/rxkidsus/
LinkedIn - https://www.linkedin.com/company/rx-kids/

Resources mentioned in the show:

https://rxkids.org/about/communities/flint/

Chevy in the Hole by Kelsey Ronan https://www.amazon.com/Chevy-Hole-Novel-Kelsey-Ronan/dp/125080390X

Luke Shaefer PhD

232. And to My Pediatric Friends

Wed, 05 Feb 2025 09:00:00 +0000

Ever wonder how the current chaotic world and the state of healthcare are affecting our children, the most vulnerable members of society and those of us who care for them?
Listen to this episode as Lia shares her angst and hope with the complexities of a world facing climate disasters, political strife, physician burnout, and a dwindling trust in science. This solo episode is a self-reflection about building the courage, commitment, and resilience required to safeguard children's health in these turbulent times.
As Lia recounts her own experiences during the pandemic and advocates for unwavering integrity in pediatric care, she challenges listeners to reflect on their role to protect the wellbeing of ALL children.. This episode is a call to action—will you answer it?
[00:05- 04:27] Insights on Pediatric Practice
The rigorous process of policy creation and revision within the American Academy of Pediatrics (AAP).
Importance of adhering to evidence-based practices and adapting policies based on scientific discoveries.
The challenges pediatricians face, including making life-and-death decisions.
Commitment to upholding the Hippocratic Oath despite mounting difficulties.


[04:28 -11:54] Challenges in Pediatric Healthcare
Long hours, difficult on-call shifts, and emotionally taxing decisions faced by pediatricians.
Inequities in healthcare access, especially for marginalized children.
Disinformation surrounding vaccines and its impact on parental decisions.
Concerns over administrators dictating healthcare delivery without medical expertise.


[11:55 - 17:58] Challenges in Pediatric Healthcare
The exhaustion and disheartenment experienced by pediatricians.
Unfair contracts, financial pressures, and charting demands that intrude on family time.
Pediatricians' dedication despite overwhelming demands, driven by a sense of calling.
The public's misconceptions about pediatricians' financial motivations regarding vaccines.

[17:59 - 22:30] Call to Action and Advocacy
A rallying message for pediatricians to support one another and remain resilient.
Reinforcement of the commitment to doing what is best for children.
The importance of unity and collective efforts to address healthcare challenges.
Encouragement to engage with future episodes featuring interesting guests.

Resources Mentioned in the Episode
Website: PediatricMeltdown.com
AAP (American Academy of Pediatrics): Highlighted as a trusted source for pediatric guidelines.
Dr. Anthony Fauci: Mentioned as a prominent figure in guiding healthcare during the COVID-19 pandemic.

https://pediatricmeltdown.com/episodes
120 ADHD: Part 4 Executive Function
119 ADHD Part 3: Executive Function
109 ADHD Symptoms: Executive Functions Part II
ADHD: Strategies for Boosting Executive Function

Tweetable Quotes:
"To my pediatric colleagues, we cannot be intimidated. We cannot be afraid. We have to lean into each other and have each other's backs."... Dr. Lia Gaggino on the power of solidarity
"Despite the insanity of misinformation, hyperbole, and conspiracy theories, he prevailed even when he and his family were threatened and continue to be threatened."...Dr. Lia Gaggino on what Dr. Fauci had to...

231. Raising Good Citizens Through Conscious Parenting

Wed, 29 Jan 2025 09:00:00 +0000

Raising Good Citizens Through Conscious Parenting
What does it take to raise thoughtful citizens and build stronger communities while navigating the challenges of parenting, aging, and personal growth?
In this episode, Dr. Robert Saul], an author and pediatrician, shares his insights from his career dedicated to advocating for children, families, and communities. Dr. Saul discusses his journey of writing books that cater to parents, children, and physicians, including one described as "Goodnight Moon with a message," using vivid illustrations and meaningful text to engage families. Through relatable examples like managing tantrums, school avoidance, and making tough decisions as both parents and children of aging parents, Dr. Saul emphasizes the importance of fostering responsibility and kindness. Drawing wisdom from the "5 M's" of mentoring, mediating, mobilizing, monitoring, and motivating, Dr. Saul inspires listeners to embrace their roles as sages and positive influences.
Will this be the conversation that reshapes the way you see parenting and citizenship?
[00:05- 11:27] Foundations of Conscious Parenting
Key realization: “I am the problem, I am the solution, I am the resource.”
The role of community engagement in addressing societal issues like teenage pregnancy and disengagement.
Introduction to the “Five Steps to Community Improvement.”
Impact of Columbine (1999) and its role in inspiring advocacy and writing.


[11:28 -20:54] Overcoming Adverse Childhood Experiences (ACEs)
The significance of nurturing, safe, and stable relationships (SSNRs).
Introduction to SSNRs as a buffer against toxic stress.
Role of parents in creating environments that foster resilience in children.
Emphasis on pediatricians' responsibility to guide and support parents.


[20:55 - 35:58] The Parental Awareness Threshold (PAT)
Concept of being "above the line" (curious and open) vs. "below the line" (closed and defensive).
Strategies for managing stress and frustration as a parent: pause, assess, choose.
Frameworks for addressing challenges like tantrums and teenage rebellion.
Balancing empathy with practical parenting techniques.

[35:59 - 46:30] Advocacy and Community Engagement
Role of pediatricians in supporting families facing poverty, domestic violence, or instability.
The importance of advocacy for systemic changes to improve family support.
Encouraging involvement in organizations like the American Academy of Pediatrics (AAP).
The significance of professional networks for mutual support and advocacy.

Connect with Dr. Saul:
robertsaul@me.com
https://mychildrenschildren.com/ to learn more.

Resources mentioned in the show:

Books
My Children’s Children
Thinking Developmentally
Conscious Parenting
Bowling Alone
Conscious Leadership

230. Payment Challenges for Pediatric Mental Healthcare and Strategies that Work

Wed, 22 Jan 2025 09:00:00 +0000

This episode was actually published in June 2022, but this is STILL a huge issue, so we thought we would take another listen …
How can pediatric primary care effectively integrate mental health services amid insurance barriers and coding complexities?
In this episode, we tackle the significant obstacles impacting the compensation and delivery of mental health services for children. By examining Medicaid, CHIP and commercial insurance coverage for mental health, we highlight challenges that hinder pediatricians and affect their young patients and families. The conversation sheds light on potential solutions, such as integrated behavioral health and group therapy, which may offer new avenues for improving care and financial viability. Through shared experiences from industry experts, we explore potential strategies to both navigate and potentially reform the delivery of pediatric mental health services.
Considering the significant implications this has on future generations, what steps must we take now to ensure a sustainable and effective approach that genuinely meets the needs of children and their families?
[00:05- 19:41] Financial and Operational Burdens
Household income criteria affect eligibility for Medicaid, impacting family financial planning.
Pediatric practices bear costs of unrecognized mental health work because of inadequate reimbursement.
Parents' financial stress increased by the lack of integration between medical and mental health services.
Complex insurance landscapes necessitate physician adaptability in operations.


[19:42 -29:58] Pediatric Practice Challenges
Mental health visits require more time but yield less reimbursement compared to physical ailments.
Physicians provide extensive unpaid follow-up care via phone calls and messages.
Insurance systems do not adequately support mental health coding for pediatricians.
Complexity in billing for mental health services creates administrative challenges.


[29:59 - 38:51] Economic and Qualitative Outcomes
Coordinated care allows pediatricians to manage comprehensive patient care plans.
Insurance company partnerships needed for sustainable pediatric mental health initiatives.
Effective systems require data to demonstrate long-term cost benefits and outcomes.
Organizations should engage with insurance companies to carve out necessary screening costs

[38:52 - 1:05:50] Advocacy and Reform Efforts
Reform needed in coding and billing processes to reflect the true nature of mental health support.
Integrated care models as a potential less visible, but essential cost benefit.
Engaging with insurance companies on mutual goals can lead to practice sustainability.
Systems must prioritize patient-centered care, integrating mental and physical health.

[1:05:51 - 1:13:48] TakeAways

Connect with our guests
Jenna Vallejo
Facebook,
Instagram,
LinkedIn

Dr. Jon Price
nationwidechildrens.com

Go to https://lifeaftercorporatepodcast.com/ for all episodes
166 Chronic Illness and...

229. What Parents Need to Know About Teenage Emotions and Suicidal Thoughts

Wed, 15 Jan 2025 09:00:00 +0000

In 2020, I had the privilege of being a guest speaker on Sandy Fowler’s podcast “Mighty Parenting” for a candid discussion about youth mental health, suicide prevention, and the critical role parents play in supporting their children through emotional challenges. I thought it would be interesting to blow the dust off this episode where I was being interviewed by Sandy.
As a medical professional deeply committed to improving mental health care in primary care settings, I shared insights specifically for parents about how to recognize warning signs, have difficult conversations, and access appropriate resources. That conversation became a pivotal moment in my career, sparking my desire to reach a broader audience through podcasting… Pediatric Meltdown was born!
Today, as the host of Pediatric Meltdown, I continue to build upon that mission, but I thought it would be worth revisiting this discussion that served as a catalyst for my current role as a podcast host. During our conversation, we tackled the crucial topic of youth suicide prevention, breaking down barriers to communication, and providing practical tools for parents to support their children's mental well-being. Unfortunately, with the impact of the Covid-19 Pandemic, this discussion remains as relevant today as it was then, perhaps even more so.
[00:05- 21:59] Brain Development & Behavior
Teen brains function differently from adult brains
Role of prefrontal cortex in decision making
Impact of developing brain on behavior
Understanding cognitive limitations

   [22:00 -32:45] Suicide Prevention Strategies
Proper approach to discussing suicidal thoughts
Importance of staying calm during difficult conversations
Available crisis resources
Steps for emergency


[32:46 - 42:51] Mental Health Statistics
25% of youth screen positive for depression
Annual screening recommendations for ages 12+
15% experience suicidal thoughts
Implementation of 54321 coping technique

[42:52 - 53:02] Action Steps for Parents
Creating safe environment for emotional expression
Understanding brain development impact
Using emotional scale assessments (1-5)
Knowing when to seek help

Go to https://lifeaftercorporatepodcast.com/ for all episodes
169. Lisa Durante's Strategy for Mastering Your Content Marketing Plan!
153 A 3-Step Guide to Skyrocketing Your Income
137 Marketing, Management, and Metrics: The Keys to Consistent Success

Tweetable Quotes:
"But in terms of completed suicides, it's firearms, and the really sad thing is, suffocation mostly by hanging is the most common and becoming more common and that one, of course, is really hard to restrict because you can hang yourself with so many items." … Dr. Lia Gaggino on the harsh reality of suicide methods

“"If you set the stage that it's okay to talk about your thoughts and feelings, then and and that's just a habit that you've had all along, then I think it makes the conversation easier." … Dr. Lia Gaggino on communicating with kids about Mental Health
**TRANSCRIPT AVAILABLE UPON REQUEST**

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228. How a Pediatric Expert Balances Life & Loss

Wed, 08 Jan 2025 09:00:00 +0000

What happens when a physician who regularly discusses wellness and burnout finds herself in need of her own advice?
In this personal episode of "Pediatric Meltdown," host Dr. Lia Gaggino candidly shares her journey through an overwhelming period in late 2024, marked by her father's death, her mother's hip surgery and subsequent move-in, and the unexpected loss of her beloved pet. Despite having a strong support system that includes her husband Rodger, adult daughters, and one-year-old grandson George, she acknowledges her exhaustion and struggles with sleep, nutrition, and exercise habits.
This episode is an honest confession of how even wellness advocates can find themselves needing to replenish their own spirit, in other words, to walk the walk in self-compassion. Some deep soul searching led to Lia’s decision to take a month-long sabbatical from the podcast while still ensuring weekly content. You can look forward to surprise episodes specially curated by her team just for you.
Key Takeaways:
1. Self-awareness and vulnerability are crucial steps in addressing burnout, as demonstrated by Dr. Lia's honest acknowledgment of her own struggles despite being a wellness expert.

2. Setting boundaries and making concrete changes (like designated phone-free zones, scheduled exercise, and sleep routines) are essential components of self-preservation during challenging times.

3. A strong support system and a temporary “leave of absence” makes space for her mental health re-boot. Dr. Lia is privileged to be able to take this break, and recognizes that a break like this may not be an option for many, but she offers some baby steps for herself that can be added to your own self-kindness tool-box. Making time for self-reflection may be the key to long-term sustainability in both personal and professional life.

Make sure to tune in all month long for some episodes that you most likely have not heard. They were curated by Dr. Lia, and her team and they hold a special place in her heart.

**TRANSCRIPT AVAILABLE UPON REQUEST**

SUBSCRIBE & LEAVE A FIVE-STAR REVIEW and share this podcast to other growing entrepreneurs!
Get weekly tips on how to create more money and meaning doing work you love and be one of the many growing entrepreneurs in our community. Connect with me on LinkedIn; https://www.linkedin.com/groups/12656341/ or on Instagram or our website at www.lifeaftercorporatepodcast.com .

227. Relationships with Others: The Antidote to Loss, Fear, Greed and Hate

Wed, 01 Jan 2025 09:00:00 +0000

What does it truly mean to cultivate resilience and well-being in today's challenging world?
In this insightful episode of Dr. Lia Gaggino's podcast (episode 227), she thoughtfully explores seven fundamental pillars of well-being while reflecting on the transition into 2025. Drawing from both professional expertise and personal experience, particularly while caring for her aging mother, Dr. Gaggino presents a comprehensive approach to health that encompasses sleep, nutrition, movement, family connections, friendships, creativity, and spirituality. She authentically acknowledges the struggles many face, from avoiding overwhelming news to managing daily stresses, while offering practical, judgment-free advice that balances aspiration with self-compassion.
Her message resonates particularly strongly when she emphasizes that relationships are the ultimate antidote to loneliness, fear, and sadness, demonstrating a deep understanding of human nature and the complexities of modern life.
Key Takeaways:
1. Well-being is multifaceted and requires attention to both physical aspects (sleep, nutrition, movement) and emotional/social components (family, friends, creativity, spirituality).
2. Perfection shouldn't be the enemy of progress - it's important to maintain healthy habits while showing yourself grace during challenging times.
3. Strong relationships and social connections are crucial for emotional resilience and long-term health, whether these connections are with family of origin or chosen family.
Let’s make 2025 the Best Year EVER!!

226. Holiday Rituals and Traditions

Wed, 25 Dec 2024 09:00:00 +0000

Ever wondered what it's like to blend personal traditions with familial expectations during the holidays?
In this episode of Pediatric Meltdown, Dr. Lia Gaggino shares her experiences with Christmas celebrations, highlighting the unique blend of Polish traditions from her husband's heritage and her own family's rituals.
Family Rituals: Dr. Gaggino discusses the significance of family rituals, such as sharing a wafer similar to the Catholic host and wishing each other well, despite some family members finding it cringey.
Meal Traditions: She talks about the specifics of their holiday meal, including mushroom soup and homemade pierogies, and how these traditions evolve over time to accommodate changing family dynamics.

Importance of Traditions: Dr. Gaggino reflects on the deeper meaning of traditions, emphasizing their role in creating predictability, routine, and reassurance for children.

Merry Christmas and Happy holidays to all of you.

225. Youth Concussion: Assessment and Management

Wed, 18 Dec 2024 09:00:00 +0000

Ever wondered how a simple injury can change the course of one's life?
This episode explores the fascinating journey of a sports enthusiast turned medical professional, inspired by a personal encounter with a sports medicine provider after a college injury. The conversation delves into the complex world of concussions, discussing the evolution of treatment protocols, the importance of individualized care, and the severe risks of prematurely returning to play. You'll learn about tools like the SCAT symptom score and the VOMS for monitoring recovery, and the often-overlooked psychological impacts of concussions on young athletes. But perhaps the most crucial takeaway is the stark reminder: concussions are no joke, and honesty about symptoms can be a matter of life or death.
Are you ready to rethink what you know about concussions?
[00:33- 10:59]Initial Assessment and Management of Concussions
The SCAT (Sport Concussion Assessment Tool) is mentioned as a crucial tool for evaluating concussions.
The importance of understanding the broad nature of concussions and their varied symptoms.
Reassuring patients and their families about the management plan.
An emphasis on the need for individualized treatment plans for concussions.

[11:00 -16:47] Red Flags and Immediate Concerns
Red flags that indicate a more serious condition, such as worsening symptoms and unusual behavior.
Specific symptoms like nausea, vomiting, and severe headaches that should raise concern.
Trusting your instincts and gut feelings when assessing a concussion.
Immediate action is needed if a patient's condition deviates from expected recovery patterns.


[16:48 - 44:47] High-Risk Sports and Gender-Specific Risks
High-risk sports for concussions, including for men: wrestling, basketball, soccer: For women: cheerleading
There is a potential for prolonged recovery in athletes with underlying medical issues.
Initial visits should focus on identifying concerning symptoms and ruling out underlying conditions.
A comprehensive approach to managing concussions is needed, especially in high-risk sports.

[44:48- 58:16] Treatment Algorithm and Activity Management
Treatment Algorithm and Activity Management
An outline of a general treatment algorithm for managing concussions in the first 48 hours and beyond.
The importance of gradually returning to activity while ensuring symptoms do not worsen.
Provide physical therapy orders and ensuring PT sites treat concussions effectively.
Educate patients and families about the expected recovery process and potential setbacks.

[58:17 - 01:10:00] Takeaways

Resources:
AAP Sports-Related Concussion Recommendations:
AAP Concussion Recommendations
AAP article and Amsterdam Consensus: Statement: AAP and Amsterdam Consensus Statement
AAP Vision and Concussion: Vision and...

224. Adult ADHD: Diagnosis and Treatment

Wed, 11 Dec 2024 09:00:00 +0000

Ever wondered how to smoothly transition pediatric patients with complex conditions like ADHD into adult care?
This episode talks about the challenges and strategies involved in this critical handoff. Dr. Peter Jensen and Dr. Lia discuss the importance of educating and empowering teens to manage their conditions independently, drawing parallels with other chronic illnesses like asthma and diabetes. They explore the nuances of preparing both the patients and the accepting providers to ensure a seamless transition. Additionally, they discuss resources for understanding adult ADHD and address some of the barriers to care when teens go out of state for college or careers.
This episode highlights the importance of systematic, careful planning and open communication to prevent gaps in care during this transition period.
[00:05- 17:16] Gender Differences in ADHD Diagnosis
Later diagnosis of ADHD in females.
Fewer hyperactive symptoms in females leading to delayed diagnosis.
Quietly distracted children may be overlooked.
Morphing of symptoms towards inattentiveness in teen and young adult years.


[17:17 -23:15] Adult ADHD and Mental Health Risks
Reduction of hyperactivity and impulsivity symptoms over time.
Increased risk of anxiety, depression, and substance use in adults with ADHD.
Challenges in recognizing adult ADHD due to comorbid mental health issues.
The role of family practice providers in identifying adult ADHD.


[23:16 - 43:50] ADHD Medication and Substance Use Concerns
There is diversion and misuse of ADHD medications.
Holding patients accountable for lost or stolen medication.
Comparing ADHD medication misuse to other substance abuse issues.
Importance of clear communication between providers and patients.

[43:51 - 48:50] Recommendations for ADHD
Mention of the book "Driven to Distraction" by Ned Hallowell.
The importance of education and awareness about adult ADHD.
The role of pediatricians in thinking about ADHD in adults.
Emphasis on ensuring pediatricians and healthcare providers are aware of the Reach Institute.

[48:51 - 57:47] Take Aways

Connect with Dr. Peter Jensen
Website: https://thereachinstitute.org/
LinkedIn: https://www.linkedin.com/company/the-reach-institute-resource-for-advancing-children-health/
Facebook: https://www.facebook.com/REACHInstitute/
Twitter: https://twitter.com/reach4kids

RESOURCES MENTIONED IN THE EPISODE
The REACH Institute: www.thereachinstitute.org
Driven to Distraction" by Ned Hallowell.
This book is highly recommended for understanding ADHD in adults. It is easily readable and includes stories and checklists of symptoms that can help readers identify ADHD traits in themselves or others.

Go to https://lifeaftercorporatepodcast.com/ for all...

223. ADHD and the Anxiety Monster: Strategies to Break the Cycle

Wed, 04 Dec 2024 09:00:00 +0000

Have you ever wondered if ADHD is being misunderstood or misdiagnosed in children, leading to feelings of failure and unchecked anxiety?
In this episode of Pediatric Meltdown, host Dr. Lia Gaggino and Dr. Norrine Russell talk about the complexities of ADHD, from its nuances to the pressing need for systemic change in how it's perceived and treated. They shed light on the importance of recognizing ADHD as non-willful behavior, the role of early intervention, and the imperative of individualized education plans. With data-backed insights and real-world anecdotes, this discussion underscores the urgency of a more equitable and comprehensive approach to ADHD treatment.
This is a must-listen for educators, parents, and healthcare providers.
[00:38 - 7:37] Unpacking ADHD and Common Misinterpretations
Definition of "pure ADHD," described as a potential "gift," affecting a smaller segment of diagnosed children.
Discussion on comorbidities like dyslexia, dysgraphia, mood disorders, and autism, affecting two-thirds of ADHD-diagnosed children.
Issues of whether anxiety stems from late-diagnosed ADHD or contributes to its symptoms.
Emphasis on early intervention to prevent ADHD from triggering anxiety and encourages proper diagnosis to avoid misunderstanding behaviors.

[07:38 - 14:07] Individualized Educational Approaches and Social Skills
Importance of personalized educational strategies for neurodivergent children, avoiding a "one size fits all" methodology.
Benefits of involving children in solution-finding processes for tailored educational support.
Highlighting social delays in children with ADHD and the role of structured activities in fostering social interactions.
Allowing children to build on their strengths and interests to enhance self-esteem and personal growth.

[14:08 - 21:15] Challenges in Diagnosing and Treating ADHD
Discussion on the misconception of oppositional defiant disorder (ODD) and its potential misinterpretation as ADHD symptoms.
Need for differential diagnosis to distinguish between ODD and ADHD, particularly in the context of trauma.
Advocacy for multimodal ADHD treatment plans, integrating medication, parent education, and school plans as per American Academy of Pediatrics guidelines.
Addressing systemic inequities in healthcare affecting children on Medicaid and the impact of racial biases on ADHD treatment.

[21:16 - 28:22] Tools, Resources, and the Path Forward
Discussing genetic links and familial patterns discovered during psychosocial intakes.
Importance of early identification to prevent negative academic cycles and enhance engagement.
Promoting ADHD acceptance and self-advocacy by normalizing brain differences.
Recommendations for educational materials, like "ADHD is Awesome" and "The Anxious Generation," and promoting Norrine’s podcast for further insights.

Resources Mentioned:
Vanderbilt and Connors Symptom Trackers (Symptom Trackers) Vanderbilt ADHD Diagnostic Rating Scale (VADRS) - Psychology Tools
Book: ADHD Is Awesome - ADHD is Awesome: A Guide To (Mostly) Thriving With ADHD: Holderness, Penn, Holderness, Kim, Edward Hallowell: 9781400338610: Amazon.com: Books
Book:

222. Physician Heal Thyself: A Holiday Gift From Me to You

Wed, 27 Nov 2024 11:45:00 +0000

Can a doctor's strongest medicine be kindness to themselves?
In this candid conversation, Dr. Kathy Stepien, physician coach and advocate for medical wellness, challenges the notion that self-criticism leads to better performance. Speaking with host Dr. Lia Gaggino, she unpacks how physician coaching has evolved from executive suites to mainstream medicine, backed by clinical trials from institutions like Mayo Clinic and Stanford. Dr. Stepien shares powerful stories about identity transitions in medicine, from early-career challenges to retirement questions, while offering practical ways to find the right support.
Her remarkable work in bringing hidden struggles to light proves that no physician needs to walk their professional journey alone.
[00:05- 15:07] Challenges Physicians Face in Their Career
Isolation despite being surrounded by accomplished colleagues, leading to internal struggles
Demanding nature of the profession requiring significant self-sacrifice beyond typical 9-to-5 hours
Struggle with maintaining autonomy, especially when transitioning from private practice to employed positions
Difficulty in managing time and energy while trying to balance multiple responsibilities

   [15:08 -26:02] Navigating Challenges in Medical Training and Practice
Seek safe persons to confide in when facing discrimination or difficult situations, particularly those slightly removed from your immediate environment
Recognize that no medical professional needs to handle struggles alone - it's acceptable and beneficial to ask for help
Address issues strategically and wisely, especially in situations with significant power differentials
Remember that supporting each other is crucial - medical professionals need connection and understanding from peers who share similar experiences


[26:03 - 39:24] Power Dynamics and Professional Growth in Medicine
Early career physicians often feel vulnerable during training periods, but gain more ability to advocate for change as they advance in their careers
The transition from clinical practice to administration reveals different cultural challenges, including slower decision-making processes and risk aversion
The importance of speaking up against inappropriate behavior, such as public humiliation, despite the professional risks involved
The value of having witnesses and support systems when addressing workplace issues

[39:25 - 57:43] Benefits of Physician Coaching
Data shows solid evidence of improved physician well-being and quality of life
Leads to profound improvement in emotional exhaustion reduction
Enhances self-compassion among medical professionals
Results in better patient outcomes when physicians are well-supported

Connect with Dr. Kathy Stepien
Website: https://www.instituteforphysicianwellness.com/
Instagram: www.instagram.com/kathystepienmd
Facebook: https://www.facebook.com/physicianwellness
LinkedIn:https://www.linkedin.com/in/kathystepienmd/

Important Links To Share:
Anti-Burnout Program for Women Physicians:

221. Reach Out and Read: How A Book Can Change A Life

Wed, 20 Nov 2024 09:00:00 +0000

What happens when a pediatrician hands a free book to a parent and changes the trajectory of a life?
Meet Claudia Aristy whose first encounter as a new immigrant mother with “Reach Out and Read” sparked a remarkable transformation. Through her work with the Health Education and Literacy for Parents (HELP) Project, Claudia demonstrates how pediatricians can encourage literacy through books while supporting immigrant families. Her personal story describes the power of how parent-child reading led to her own high school completion and college graduation. Her work showcases how simple interventions can create lasting impact on children's development. Her conversation with Dr. Lia Gaggino explores innovative ways to promote bilingual literacy and to strengthen parent-child interactions through reading, while turning waiting room time into valuable learning opportunities.
This episode proves that when healthcare meets literacy, extraordinary changes happen in families' lives.
[00:05- 17:39] Impact of Early Reading Programs in Pediatric Settings
A powerful moment of transformation occurs when pediatricians gift books to families during well-child visits, creating a bridge between healthcare and literacy
Through programs like Reach Out and Read, medical providers effectively communicate how daily reading routines contribute to brain development and school readiness
Free book distribution in medical settings removes financial barriers, especially beneficial for immigrant families who may find traditional bookstores inaccessible or unaffordable
Pediatricians serve as trusted messengers, helping parents understand the connection between early reading and cognitive development

  [17:40 -24:13] Bridging Healthcare and Literacy Through Reach Out and Read
Pediatricians serve as crucial advocates for child literacy by incorporating books into medical visits, creating meaningful connections with families beyond just medical care
The program transforms routine medical checkups into opportunities for promoting parent-child reading interactions, making healthcare settings more welcoming and educational
Free book programs integrated into medical visits help break down barriers to literacy, especially for families with limited resources
Pediatric literacy initiatives become more effective when healthcare providers take time to make genuine connections and offer encouragement to parents


[24:14 - 35:20] Effective Parent-Child Reading Engagement
Positive interactions during reading sessions go beyond literacy - making eye contact and smiling are simple yet powerful ways to connect, requiring no formal education or special training
Parents don't need advanced degrees to make meaningful contributions to their children's development through reading and storytelling
Creating joyful memories around books is more valuable than perfect reading skills, especially for parents who may struggle with literacy themselves
Daily reading can be adapted to busy family schedules, acknowledging real-world challenges like multiple jobs and time constraints

[35:21- 53:07] Empowering Parents Through Healthcare-Based Literacy Initiatives
The HELP (Health Education and Literacy For Parents) project maximizes waiting room time by conducting health literacy activities, transforming passive waiting into active learning
Pediatricians serve as trusted authority figures who can effectively encourage and validate parents' roles as their children's first teachers
Free resources are available through greenlighthelp.org, offering evidence-based information aligned...

220. Bipolar Disorder in Youth Part 2: Medications and Monitoring

Wed, 13 Nov 2024 09:00:00 +0000

How can we help teens with bipolar disorder manage their symptoms and transition successfully into adulthood?
In this (part 2) episode of Pediatric Meltdown, host Dr. Lia Gaggino and child psychiatrist Dr. Jeanette Scheid discuss managing bipolar disorder in young adults during major life transitions. From medications for bipolar disorder in youth to support resources, they explore how parents and healthcare providers can identify early signs of a bipolar manic or depressive episode and implement effective treatments. Dr. Scheid shares practical strategies for maintaining stability, including sleep schedules, substance use prevention, and the vital role of college support services.
Whether you're a healthcare provider or parent seeking to understand bipolar disorder treatment for teens, this conversation offers clear guidance for helping young people thrive.

[00:33 -10:28] Critical Warning Signs and Transition Risks for Young Adults with Bipolar Disorder
Poor sleep patterns often emerge as one of the earliest indicators of potential manic episodes
Early symptom recognition training for both parents and youth helps prevent severe episodes
Regular psychoeducational conversations with everyone in the youth's support system enhance management success
Living independently introduces new challenges that require careful monitoring and support

[10:29 - 19:29] FDA-Approved Medications for Youth Bipolar Disorder: A Primary Care Guide
Key antipsychotics including aripiprazole, quetiapine, risperidone, olanzapine, asenapine, and lurasidone are FDA-approved, for adults with bipolar disorders. There are fewer medications approved for youth due to lack of clinical studies.
No anti-seizure medications currently hold FDA approval for bipolar disorder in youth, though some are approved for adults
Most common lithium side effects include headache, nausea, increased thirst, and mild tremors
Regular thyroid function monitoring is essential, often requiring collaboration between pediatricians, endocrinologists, and psychiatrists

[19:30 -39:22] Understanding Lithium Treatment in Youth Bipolar Management
Therapeutic window for lithium is narrow, ranging from 0.6 to 1.2 milliequivalents per liter, requiring careful monitoring and frequent lab work
Dehydration and changes in salt balance can trigger dangerous lithium toxicity levels
Family medical history plays a crucial role in treatment decisions, as demonstrated by cases where lithium proved more effective than second-generation antipsychotics
Regular lithium level monitoring (1-2 times yearly) is necessary for stable patients, with more frequent checks during dose adjustments

[39:23 - 50:50] Building Knowledge Bridges: What Primary Care Needs to Know About Youth Bipolar Care
Utilizing child psychiatry access programs as learning resources for medication management
Understanding safety profiles of common medications, even when not directly prescribing
Recognition of medication effects similar to monitoring diabetes care in primary practice
Value of ongoing consultation with psychiatric specialists for medication questions

[50:51 - 1:04:37] Closing segment Takeaway

Links to resources mentioned on the show

Resources Part 1:
AACAP Facts for Families: Facts for...

219. Bipolar Disorder in Youth: Symptom Recognition and Diagnosis (pt 1)

Wed, 06 Nov 2024 11:45:00 +0000

In this episode, child psychiatrist Dr. Jeanette Scheid joins Dr. Lia Gaggino to discuss the complexities of pediatric bipolar disorder, and sorting through the diagnostic possibilities is central to making an accurate diagnosis Dr. Scheid offers insights to tease out what are the childhood behaviors that are developmentally normal, for example imaginary friends, and what are concerning symptoms such as auditory hallucinations. Dr Scheid highlights the critical role pediatricians play in the early identification of youth bipolar disorder with enormous implications for decreasing serious illness in adulthood.
With mental health in children becoming increasingly important, this conversation offers practical guidance for pediatric clinicians.
[00:33 -10:49] Key Diagnostic Criteria for Bipolar Disorder
Major depressive episodes often appear as the first signs, lasting at least 2 weeks with predominantly low mood
Grandiosity and racing thoughts are significant indicators, particularly when accompanied by uncharacteristic risk-taking behaviors
Sleep patterns change dramatically, with some people feeling rested after less than 3 hours of sleep
Increased talkativeness, faster speech, and heightened distractibility are common symptoms

[10:50 - 19:01] Challenges in Early Identification
Distinguishing between normal childhood behavior and pathological symptoms
Complexity increases when combined with autism or intellectual disabilities
Initial misdiagnosis as oppositional defiant disorder or treatment-resistant ADHD
Need to differentiate between typical defiant behavior and true mood episodes

[19:02 -31:42] Understanding Trauma's Relationship with Mental Health Symptoms
Trauma symptoms can overlap with other mental health conditions, making diagnosis complex
Flashbacks from trauma can present similarly to perceptual disturbances or hallucinations
Content of experiences often connects directly to past traumatic events and safety concerns
Both trauma and other mental health conditions can coexist - it's not an either/or situation

[31:43 - 32:13] Adapting Primary Care to Modern Mental Health Challenges
Pediatricians can't opt out of mental health care, just as they didn't opt out of COVID care
Primary care providers are being called upon to manage medications when psychiatric access is limited
Professional relationships and collegial connections make difficult cases more manageable
There's a growing recognition that early intervention in mental health can prevent future complications, including involvement in the juvenile justice system

[50:51 - 58:26] Closing segment Takeaway

Links to resources mentioned on the show

AACAP Facts for Families: Facts for Families

AACAP Resource Center Bipolar Disorder

Other episodes you may like:
Episodes - Pediatric Meltdown
161 Menstrual Equity Changes Lives: The Power of Days
151 American...

218. Vote For Kids

Wed, 30 Oct 2024 09:00:00 +0000

What happens when the wealthiest nation in the world fails its children?
In this short but important solo episode, Dr. Lia Gaggino, speaking as a mother, grandmother, and pediatrician, shares her concerns about the state of children's welfare in America. She addresses multiple challenges facing our youth today, from healthcare and poverty to gun violence and education. As the November 5th election approaches, Dr. Gaggino makes an impassioned plea to voters to consider the impact their choices will have on the next generation. Her message transcends political lines, focusing instead on fundamental human values and the moral imperative to protect and nurture our children.
After all, as she poignantly asks, “who will lead, teach, build, and protect our nation if we continue to fail our children today?”
Links to resources mentioned on the show

CDC https://www.cdc.gov/maternal-infant-health/infant-mortality/index.html
Commonwealth Fund: https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison#:~:text=Recent%20Maternal%20Mortality%20Trends,deaths%20per%20100%2C000%20live%20births.
Annie E. Casey Kids Count: https://datacenter.aecf.org

Other episodes you may like:
Episodes - Pediatric Meltdown
161 Menstrual Equity Changes Lives: The Power of Days
151 American Indian/Alaskan Native Youth: Beyond Adversity

Key quotes for Twitter:

"In the United States, 25% of children live in poverty. 50% are covered by Medicaid insurance."... Dr. Lia Gaggino on the child poverty crisis
"Should they bleed out on waiting room floors? Should they die of sepsis because they can't get the care they need to treat a miscarriage because doctors are afraid in states that ban all abortion?".... Dr. Lia Gaggino on the reality of abortion bans

FULL TRANSCRIPTS AVAILABLE UPON REQUEST

THANK YOU FOR YOUR SUPPORT!
Pediatric Meltdown was listed as a Top 20 Pediatric Podcast on FeedSpot.
If you’d like to connect with me, you can find me on LinkedIn, Facebook, and Instagram, or email me at gagginol@gmail.com. To learn more about me visit https://www.pediatricmeltdown.com

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217. Inside the Toddler Mind: What Adults Can Learn from Tots

Wed, 23 Oct 2024 09:00:00 +0000

What if the key to happiness lies in thinking like a toddler?
Dr. Lia Gaggino's Pediatric Meltdown podcast features Dr. Hasan Merali, who unveils the wisdom hidden in toddler behavior. Uncover the science behind child development, learning how to handle toddler tantrums and why the "terrible twos" might be a misnomer. Dr. Merali offers unique parenting tips, from encouraging kindness to establishing sleep routines. Explore how childhood creativity can enhance adult life, and gain strategies for improving work-life balance. This episode challenges conventional wisdom about child behavior, offering fresh perspectives on fostering kindness and learning from kids.
This episode will leave you eager to embrace your inner toddler and find joy in life's little moments.
[00:33 -11:26] Toddler Brain Development and Adult Learning
The less-developed prefrontal cortex allows toddlers to live in the moment
Toddlers have enhanced visual attention, noticing tiny details adults might miss
Young children think differently due to fewer preconceived notions
Toddlers exhibit twice as much laughter as adults

[11:27 - 22:28] Positive Mindset: Reframing Tantrums and Embracing Toddler Traits
The median time for a toddler tantrum is 3 minutes, occurring on average once a day
Changing vocabulary from "Terrible Twos" to "Terrific Twos" promotes learning from toddlers
Toddlers have a basic tendency to be nice to others, even when faced with selfish behavior
Toddlers focus on building relationships and learning

[22:29 -30:14] Self-Talk Strategies: Enhancing Adult Mental Well-being
Self-talk is prevalent when kids are little, especially in the toddler preschooler age
They use it to guide themselves through tasks and to encourage themselves
MRI studies show we can decrease our emotional reactivity if we talk to ourselves in 2nd and 3rd person
Instead of "What am I feeling right now," ask "What is [your name] feeling right now?"

[30:15 - 39:18] Toddler Sleep Routine for Better Adult Sleep
No screens 1 hour before bedtime
Take a hot bath or shower to cool down core body temperature
Perform a quiet activity, preferably reading
Plug your phone in a different room, not beside your bed

[39:19 - 45:41] Closing segment Takeaway

You can reach Dr. Hasan Merali
LinkedIn: https://www.linkedin.com/in/hasan-merali/
X: https://twitter.com/Hasan_Merali
Facebook: https://www.facebook.com/HasanMeraliMD/

Links to resources mentioned on the show
Dr. Merali, website: HasanMerali.com
Book: Sleep Well, Take Risks, Squish the Peas: Secrets from the Science of Toddlers for a Happier and More Successful Way of Life: https://www.amazon.com/Sleep-Well-Take-Risks-Squish/dp/0757324711
NYT Article:

216. Fostering Curiosity: A Pediatrician’s Guide to Early Brain Development

Wed, 16 Oct 2024 09:00:00 +0000

What if the key to unlocking your child's potential lies in their natural curiosity?
In this enlightening episode of "Pediatric Meltdown," host Dr. Lia Gaggino welcomes developmental-behavioral pediatrician Dr. Prachi Shah to explore the fascinating world of child development. Together, they unpack the importance of play in child development and reveal strategies to encourage exploration. Dr. Shah shares her expertise on early brain development and cognitive growth. Discover how play and exploration shape a child's future, and learn easy practical strategies for encouraging your little one's inquisitive nature.
This episode is a must-listen for parents and caregivers eager to nurture their child's innate wonder and set the stage for lifelong learning.
[00:33 -15:43] Fostering Curiosity in Young Children: Key Strategies
Curiosity starts with the child's intrinsic motivation and captures their attention
Entering a child's world helps adults see things with "a new set of eyes"
Observing nature, like watching insects or plants, stimulates curiosity
Simple activities, like using a "play right here stick," can encourage wonder and exploration

[15:44 - 26:32] Impact of Curiosity on Academic Achievement in Early Education
Higher curiosity at kindergarten correlated with higher academic achievement in reading and math
At low levels of curiosity, there was lower academic achievement
Safe, stable, nurturing relationships (SSNRs) provide the foundation for exploratory behavior
Promoting curiosity can foster academic resilience in children from under-resourced environments

[26:33 -36:22] Early Childhood Curiosity and Parental Interaction
Children from under-resourced areas hear fewer words, creating a 30-million-word gap by kindergarten
Frequent conversational exchanges between parents and children are associated with higher curiosity
High-quality linguistic environments lead to better academic, occupational, and social outcomes
Serve-and-return conversational exchanges are recommended by pediatric anticipatory guidance

[36:23 - 55:50] Promoting Curiosity in Pediatric Care:
The American Academy of Pediatrics recommends prescribing play at every well-child visit
Unstructured play time and playful learning with parents are crucial for building cognitive and social-emotional skills
Safe, stable, nurturing relationships (SSNRs) are foundational for the development of a child's curiosity
Pediatricians can encourage parents to engage in scaffolding and special "sunshine time" with their children to boost curiosity

[55:51 - 01:02:58] Closing segment Takeaway

Links to resources mentioned on the show
AAP Resources Early Relational Health: https://www.aap.org/en/patient-care/early-childhood/early-relational-health/
AAP Early Relational Health Implementation Guide: Early Relational Health Guide
Reading Tips from AAP http://Healthychildren.org Falling in Love with Reading..
Reach Out and Read https://reachoutandread.org

Other episodes you may like:
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176 ACES and the Power of Positive Relationships
175 Beyond...

215. Pediatric Social Influencers of Health: Screening and Intervention

Wed, 09 Oct 2024 09:00:00 +0000

In the realm of pediatrics, can a child's ZIP code be a stronger predictor of health outcomes than their genetic code?
Dr. Lia Gaggino examines this critical question alongside pediatric residents Dr. Nicole Hickman and Dr. Kathleen Kelly. These passionate advocates for health equity discuss their innovative work integrating social influencers of health into pediatric residency programs and primary care practices. They address the complexities of tackling food insecurity, housing instability, and other social influencers of health that significantly impact children's well-being.
Drs. Hickman and Kelly provide practical strategies for screening patients and implementing community resource referral systems, showcasing how targeted interventions can yield substantial improvements in care. Their groundbreaking approach to the medical education curriculum and inpatient systems interventions aims to reduce healthcare inequities. Their dedication to advocacy and addressing social determinants in pediatric residency will inspire listeners to become catalysts for change in pediatric healthcare.
[00:33 -14:46] The Role of Social Influencers of Health in Pediatric Care
Social influencers, such as access to healthcare, education, and neighborhood environment, significantly affect children's health outcomes.
Pediatricians must recognize the importance of community context, economic stability, and access to quality resources in shaping child health.
Families living in food deserts face challenges in accessing nutritious foods, affecting children's overall health and development.
Addressing social influencers can help mitigate health disparities, offering opportunities for intervention to improve pediatric health.

[14:47 - 24:08] Addressing Structural Racism and Intersectionality in Pediatric Health Outcomes
Structural racism, reinforced through housing, education, and healthcare systems, significantly affects health outcomes, particularly in marginalized communities.
In Chicago, a stark 30-year difference in life expectancy exists between predominantly white and Black neighborhoods, exemplifying the impact of systemic discrimination.
Pediatric care must acknowledge and address the broader societal factors, like redlining and economic disinvestment, that contribute to health inequities.
Developing pediatric training to address structural racism is critical for reducing the health gaps caused by these deeply rooted societal factors.

[24:09 -32:16] Trauma-Informed Approaches in Pediatric Social Health Screenings
Using sensitive language during screenings encourages trust, which helps families feel comfortable discussing social challenges over time.
Normalizing the screening process by introducing it as a routine part of every patient encounter helps build rapport and reduce stigma.
Pediatricians should reassure families that resources are available to help address needs identified during screenings, reinforcing that support is ongoing.
Offering social work support and providing a list of community resources upfront can prepare families for future needs, even if they don’t require immediate assistance(pm03).

[32:17 - 43:44] Pediatric Screening Tools for Addressing Social Determinants of Health
The hospital system uses a comprehensive screening questionnaire that includes housing insecurity, food insecurity, and physical violence.
The tool incorporates questions related to gun access in the home, combining different social screeners and abuse screeners.
Pediatricians can track outcomes using a closed-loop referral system, ensuring patients receive the resources they need.
Screening tools are integrated...

214 Autism and Sexuality: The Birds and The Bees

Wed, 02 Oct 2024 09:00:00 +0000

How do we address the often-overlooked sexual health needs of individuals with Autism Spectrum Disorder (ASD)?
Dr. Zakia Alavi, a seasoned child and adolescent psychiatrist specializing in pediatric mental health and developmental disabilities, joins Dr. Lia Gaggino to unpack this critical yet often neglected aspect of care for individuals on the autism spectrum. Drawing from her extensive experience in child and adolescent psychiatry, Dr. Alavi reveals the patterns she's observed in patient referrals, particularly concerning autism and behavior problems, including inappropriate sexual behavior. This frank discussion covers everything from understanding puberty in children with autism to addressing the complex challenges surrounding sexuality education for neurodivergent individuals.
Dr. Alavi emphasizes the need for tailored sexual health curricula and the importance of behavioral therapy for youth with autism to manage sexuality-related issues. She also touches on the pressing concern of victimization of youth on the autism spectrum and the role of promoting comprehensive sexual education for these youth..
Listen in and discover why Dr. Alavi believes sexuality is not just a basic human need, but a fundamental right for all, regardless of their neurodevelopmental status, including those with neurodevelopmental disorders like ASD.
[00:33 -10:59] Autistic Traits and Abuse Risk
  Explores the higher risk of abuse due to social awareness and communication deficits in youth with autism.
  Non-verbal children or those who misinterpret situations are especially vulnerable.
  Defines sexual awareness as understanding feelings, desires, and sexual situations.
  Highlights the struggle of youth on the autism spectrum in independently navigating sexual awareness.

[11:00 - 22:49] Discussion on Sexual Awareness
  Defines sexual monitoring as understanding others' impacts on one's sexuality.
  Emphasizes the importance of sexual assertiveness and consciousness for protection.
  Single parents, in particular, may struggle with providing comprehensive sexual education.
  Suggests the presence of another person during these discussions for better handling.

[22:50 -28:59] Victimization and the Role of Media
  Notes the heightened risk of victimization, especially among females with autism spectrum disorders.
  Emphasizes the need for protective measures and greater awareness.
  Role of parents and educators in continual skill-building around privacy and sexual norms.
  Suggests personalized approaches tailored to each child's level of understanding.

[29:00 - 32:13] Sexuality as a Human Right:
  Encourage self-reflection about perspectives on sexuality for oneself and others.
  Highlight the importance of helping children achieve their fullest potential in all aspects.
  Reiterates the significance of protecting neurodiverse youth from victimization through education.
  Encourages proactive approaches to ensure youth understand and navigate normal sexual behaviors

[32:14 - 40:00] Closing segment Takeaway

You can reach Dr. Zakia Alavi
LinkedIn: linkedin.com/in/zakia-alavi-7289a9118

Links to resources mentioned on the...

213. Vaccine Hesitancy and Refusal: Fact and Emotion

Wed, 25 Sep 2024 13:00:00 +0000

Vaccine Hesitancy and Refusal: Fact and Emotion
Have you ever wondered why vaccines spark such strong opinions, even as they play a pivotal role in infectious disease prevention and public health response?
Join Dr. Lia Gaggino and guest Dr. Robert Frenck as they unravel the complexities of vaccine hesitancy in our pandemic-prepared world. They delve into how the effectiveness of the COVID-19 vaccine and childhood vaccinations paradoxically fuels skepticism, and how public health communication strategies can bridge the gap between medical professionals and parents.
Dr. Frenck shares real-life stories and explains the benefits of childhood vaccinations, emphasizing straightforward conversation to discuss childhood vaccines including the COVID-19 vaccine, side effects, and the importance of herd immunity. Discover strategies for overcoming vaccine hesitancy and infectious disease outbreak management—listen now to rethink your understanding of vaccinations, their role in our society, and their impact on vaccine preventable disease outbreaks..

[00:33 -16:05] Vaccine Hesitancy and Public Health Challenges
Infectious diseases like respiratory illnesses, diarrheal diseases, and malaria are still leading causes of death in children globally.
Vaccines play a crucial role in protecting communities through herd immunity.
Skipping vaccines can have a significant impact on disease transmission and outbreaks.
Healthcare providers have an ethical duty to make recommendations and address vaccine hesitancy.

[16:06 - 26:41] Public Health Challenges: Overcoming Politicization and Misinformation
Recognize that infectious diseases do not discriminate based on political affiliation, race, religion, or other factors.
Address the concerning trend of public health becoming a political issue, rather than a matter of keeping everyone healthy.
Combat the misconception that vaccine-preventable diseases are gone or no longer a threat.
Highlight the need for expertise, coordination, and preparedness in public health responses to infectious diseases.

[26:42 -35:33] Mandatory Vaccination Policies for Healthcare Workers
Prioritizing workplace safety for patients, especially those with compromised immunity
Addressing concerns about mixed messaging from unvaccinated healthcare providers
Considering vaccination as a fundamental requirement for healthcare professions
Highlighting the ethical responsibility to protect vulnerable populations

[35:34 - 56:57] Pandemic Challenges: Adapting Medical Practices and Communication
Acknowledging the need to alter recommendations as new data emerges during a rapidly evolving pandemic situation.
Emphasizing the critical role of healthcare professionals as experts and trusted sources of information during public health crises.
Highlighting the ethical responsibility of leaders and public figures to prioritize public health over personal or political gain.
Underscoring the value of respectful dialogue, finding common ground, and starting from areas of agreement in addressing divisive issues.

[56:58 - 1:09:23] Closing segment Takeaway

You can reach Dr. Frenck
LinkedIn @Robert Frenck

Links to resources mentioned on the show
AAP Immunization Resources for Parents:

212. Chronic School Absenteeism: The Role of Pediatricians

Wed, 18 Sep 2024 09:00:00 +0000

Have you ever wondered how missing a few school days could dramatically alter a child's future?
In this eye-opening episode of Pediatric Meltdown, host Dr. Lia Gaggino and guest Dr. Heidi Schumacher unravel the staggering disparities in school quality and attendance amplified by the pandemic. As a general pediatrician and health policy advocate, Heidi discusses the urgent need for systemic support, the hidden toll of chronic absenteeism, and the crucial interventions needed to ensure educational equity.
While truancy often leads to punitive measures, chronic absenteeism requires a supportive and compassionate approach to unveil the deeper health and social issues behind missed school days. Pediatricians can play a transformative role by addressing these needs early, fostering environments where every child thrives. Are you curious about the actionable steps you can take to combat chronic absenteeism in your community? Listen to this episode now and empower yourself to make a difference!
[04:39 -15:21] Understanding Chronic Absenteeism in Schools
Chronic absenteeism differs from truancy and includes both excused and unexcused absences.
Chronic absenteeism is defined as missing about 18 school days a year, or approximately 10% of the school year.
The response to chronic absenteeism is more supportive rather than punitive, focusing on understanding and addressing family challenges.
Economic impacts of absenteeism include affecting educational opportunities and potential long-term financial stability.

[15:22 - 26:48] The Critical Role of Health Professionals in Boosting School Attendance
Clinical visits offer an opportunity to discuss the importance of regular school attendance with families.
Some clinics are piloting the addition of questions about missed school to pre-visit questionnaires or child check-ups.
By understanding the reasons behind missed school days, health practices can address specific needs that may hinder attendance.
Collaborating with school nurses and advocating for more healthcare resources in schools can improve attendance and engagement.

[26:49 -35:25] Addressing Barriers to School Attendance through Health and Community Support
Factors such as toxic exposures, food insecurity, and lack of reliable transportation are identified as key barriers that affect school attendance.
The lack of reliable electricity, food, and secure housing strongly correlates with issues in school attendance.
Pediatricians are encouraged to inquire about school attendance when they encounter social drivers or chronic conditions in children.
Understanding attendance patterns helps identify disparities in educational access related to health and social determinants.

[35:26 - 45:46] The Importance of School Attendance and Engagement Strategies
The Everyday Counts Summit emphasized the need for federal investments to support school reengagement and consistent attendance.
Leveraging pandemic recovery funds for enhancing school attendance and engagement has been a focus for many states.
Collaborative partnerships between government entities and organizations, like the American Academy of Pediatrics, are crucial.
Evidence-based interventions and localized data analysis are essential for closing equity and opportunity gaps.

[45:47 - 54:28] Closing segment Takeaway

You can reachDr. Heidi Schumacher
linkedin.com/in/heidi-schumacher-md-3504433

Links to resources...

211. Medicine, Mountains and Meditation: The Art of Healing

Wed, 11 Sep 2024 09:00:00 +0000

Have you ever wondered how ancient practices like mindfulness and the Pranayama breathing technique could revolutionize the high-stress environments like the NICU?
In this episode, Dr. Nitin Ron, a neonatologist with a unique perspective, shares his journey of integrating meditation and compassionate care into his medical practice. From scaling Mount Everest to working in an art museum, Dr. Ron's multifaceted experiences have shaped his approach to healing. Discover how these techniques not only benefit patients but also provide crucial stress relief for healthcare workers, particularly during the challenging times of COVID-19. Learn about the science behind these practices and their potential to prevent burnout in medical professionals. This episode offers a rare glimpse into the transformative power of combining ancient wisdom with cutting-edge medicine, promising a new era of holistic healthcare that nurtures both patients and caregivers alike.
[05:42 -17:20] Awareness and Resilience in Pediatric Healthcare
Babies demonstrate an inspiring ability to have present moment awareness, even in challenging medical situations.
Healthcare professionals can find inspiration by observing the strength and resilience of babies in the NICU.
The ability of infants to smile despite medical interventions serves as a powerful lesson in maintaining a positive outlook.
The practice of pediatrics is referred to as a "calling" rather than just a job, emphasizing its profound impact on practitioners.

[17:21 - 23:54] Ancient Breathing Practices Meet Modern Medical Science
Pranayama, an ancient Indian breathing technique, has similarities with modern high-altitude acclimation methods
Research presented at the Pediatric Academic Society's meeting compared ancient pranayama to current medical science
The book serves as a textbook for meditation and pranayama research, as well as a practical guide
The project brought together contributors from four different countries, showcasing global collaboration in healthcare

[23:55 -44:47] COVID-19 Pandemic: Lessons in Isolation and Community Support
The pandemic highlighted the negative effects of isolation on human well-being
Children were particularly affected by the inability to see friends and grandparents
The crisis emphasized the crucial role of community in maintaining hope and mutual support
The experience reinforced the importance of human connection and support systems in healthcare

[44:48 - 55:17] Mindfulness and Meditation in Healthcare: Practical Applications
Even 3 minutes of watching thoughts without reacting can be beneficial
Regular practice of meditation helps maintain mental equilibrium, like a movie screen unaffected by the images
The intention to meditate and practice self-care is 95% of the journey towards happiness
Research shows brainwaves start changing in 6 weeks with just 8 minutes of practice once a week

[55:18 - 59:34] Closing segment Takeaway

Links to resources mentioned on the show
Book - Pranayam Breathing: Techniques for Health, Healing and Tranquility

Pranayam Breathing Techniques for Health, Healing and Tranquility:...

210. Understanding Suicide: The Loss of a Mother

Wed, 04 Sep 2024 09:00:00 +0000

What happens when personal trauma intersects with professional purpose in the world of child psychiatry?
Discover the compelling story of Dr. Nancy Rappaport, who turned the tragedy of losing her mother to suicide into a life-long commitment to prevent similar losses in others. This podcast episode explores the intricate links between personal history and professional practice with a focus on child and family psychiatry. It illuminates the often-overlooked nuances of family dynamics, the importance of understanding children's challenging behaviors, and the sensitive discourse surrounding suicide prevention. The conversation unearths how small moments of humanity in therapy can bridge profound professional gaps and reinforce the resilience required in dealing with complex familial issues. Listeners will leave with a renewed understanding of why appropriate conversation about suicide is a poignant necessity in both clinical practice and families. Listen now to uncover insights that might just redefine the approach to mental health support.
[03:43 -12:26] Child Psychiatry & Personal History
September marks Suicide Prevention Awareness Month, underscoring the episode's thematic urgency.
Discussion on how her experiences informed her choice to focus on child psychiatry.
Importance of not using stigmatizing language like "committed suicide."
Emphasis on reducing stigma and opening dialogues about suicide.

[12:27 - 22:00] Trauma, Suicide, and Professional Development in Child Psychiatry
Personal experiences with trauma and loss can influence a therapist's approach to working with children and families
The saying "when someone dies by suicide, they take their skeleton and put it in your closet" highlights the complex impact on survivors
Shifting from individual therapy to family therapy can provide new insights into family dynamics and behaviors
Balancing personal emotional experiences with professional rigor is crucial in the field of child psychiatry

[22:01 -32:46] Childhood Behavior and Parenting Challenges
Strategies for pediatric clinicians dealing with suicidal patients.
The role of programs like the National Alliance on Mental Illness in aiding families with psychiatric issues.
The importance of local resources, like those in Boston, for mental health support.
Encouragement for clinicians to remind patients of their value, especially post-suicide attempts.

[32:47 - 41:46] Childhood Behavior and Parenting Challenges
The behavior code was written drawing on that was published in 2012. It's been on the bestseller of Harvard Ed Press for about 8 years.
It was written about angry kids, oppositional kids, kids with sexualized behavior, and kids with withdrawn behavior.
As parents, you're doing this dance, and then it's not perfect. Sometimes you step on each other's toes, but there is this room for repair.
You have to have a lot of humility when working with parents because Yes. We all are doing the best we can.

[41:47 - 48:19] Closing segment Takeaway

You can reach Dr. Nancy Rapaport
Email: nancy@nancyrapaport.com LinkedeIn:

209. The Joy of Pediatrics: The Magic in the Room

Wed, 28 Aug 2024 09:00:00 +0000

Have you ever wondered what keeps pediatricians going despite the challenges of modern healthcare? In this episode of the Pediatric Meltdown podcast, host Dr. Lia Gaggino celebrates four years of insightful conversations while going into the heart of pediatric practice. She talks about the delicate balance between technology and human connection, emphasizing the importance of creating space for magical moments with patients. From the joys of a baby's laughter to the struggles with electronic health records, Lia paints a vivid picture of the pediatric landscape. As she reflects on the evolution of her podcast and the field itself, one question emerges:
How can we preserve the magic of pediatrics in an increasingly technology driven world?
[00:33 - 03:02] Celebrating Four Years of Pediatric Insights
Reflection on the podcast's 4-year journey and growth
Gratitude for amazing guests and their contributions
Acknowledgment of initial challenges in podcast production
Introduction of the concept "joy of pediatrics" and "magic in the room"

[03:06 - 08:12] Balancing Technology and Patient Care
Importance of creating time for meaningful patient interactions
Challenges of electronic health records vs. paper charts
Encouragement to look away from screens during consultations
Hope for future improvements through AI scribing technology

[08:11 -10:19] Fostering Professional Growth and Community
Upcoming national meeting in Orlando for pediatric professionals
Invitation for listeners to connect with Lia at the event
Encouragement to find and create magical moments in practice
Teaser for interesting upcoming podcast guests

Links to resources mentioned on the show
Podcast Production
MouthyBroadMedia.com

Social Media Management
EC8Consulting@gmail.com

AAP
aap.org

2024 Practical Pediatrics CME Course - San Diego, CA
2024 Practical Pediatrics CME Course - San Diego, CA | shopAAP

MIAAP
MIAAP

Other episodes you may like:
Episodes - Pediatric Meltdown
205. Social Media and Families: Creating Culturally Relevant Content
182. Social Media Dangers: Protecting and Educating Youth

Key quotes for Twitter:
"And I have to say, there was a lot of stuff I didn't know. Some of the episodes were pretty rough, but I have had just the most amazing guests."... Dr. Lia Gaggino reflecting on four years of the Pediatric Meltdown podcast.
"The AAP is the best because it is pediatricians. It's us. And there is just nothing better than being with other people who love children and love thinking about ways to make their world better and how to do a better job.".... Dr. Lia Gaggino reflecting on the importance of pediatricians connecting

FULL TRANSCRIPT WILL BE AVAILABLE UPON REQUEST

THANK YOU FOR...

207. Am I Smart Enough?: Self-Esteem Booster for Pediatricians

Wed, 14 Aug 2024 09:00:00 +0000

Are you feeling overwhelmed by the constant need to prove your medical expertise?
In this week’s episode, Dr. Lia talks about the challenges and anxieties surrounding board certification for pediatricians, particularly focusing on the evolution of the MOCA peds program. She shares personal experiences with various certification methods, from proctored exams to open-book tests, highlighting the stress and self-doubt that often accompany these processes. The importance of continuous learning in the medical field is also mentioned, recommending resources like pediatric board review materials and various CME opportunities. You’ll hear Dr. Lia will also touch on the prevalence of imposter syndrome among medical professionals, reassuring listeners that it's normal to not know everything and encouraging them to ask for help when needed. Ultimately, she advocates for a balanced approach to professional development, acknowledging both the necessity of expertise and the reality of human limitations in medical practice.

[2:54 -05:07] The Evolution of Board Certification Methods
Proctored exams: Anxiety-inducing and challenging to concentrate
Open-book tests: Time-consuming but aligned with real-world practice
Return to proctored exams: Disliked by many professionals
MOCA Peds: A modern, quarterly assessment approach

[5:08 - 07:14] Navigating MOCA peds and Continuous Learning
Utilize pediatric board review materials for preparation
Approach questions as real-life cases, not trick questions
Take advantage of the 5-minute time limit per question
Embrace continuous learning through various CME opportunities

[07:15 - 12:30] Expanding Mental Health Knowledge in Pediatrics
Seek out mental health sessions at national conferences
Attend specialized mental health conferences for pediatricians
Consider long-term training programs like the REACH Institute
Utilize resources from AAP and ACAP for ongoing education

Resources mentioned on the show

MOCA-PBR www.pediatricsboardreview.com
Neuroscience Education Institute https://www.neiglobal.com/
REACH https://thereachinstitute.org/
nncpap.org
aap.org
aacap.org
AAP National Conference https://aapexperience.org/

Other episodes mentioned on the show:
https://pediatricmeltdown.com/episodes
116. Physician Wellness Coaching: Proven Benefit!
  98. Anxiety? Inattention? Depression?: Prescribe Nature! Dr. Stacy Beller Stryker
  76. Pediatric Practices: Find Your Balance

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206. Pediatric Meltdown Reflections

Wed, 07 Aug 2024 09:00:00 +0000

Have you ever wondered what parents truly desire from their pediatricians?
In this week's episode of Pediatric Meltdown, Dr. Lia goes into the heart of parental needs, drawing from her 34 years of experience and insights gleaned from her podcast interviews. She explores the universal desire for reassurance, the challenges of modern parenting in the age of social media, and the importance of fostering positive childhood experiences.
Dr. Lia emphasizes the critical role of relational health in supporting families, especially those facing adversity. She reminds us that the most powerful tool in a pediatrician's arsenal isn't fancy gadgets or cutting-edge treatments, but the ability to listen and validate parents' experiences. From navigating preschool expulsions to dealing with developmental milestones, this episode offers a compassionate perspective on the complexities of raising children. Whether you're a healthcare professional or a parent, this episode promises to leave you with valuable insights and a renewed appreciation for the power of human connection in pediatric care. Remember, in the journey of parenting, you're not alone – and sometimes, that's the most important message of all.
     [0:00 -01:46] Observations from a Seasoned Pediatrician: Parental Needs
Episode focuses on what parents want most from pediatricians
Addresses the pressure parents face, especially from social media
Emphasizes that fancy gadgets aren't necessary; however, relationship with the baby is key

[1:47 - 17:48] Reassurance: The Foundation of Parent Support
Parents need reassurance that they're not failing
Importance of praising parents for their efforts
Reminder that the parent-child relationship is more important than material things

[17:48 - 18:29] Navigating Challenges: A Collaborative Approach
Addresses issues like preschool expulsions and daycare problems
Encourages pediatricians to "ride the ride" with parents
Suggests calling in reinforcements when needed (e.g., social work, community mental health)

[18:30 - 26:14] Building Relational Health and Positive Experiences
Focuses on fostering positive childhood experiences
Explains how supportive adults can help children overcome adversity
Emphasizes teaching parenting skills, as they're not innate

Resources mentioned on the show
https://www.healthychildren.org
The Healthy Children Podcast: Healthy Children (pod.link)

Other episodes mentioned on the show:
https://pediatricmeltdown.com/episodes
202. Functional Neurologic Disorders: Recognition and Management
175. Beyond Trauma: Strengthening the Caregiver-Infant Dyad
162. Migraine Headaches: Assessment, Management and Relief
152. The Mysteries of Abdominal Pain: Disorders of the Gut-Brain Interactions
115. Chronic Pain Syndromes: Assessment and Management
114. Palliative and Hospice Care: A Conversation on Grief and Joy

Building Better Workflows Podcast
Building Better Workflows

Key quotes for Twitter:
"Vaccines are the most important public health endeavor that...

205. Social Media and Families: Creating Culturally Relevant Content

Wed, 31 Jul 2024 09:00:00 +0000

What if you could revolutionize healthcare communication for diverse communities with just a 90-second video?
That's exactly what Dr. Ripudaman Singh Minhas and his team are doing with their innovative approach to health education. Imagine a world where families can access vital health information in their native language, delivered by someone who looks like them and understands their cultural nuances. From TikTok-style snippets to in-depth Instagram lives, this initiative is breaking down barriers and building trust across various cultural and linguistic groups. With a focus on accessibility, hope, and cultural representation, they're transforming how health information is shared and received. By leveraging the power of "trusted messenger models" and collaborating with community advisory boards, they ensure that their content resonates deeply with their target audiences. From pediatricians to psychologists, a diverse team of over 60 clinicians volunteer their expertise to create content that's not just informative, but also engaging and culturally sensitive. This groundbreaking approach isn't just changing how we communicate health information – it's potentially saving lives, one short video at a time.

[02:06 -09:46] Cultural Representation in Online Health Resources
Created resources that were culturally responsive and adapted, translated where needed
Aimed to build rapport and trust, answering questions families had
Applied the trusted messenger model to an online space
Each channel has healthcare providers on screen who are from the communities they serve, communicating in bilingual channels where appropriate

[09:47 - 17:07] Social Media for Public Health: Innovative Content Strategies

Most videos are TikTok-style, 90 seconds long, offering quick bites of health content
Longer content, up to 45 minutes, delves into specific topics like speech delay or summer safety
Content is community-led, responding to questions and analytics from social media
Videos feature practitioners from the community, speaking in their native language

[17:08 - 21:26] Expanding Digital Health Education for Youth and Diverse Communities
Goal to create more channels and content for families in over 40 countries
Plans to develop content specifically for grandparents and fathers
Implementation of the Digital Health Youth Fellowship Program
Training young content creators on video creation, self-care, and critical information appraisal

[21:27 - 33:48] Social Media Impact on Pediatric Health Education
The project has seen significant impact in terms of audience reach and engagement.
Research is being conducted to evaluate how the project impacts parenting journeys.
A study is examining how social media was used as a tool in the resettlement process for families displaced by the war in Ukraine.
The project aims to do "microdoses of positive pediatric content" amidst other content families are scrolling through

[33:49 - 40:23] Closing segment Takeaways

Links to resources mentioned on the show
Newsletter Sign Up: Our Kids Health
Website: Our Kids Health - Our Kids Health
LinkedIn:

204. Perinatal Mood Disorders: Dr. Lia Gaggino's Personal Story

Wed, 24 Jul 2024 09:00:00 +0000

What life-saving benefits can psychopharmacology offer for mental health disorders postpartum?
In this week’s episode of Pediatric Meltdown, Dr. Lia Gaggino unravels the intense highs and lows of perinatal mood and anxiety disorders (PMADs), as she bravely shares her own struggles and triumphs. She highlights the crucial red flags that every parent and healthcare provider should recognize as well as practical strategies from top experts to enhance your clinical practice and better support families navigating this emotional landscape. With this useful advice and resources, Dr. Gaggino provides a beacon of hope and understanding for both healthcare professionals and new parents. Curious to discover the one tip that can transform your postpartum experience? Click here to learn more!

[0:04 - 06:07] Introduction to Perinatal Mood and Anxiety Disorders
The host recounts her personal experience with PMADs during her residency.
Discusses the struggle of timing motherhood with professional life.
The emotional and logistical challenges of pregnancy, delivery, and motherhood.

[06:08 - 13:12] Postpartum Challenges: Real-life Experiences
The intense anxiety and feelings of incompetence in the early postpartum period.
Support system breakdown: How a lack of nurturing support impacted mental health.
The importance of seeking professional help and the stigma surrounding it.

[13:13 - 17:03] Tools and Strategies for Managing PMADs
Routine screening for risk factors using tools like the Edinburgh Postnatal Depression Scale.
Normalizing conversations about PMADs with new parents and their partners.
Encouraging healthcare providers to ask the right questions to identify at-risk parents.

[17:04 - 22:38] Empowering Parents and Clinicians
The impact of social media and unrealistic expectations on new mothers.
Practical advice for partners and extended family members to support postpartum parents.
A call to action: Encouraging listeners to share their experiences and support each other.

Links to resources mentioned on the show
- Edinburgh Postnatal Depression Scale: (https://psychology-tools.com/epds/)
- Postpartum Support International: (https://www.postpartum.net)
- Books by Karen Kleiman: (Amazon.com)

Other episodes you may like:
https://pediatricmeltdown.com/episodes
185. Cultural Competency: Health Equity and Outcomes
175 Beyond Trauma: Strengthening the Caregiver-Infant Dyad
161 Menstrual Equity Changes Lives: The Power of Day
147 Racial Discrimination and Black Infant Morbidity and Mortality
134 Early Childhood Education: Empowering Parents

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Key quotes for Twitter:
"Because the reality is medication for mental health disorders can be life saving.".. Dr. Lia Gaggino on medication and postpartum depression
"Babies eat, sleep, cry, and poop. They don't smile at you to...

203. Perinatal Mood and Anxiety Disorders: Coping Strategies for New Parents

Wed, 17 Jul 2024 09:00:00 +0000

Have you ever wondered what it truly takes to support perinatal mental health in our communities?
This week’s episode goes into just that, featuring expert Kristina Ledlow, who emphasizes the power of community in addressing mental health needs for new mothers. Kristina and Dr. Lia explore the revolutionary risk assessment tool developed by Nancy Roberts, stressing the importance of concrete data in securing sustainable funding and resources. They discuss key strategies for overcoming perinatal mental health disparities, such as finding champions and building coalitions. Christina shares her vision of establishing a perinatal and infant mental health center, aiming to prioritize this crucial issue on both national and international levels. The conversation also explores the negative effects of healthcare silos and the transformative impact of interdisciplinary teamwork.
Furthermore, they tackle pressing issues like social media pressures, mommy shaming, and the fear surrounding perinatal mental health medications. Christina provides invaluable insights into creating a postpartum plan, leveraging support systems, and the indispensable role of partners. From online support groups through Postpartum Support International (PSI) to dedicated resources in multiple languages, this episode is a comprehensive guide to improving perinatal mental health for all.

[05:27 -14:30] The Importance of Community and Data
Risk Assessment Tool: Discussion on Nancy Roberts’ risk assessment tool, highlighting the significance of obtaining tangible numbers and statistics.
Championing the Cause: Finding champions, leveraging clout, and building coalitions are essential for addressing perinatal mental health disparities.
Sustainable Funding: Emphasizes the need for sustainable funding beyond grants.
Communication and Collaboration: Impacts of interdisciplinary teamwork in healthcare, importance of breaking down silos.

[14:31 - 23:38] The Role of Therapy and Medication
Medication During Pregnancy: Concerns about medication during pregnancy and the benefits of therapy and medications in treatment.
Postpartum Plan: Creating a postpartum plan prioritizing sleep, nutrition, and support from visitors.
Online Support Groups: Availability of online support groups through PSI, offering spaces of unconditional acceptance and healing.
Mental Health Hotline: Use of resources like PSI's consult lines and maternal mental health hotlines that support in various languages.

[23:39 - 34:13] Addressing Disparities and Systemic Racism
Systemic Racism's Impact: Impact of systemic racism, lack of healthcare access, and generational trauma.
NICU Family Stress: Stress experienced by families of color in NICUs and the need for inclusive care.
Healthcare Professional Support: Role of healthcare professionals in supporting parents and infants, involving families in decision-making.
PSI Support Groups: Online support groups for partners, LGBTQ+ individuals, and Spanish-speaking groups for better inclusivity..

[34:14 - 46:19] Building a Community-centric Postpartum Program
Local and National Aspirations: Sharing aspirations for establishing a local perinatal and infant mental health center and advocating on a larger scale.
Postpartum Challenges: Common challenges for new parents: lack of sleep, postpartum expectations, and pressures from social media.
Postpartum Planning: Encouragement to create a postpartum plan and make use of resources like the free postpartum planning class.
Role of Partners: Discussing the critical role of dads and partners in supporting new mothers and...

202. Functional Neurologic Disorders: Recognition and Management

Wed, 10 Jul 2024 09:00:00 +0000

How can primary care providers better educate themselves about functional neurologic disorders to reduce stigma and support quicker treatment for their patients?
Ever wondered why some neurologic symptoms defy typical diagnostic tests? This week's episode of Pediatric Meltdown will talk about this mystery with guests Dr. Sarah Dixon and Dr. Alex Gamber, two experts in pediatric neurology. Through their expert insights, you'll learn about the difference between epileptic seizures and FND spells, and the importance of therapeutic approaches like cognitive behavioral therapy. With actionable advice for primary care providers and families alike, this episode is a treasure trove of knowledge. Learn about innovative treatment strategies and why understanding both the psychological and neurobiological aspects is so essential. Curious to know the ultimate strategies for tackling FND symptoms? tap on PLAY to discover the key clinical pearls now!

[04:31 -14:11] Defining Pediatric Functional Neurologic Disorders (FND)
FND is a group of conditions causing nervous system symptoms without structural abnormalities.
They result from malfunctions in how information is transmitted and received in the brain.
The symptoms do not arise due to any other neurologic disorder.
It represents an undamaged brain experiencing processing issues.

[14:12 - 25:52] Diagnostic Approaches for Functional Neurologic Disorders in Pediatrics
Subconscious learned motor patterns play a significant role in FND.
Resting state functional connectivity MRI studies show increased connectivity between emotional processing centers and motor control networks in FND patients.
Functional movement disorders, including functional tremor and tics, exhibit distinct physical exam findings.
Neurologists heavily rely on physical exam findings to diagnose functional disorders.

[25:53 - 34:46] Understanding Psychogenic Non-Epileptic Spells in FND Management
Addressing the need for effective treatment interventions.
Ensuring that patient and family concerns are acknowledged and managed.
Importance of patient education in understanding their condition.
Strategies for managing subacute subconscious pressure or stress in patients.

[34:47 - 45:48] Effective Communication in Diagnosing Pediatric FND
Emphasize the importance of clear and compassionate communication when suspecting Functional Neurologic Disorder (FND) in pediatric patients.
Highlight how setting the stage correctly can significantly influence the patient's treatment, prognosis, and overall improvement.
Include educational information in the referral note to neurology, detailing the basics of FND diagnosis and the treatment plan.
Use the referral note to walk through clinical reasoning and explain the natural history of FND.

[45:49 - 54:16] Closing segment Takeaways
Links to resources mentioned on the show
Taking Control of Your Seizures: Workbook
Joel M. Reiter, Donna Andrews, Charlotte Reiter, W. Curt LaFrance, JR
https://www.amazon.com/Taking-Control-Your-Seizures-Treatments/dp/019933501X

Neurosymptoms.org
FNDhope.org

Epilepsy Foundation:

201. Sexual Assault Services: Supporting Victims

Wed, 03 Jul 2024 09:00:00 +0000

This week we’re tackling the critical issue of child sexual abuse prevention. The conversation goes into various aspects, including the prevalence of sexual abuse among children and the different levels of sexual behaviors in children—normative, cautionary, and problematic. Understanding these distinctions is essential for proper management and intervention. Special guests, experts Dannielle Kostrab-Boyd and Sherri Killiah, who work with sexual assault services, share invaluable insights. They reveal alarming statistics and underscore the pediatricians' role in preventing abuse through early intervention. We also highlight the need for open communication on body safety, urging parents to create a safe and trusting environment for their children.
The episode provides an in-depth look at the services offered by Sexual Assault Nurse Examiners (SANE), covering the meticulous process of forensic examinations in child abuse cases. The discussion underscores the critical need for a compassionate and non-judgmental approach to both care and communication. By fostering open lines of communication and ensuring education on body autonomy for kids, we aim to arm parents, healthcare providers, and specialized services with the tools needed to effectively address and prevent child sexual abuse. To understand the collective effort required to support and protect the most vulnerable members of our society, just tap on “play”
[02:58-17:33 Importance of Recognizing Child Sexual Abuse
Prevalence of Child Sexual Abuse: 1 in 10 children will experience sexual abuse before the age of 18, a statistic likely underestimated.
Age Range of Affected Individuals: Victims can range from as young as 5-6 weeks to 96 years old.
Levels of Sexualized Behaviors:

    - Normative: Voluntary, infrequent, easily redirected behaviors with familiar children.
    - Cautionary: Behaviors occurring in inappropriate places, increasing in frequency and involving technology.
    - Problematic: Behaviors involving self-harm, coercion, and inappropriate sexual content for the child’s age.
[17:34 - 32:25] Emotional and Psychological Impact of Abuse
Behavioral Changes: Indicators include regression, depression, anxiety, and fear.
Physical Symptoms: Nightmares, bedwetting, and advanced sexual knowledge are common signs.
Educational and Social Challenges: Difficulties in school performance and peer relationships.
Clinical Guidance: Clinicians should prioritize open communication, ask about behavioral changes, and provide a private space for discussions.

[32:26 - 48:19] The Role of Pediatricians in Prevention
Resource: Pediatricians should ensure prevention information is accessible in waiting rooms, including books and posters.
Building Trust: Establish a safe, trusting relationship with both caregivers and children.
Body Autonomy : Encourage expectations for body autonomy and offer choices during examinations, especially private areas.
Correct Terminology: Using correct medical terminology and explaining the necessity of examinations to create a safe space

[48:20 - 51:01] Available Resources and Support Services
SANE Program: Regional program providing specialized medical and forensic exams, victim advocacy, provides empowerment-based care, emotional support, and follow-up for survivors.
24-Hour Crisis Line: Immediate support available through a crisis hotline.
Comprehensive Services: Individual, family, and group counseling, children’s advocacy center, and prevention programming.
National Resources: Accessing services through national organizations and text...

200. Reflections of 200 Episodes

Wed, 26 Jun 2024 09:00:00 +0000

In this milestone episode of Pediatric Meltdown, host Dr. Lia Gaggino takes a few minutes and celebrates an incredible achievement—reaching episode #200 and marking nearly four years of engaging, insightful, and impactful discussions centered on children’s mental health and emotional well-being. She expresses profound gratitude to her global audience, spanning six continents, and reflects on the journey that has brought her and her listeners to this point.
Dr. Gaggino reminisces about some of her favorite episodes and gives thanks to her mentor Mark Sloane who inspired her venture into mental health. She also extends her appreciation to the many pediatricians, mental health clinicians, and parents who have contributed to the podcast, advocating for better mental health care for children.
In closing, Dr. Gaggino encourages listeners to continue their journey together, emphasizing the unique position they hold in making a positive impact on children's lives. She invites them to explore her new initiative, the Building Better Workflows podcast and workbook, and hints at future episodes filled with practical strategies and heartfelt conversations.
Referenced in this Episode :
https://pediatricmeltdown.com/episodes
  01 Words Matter- Talking about Weight and BMI
  02 Caring for Children in Foster and Kinship Care with Moira Szilagyi
  03 Pediatric Hero: Building Safe Spaces for Kids Emotions with Dr. Mark Sloane
  29 Goldilocks, Tigger and Eeyore: Regulation and Childhood Behaviors
128 Trauma and Resilience: “Connect Before You Correct”
114 Palliative and Hospice Care: A Conversation on Grief and Joy

Building Better Workflows Podcast
Building Better Workflows

**Transcript of Episode Available upon request**

THANK YOU FOR YOUR SUPPORT!
Pediatric Meltdown was listed as a Top 20 Pediatric Podcast on FeedSpot.
If you’d like to connect with me, you can Tap the “What Are Your Thoughts” button at the top of the notes or you can find me on LinkedIn, Facebook, Instagram, and Twitter, or email me at gagginol@gmail.com. To learn more about me visit https://www.pediatricmeltdown.com/ or reach out, DM me on IG, FB or LI and if you’d like to chat set up a discovery call to talk about your needs and challenges: https://calendly.com/gagginol/discovery-call

199. Therapeutic Techniques for OCD, Tics and Tourette's: Non-pharmacologic Treatment

Wed, 19 Jun 2024 09:00:00 +0000

Imagine a world where children with OCD and Tourette’s can manage their symptoms without relying solely on medications. In this episode of Pediatric Meltdown, we explore innovative interventions like Habit Reversal Training and ERP Therapy that offer new hope for young patients. Dr. Lia’s guest is a listener’s favorite, Dr. Colleen Cullinan. She has a gift for taking you inside the child’s mind and telling you exactly what they’re thinking. She’ll talk about the profound impact of intentional, compassionate care and the crucial role of family support in the treatment process. Tune in to discover effective strategies for tackling the emotional and psychological struggles these children face and how these methods pave the way for lasting improvements.

[03:13 -17:21] Understanding Isolation and Negative Reinforcement in Mental Health
Concept of breaking the cycle of negative reinforcement and the importance of compassionate interventions.
Connection between emotional regulation in various scenarios and therapies like cognitive behavioral therapy and acceptance and commitment therapy.
Discussion on how the brain’s problem-solving nature struggles with internal experiences, leading to anxiety.
Therapies offer solutions that counter the brain's intuitive problem-solving approach.

[17:22 - 29:42] Exposure and Response Prevention (ERP) for OCD
Emphasis on intentionally facing fears without engaging in compulsive behaviors.
Insights into how ERP can be rewarding for families affected by OCD.
Challenges and solutions in treating internal obsessions and related mental compulsions.
Significance of ERP in helping individuals understand their fears are not dangerous.

[29:43 - 41:52] Nonpharmacologic Therapies for OCD, Tics, and Tourette's
Overview of therapies like exposure and response prevention, habit reversal training, and comprehensive behavioral intervention for tics.
Discussion of the non-logical and visceral nature of these behaviors and breaking the cycle of negative reinforcement.
Strategies for managing compulsive skin picking, including competing responses and awareness.
Practice and gradual exposure to triggers as critical parts of treatment.

[41:53 - 55:12] Resources and Tools for Comprehensive Behavioral Intervention for Tics
Introduction to CBIT as a detailed treatment involving awareness building and breaking down tics.
Challenges in finding CBIT-trained therapists and resources to locate such providers.
Mention of the Tourette Association of America and the TLC Foundation for Body Focused Repetitive Behaviors.
University training programs in clinical psychology as potential access points for therapists trained in habit reversal training.

[55:13 - 59:58] Closing segment Takeaways

Links to resources mentioned on the show
International OCD Foundation: https://iocdf.org
Tourette’s Association of America: https://tourette.org
TLC Foundation for Body-Focused Repetitive Behaviors https://www.bfrb.org
AACAP Facts for Families OCD:

198. PANS and PANDAS (pt 2 of 2)

Wed, 12 Jun 2024 09:00:00 +0000

In this second part of a 2-part series from last week’s show, host Dr. Lia talks with Dr. Erica Greenberg about some of the surprising research looking at the association between autoimmune and inflammatory conditions and higher rates of OCD. Dr. Greenberg discusses the neuroscience around OCD from genetic to environmental factors, and the puzzling overlap of symptoms in disorders like Tourette's and OCD. She stresses the crucial need for interdisciplinary research to shed further light on these intricate associations.
You’ll get insights into why certain treatments are recommended with caution and why controversy still remains around PANDAS and the desperate need for collaboration and comprehensive research to truly understand these complex conditions. You’ll also hear about the role of stress-induced inflammatory responses and how they render some individuals more susceptible to immune-related dysfunctions, shedding light on the significant impact of environmental factors like lead exposure on basal ganglia circuitry. Dr. Lia’s conversation with Dr. Greenberg reveals the interconnected nature of disorders such as OCD, Tourette syndrome, and other neuropsychiatric ailments, underscoring the necessity for further research.
Conversations like these illuminate the path forward, emphasizing that the key to understanding and treating these conditions lies in collaborative research efforts across various disciplines.

[01:46 -12:40] Understanding PANDAS and PANS Origins and Symptoms
PANDAS is specifically linked to post-infectious streptococcal etiology.
PANDAS involves the sudden onset of tics and/or OCD.
PANS shares a similar characteristic of sudden, rapid onset of a complex of symptoms.
Importance of understanding the specific triggers and symptoms associated with both PANDAS and PANS.

[12:41 - 23:32] Understanding the Clinical Outcomes of PANS/PANDAS Treatment
Sudden onset of symptoms such as tics, OCD, and separation anxiety is notable in these conditions.
Some children experience complete recovery back to baseline after antibiotic treatment within a week.
There is ongoing research into the different potential clinical courses following a PANS/PANDAS diagnosis.
Emphasis on the importance of recognizing and understanding the diverse range of clinical outcomes.

[23:33 - 35:37] Genetic and Environmental Influences on OCD and Tourette Syndrome
Studies show significant associations between OCD, Tourette syndrome, and increased rates of throat infections.
Research indicates higher odds ratios of developing OCD and Tourette in youth with infection histories.
A dose-response relationship exists between strep infections and OCD/Tourette symptom severity.
Studies find higher rates of autoimmune disorders in individuals with OCD and Tourette and their family members.

[35:38 - 48:00] Key Information and Challenges Surrounding PANS and PANDAS
Need for more thoughtful, nuanced, safe, appropriate information for parents.
There's evidence that PANS and PANDAS have a more negative impact on families compared to typical OCD
OCD and Tourette syndrome develop slowly, while PANS and PANDAS show abrupt changes.
Families face significant trauma, especially when providers dismiss their concerns.

[48:01 - 55:17] Closing segment Takeaways

Links to resources mentioned on the show
Erica Greenberg, MD PANDA AND PANS Presentation Swipe Files

197. Tics, Tourette’s and OCD

Wed, 05 Jun 2024 09:00:00 +0000

How do mental compulsions, such as intrusive sexual thoughts and reassurance-seeking behaviors, manifest in children with OCD?
What are some common co-occurring conditions with OCD in children, and how do they complicate diagnosis and treatment?
These questions are answered in this week's episode of Pediatric Meltdown, where Lia sits down with child psychiatry expert Dr. Erica Greenberg to unravel the complexities of obsessive-compulsive disorder (OCD) in children. Dr. Greenberg shares her journey into child psychiatry and sheds light on the diagnostic criteria for OCD, the common and individual themes that kids with this condition struggle with, and the impact OCD has on their lives. Erica explains the common categories like contamination and intrusive thoughts and dispels myths regarding the treatment and prognosis of pediatric OCD. By discussing various treatment strategies, from exposure response prevention therapy to medication options, this episode underscores the importance of comprehensive care. For parents and caregivers, recognizing the early signs and seeking appropriate treatment can make all the difference in a child's developmental journey. Curious about an unconventional strategy that’s making waves in OCD treatment? This episode is the ultimate guide!
     [03:22 -18:14] OCD Symptoms in Children: Key Diagnostic Criteria and Common Presentations
To diagnose OCD, a child must have obsessions and/or compulsions, which are often both present.
Obsessions are unwanted, repetitive, intrusive ideas, thoughts, images, or urges that cause significant distress.
Compulsions are behaviors, either mental or physical, performed to get rid of the distress caused by obsessions.
Examples of mental compulsions include body checking and repetitive counting to alleviate intrusive thoughts.

[18:15 - 28:13] Impact of OCD on Daily Life and Family Dynamics
OCD can consume significant time daily, impacting children’s social and developmental trajectories.
Children may miss social cues or avoid activities due to obsessions, leading to social withdrawal and alienation.
Constant reassurance seeking from peers can alienate children, exacerbating their fears of social rejection.
OCD affects families, often leading to strained relationships and the need for family involvement in therapy.

[28:14 - 37:32] Medication Treatment for Pediatric OCD: Key Insights
SSRIs are the main medication used to treat OCD in children, with common choices including fluoxetine, sertraline, and escitalopram.
Studies show that most of the beneficial effects of SSRIs can be observed within the first 2 to 4 weeks of treatment.
Higher doses of SSRIs may be necessary for some children, but it's important to monitor for any side effects, especially activation symptoms in younger kids.
The combination of fluvoxamine and clomipramine may be beneficial, though fluvoxamine is not inherently superior to other SSRIs for OCD treatment.

[37:33 - 55:37] The Relationship Between Tourette Syndrome and OCD in Children
Tourette syndrome involves at least two motor tics and one vocal tic for a duration of at least a year, which can overlap significantly with OCD symptoms.
Tics are suggestible and can be simple (e.g., shoulder shrug) or complex (e.g., more deliberate movements or sounds), making them sometimes hard to distinguish from OCD compulsions.
Up to 85% of individuals with Tourette syndrome have a co-occurring condition, with OCD being a common comorbidity.
The presence of tics often signals the need to monitor for other conditions such as ADHD, anxiety, mood dysregulation, and sensory...

196. Sleep Struggles in Kids: Managing Insomnia

Wed, 29 May 2024 09:00:00 +0000

How can primary care providers and pediatricians play a role in educating families and children about the importance of sleep and identifying sleep issues early on?
Join Dr. Lia and her guest, Sleep expert, Dr. Jess Shatkin have the answers to that question and many more! This episode delves into various aspects of pediatric sleep health, from exploring pediatric sleep medications to offering practical tips on establishing solid sleep hygiene for kids. Understanding the intricate relationship between children's sleep disorders and their mental health is crucial for providing comprehensive care to children and adolescents. Dr. Jess's insights into the effectiveness of Cognitive Behavioral Therapy for Insomnia (CBTI) highlight effective treatment strategies that emphasize long-term well-being over quick fixes. By incorporating sleep education, implementing evidence-based approaches like CBTI, and advocating for holistic health practices, we can pave the way for a brighter, more well-rested future for our youth. Join us in unraveling the mysteries of pediatric sleep problems and mental health, and discover the transformative power of a good night's rest!
[03:13 -13:50] Understanding Pediatric Insomnia and Its Prevalence
Insomnia is identified as the most common pediatric sleep problem.
Highlighted the essential nature of sleep for both kids and adults.
Emphasis on the importance of routine for improving sleep in children.
Discussion emphasizes the various factors impacting sleep quality and quantity.

[13:51 - 29:50] Pediatric Sleep Hygiene and Its Limitations
Sleep hygiene is frequently discussed as an essential component of managing sleep problems.
The data supporting the effectiveness of sleep hygiene on its own is not promising.
Integrating sleep hygiene with CBTI can lead to better outcomes for children.
It’s crucial to combine different strategies to effectively manage pediatric sleep problems.

[29:51 - 38:21] Finding a Therapist for Cognitive Behavioral Therapy for Insomnia (CBTI)
It can be challenging to find professionals specializing in CBTI.
Resources for locating CBTI therapists may be limited.
Workshops on CBTI are conducted at annual conventions.
Preparing through sleep education is crucial for effective CBTI..

[38:22 - 58:42] Addressing Sleep Problems in Children with Psychiatric Disorders
Children often present with sleep issues when treated for other conditions like ADHD or depression.
Sleep problems are common among these pediatric patients, even if not the primary reason for consultation.
Many children are already deeply entrenched in sleep medication routines before they receive specialized care.
CBTI techniques in treatment routines for children suffering from psychiatric disorders is suggested.

[58:43 - 1:08:20] Closing segment Takeaways

Links to resources mentioned on the show
His website:Dr. Jess P. Shatkin - Home (drjesspshatkin.com)
Host of About Our Kids on Doctor Radio SiriusXM 110

FB: Facebook
X (Twitter) @‌DrJessPShatkin ...

195. Birthday Reflections: Parenting Adult Children and Lessons in Letting Go

Wed, 22 May 2024 09:00:00 +0000

Summary:
In this special episode of Pediatric Meltdown where Dr. Lia shares personal insights and heartfelt reflections on the journey of parenting adult children and stepping into the joyous role of a grandparent. As Lia celebrates her birthday, she takes a moment to delve into the complexities and rewards of these intergenerational family relationships. Grandparenting tips are sprinkled throughout the episode, offering valuable advice to listeners who are navigating similar life stages. She emphasizes the importance of balancing advice and support for adult children, noting how her preferred approach is to offer help only when asked. Lia draws from one of her favorite books, "Walking on Eggshells, Parenting Your Adult Child," which underscores the wisdom of refraining from unsolicited advice and simply being present when needed.
This approach, she finds, is essential to maintaining healthy and respectful relationships with adult children. She candidly admits to having been a helicopter parent at times, but stresses that letting children face challenges and failures is crucial for their growth and independence. Lia's reflections eloquently capture the essence of parenting adult children by acknowledging that each generation might do things differently but with the same core love and intent. In essence, her stories remind listeners that letting go is part of the process, and it is often the hardest, yet most rewarding part of parenting adult children.
Her reflections serve as a gentle reminder of the importance of savoring these precious intergenerational family relationships and the joy they bring, a fitting contemplation as she marks another year of her life's journey.
Bullet points of key topics
Reflections on Parenting and Grandparenting and the Impact on Mental Health
Parenting Adult Children and advice from her favorite book.
Respecting children’s different parenting methods.

Calls to action:
Click Here for your BBW Workbook
Click here for your Freebie #1
Click here for your Freebie #2
Book a Discovery Call Here

194. MC3's Clinical Pearls: Education for Managing Pediatric Mental Issues

Wed, 15 May 2024 09:00:00 +0000

Are you a pediatric care provider feeling overwhelmed by complex mental health cases? Discover a solution that’s transforming pediatric care in Michigan and beyond! In the latest episode of Pediatric Meltdown, Alyssa Wealty and Dr. Nasuh Malas teach us about the MC3 program (Michigan Child Collaborative Care) and how it’s making waves by providing tools like the Clinical Pearls educational series, that’s proving to be a lifeline for primary care providers who are grappling with mental health issues in young patients. From leveraging expert consultations to utilizing targeted educational resources, and handling cases of anxiety, aggression, or substance use, this episode is a gold mine for those on the front lines of pediatric health care. At the center of MC3’s offerings is the power of connection and education. Like addressing urgent mental health needs in pediatric settings or providing accessible educational tools like the Clinical Pearls video series. No matter where you are in your healthcare journey, the MC3 resources offer concise, expert-driven advice that can dramatically improve your care strategies. Interested in enhancing your clinical skills with quick, impactful lessons? Get your pen and paper ready. This episode is packed with information.
PRO Tip: These resources aren't limited to healthcare professionals; parents and educators can gain insights too!

[03:47 -09:04] Integrating Mental Health Education in Primary Care
Designed to deliver concise insights on common pediatric mental health conditions for primary care providers.
The program's educational component underscores the importance of mental health knowledge in primary care.
Enhances primary care providers' ability to diagnose and manage pediatric mental health.
Program grows to support schools and perinatal care providers for integrated mental health.

[09:05- 21:28] Clinical Pearls Series - A Resource for Pediatric Mental Health Education
"Clinical Pearls" features key learning videos on fundamental mental health topics.
The series includes a resource list and self-assessment for provider education.
It enriches learning with extra materials alongside the main videos.
The series is accessible globally, benefiting clinicians in Michigan and worldwide.

[19:18 -29:30] Advancing Primary Care through Educational Support and Teleconsultation
Primary care providers get guidance on conducting thorough evaluations with fellow mental health professionals.
Feedback from participants in the MC3 program informs the creation of practice-enhancing content.
Merging mental health and primary care responds to the need for increased support in managing pediatric cases.
The MC3 teleconsultation service outreach includes critical care points,like emergency rooms and schools.

[29:31 - 33:11] Closing segment Takeaway

Links to resources mentioned on the show
MC3: https://mc3michigan.org
MC3 Clinical Pearls: https://mc3michigan.org/clinical-pearls-video-series/

Other episodes you may like:
For all episodes, go to Episodes - Pediatric Meltdown
Ep #139 School Based Health: Literally Meeting Kids Where They Are!
Ep #128 Trauma and Resilience: “Connect Before You...

193. Understanding Challenging Kids: The Behavior Code

Wed, 08 May 2024 09:00:00 +0000

Tune into this week’s episode where we sit down with the Dr. Nancy Rappaport, who shares her groundbreaking approach to comprehending and managing children’s behaviors, including anxiety-related and oppositional tendencies as well as the theory of why stepping back as a parent and allowing your children to encounter and navigate challenges by themselves is crucial for their development. Dr. Rappaport provides an in-depth look at how structured environments and small rituals can significantly improve how children cope with everyday stresses and transitions. From addressing the influences of trauma to understanding normal age-appropriate curiosity, Dr. Rappaport provides a balanced perspective on navigating sensitive topics. She emphasizes the necessity of not misinterpreting behavioral cues, as they can vary significantly depending on a child’s personal experiences and challenges. Are you ready to learn how to respond playfully and effectively to children’s complicated behaviors? Tune in to gain unique strategies that could not only revolutionize your approach to parenting but alter how you perceive and interact with childhood behaviors forever!

[03:13 -19:31] Understanding and Managing Anxiety-Related Behaviors in Children
Discussion on how unstructured times, transitions, social demands, and unexpected changes can trigger anxiety-related behaviors in children.
Emphasis on the importance of creating structured environments during typically unstructured times to provide stability for anxious children.
Introduction of tools like emotional thermometers and comfort boxes to help children manage their anxiety.
Strategies for preparing anxious children for impending changes to reduce stress and behavioral issues.

[19:31 - 32:18] Addressing Oppositional Behaviors in Children
Exploration of the antecedents to oppositional behaviors, including environmental triggers and emotional distress.
The use of encouragement cards, affirmations, and undirected play to positively influence children's behaviors.
Importance of understanding the meaning behind behavior as a form of communication rather than simply reacting to the behavior itself.
Psychological insights revealing that a third of children who completed suicide had shown oppositional behaviors.

[32:19 - 46:04] Strategies for Building Rapport with Withdrawn Children
Not making assumptions about withdrawn behaviors, as these can vary drastically between children.
Insights into how parents' personal characteristics can influence their perception of a child's withdrawn behavior.
Methods for engaging withdrawn children in communication and activities at a pace comfortable for the child.
Highlighting the reasons behind withdrawn behavior, including possible underlying health issues or past traumas.

[46:05 - 50:06] Effective Use and Concerns of Medications in Managing Child Behavior
The use of stimulant medication and its effects on participation in regular classroom activities and field trips.
Overprescription of antipsychotic medications for behavior management and the ensuing need for skill-building and robust support systems.
Contrast between the child psychiatrists and pediatricians to behavior management and the synergies of their collaboration.
The value of pediatricians in the ongoing health and wellness journey of children, especially aligned with psychiatric insights.

[50:07 - 57:37] Closing segment Takeaways

Links to resources mentioned on the show
Her website:

192. Explosive Outbursts in Kids: Guide to Diagnosis and Treatment

Wed, 01 May 2024 12:00:00 +0000

In this episode of Pediatric Meltdown, we dive into the complexities of disruptive mood dysregulation disorder (DMDD) and how the DSM-5's new classification aims to solve the puzzle of childhood bipolar misdiagnosis by distinguishing DMDD from other behavioral disorders like conduct disorder and oppositional defiant disorder. Join host Dr. Lia Gaggino and child psychiatry expert Dr. Gabrielle Carlson as they explore the intricate challenges of diagnosing and treating irritability and outbursts in children. This episode is essential for anyone struggling to understand or manage aggressive behavior in children, providing a roadmap to better interventions and outcomes. You’ll find that today’s discussion with Dr. Gabrielle will bring some much-needed clarity to the often-misunderstood world of Conduct Disorder.

[03:21-05:54] Understanding Disruptive Mood Dysregulation Disorder (DMDD)
Concerns of overdiagnosis of bipolar disorder in children as per changes in DSM-5.
Discusses the need for a "diagnostic home" for children exhibiting chronic irritability and frequent outbursts.
Differentiates DMDD from bipolar disorder, highlighting less episodic mood change and more persistent irritability.
Discusses using medical and psychiatric collaborative approaches for accurate diagnosis.

[05:55 - 18:49] Diagnostic Challenges in Pediatric Psychiatry
Explores the complexity of diagnosing behavioral disorders in children, stressing the influence of parental worries.
Differences between conduct disorder and oppositional defiant disorder in the context of purposeful aggression and core outbursts.
Highlights how the underestimation of trauma impacts behavioral assessments.
descriptive codes to assist in more accurate diagnosing, particularly in children with overlapping symptoms.

[18:50 - 33:15] The Role of Environmental Factors and Parental Involvement
Discussion on the triggers and antecedents in aggressive behavior management in pediatric patients.
Examines the impact of environmental factors, especially in relation to ADHD and pediatric bipolar disorder.
Highlights parental involvement as crucial in the management and treatment of behavioral issues.
The challenges of finding effective medication for aggression treating irritability specifically in relation to autism.

[33:16 - 4613] Resources and Treatment Approaches in Child Psychiatry
Details on Gabrielle's routine evaluation process including her developed rating scale ‘emo eye’.
The utility of the ACAP (American Academy of Child and Adolescent Psychiatry) Resource Center resources for clinicians and families. [ACAP Resource Center](https://www.aacap.org)
Talks about the necessity of evidence-backed treatment options and FDA approvals for therapy tools.
Covers the importance of educating parents using resources such as medication guides available through ACAP.

[46:14 - 55:23] Closing segment Takeaway

Links to resources mentioned on the show
AACAP Outbursts, Irriitability, and Emotional Dysregulation Resource Center:
https://www.aacap.org/AACAP/Families_Youth/Resource_Centers/AACAP/Families_and_Youth/Resource_Centers/Emotional_Dysregulation/Home.aspx

AACAP Parent’s Medication Guide:

191. Prescribing Psychotropic Medications: The Role of Primary Care

Wed, 24 Apr 2024 09:00:00 +0000

Are you navigating the complex world of psychiatric medication management in primary care? Look no further! In this episode of Pediatric Meltdown Dr. Lia talks frankly about the hesitancy of pediatric clinicians to prescribe psychotropic medications as one of the biggest barriers to providing mental health care in pediatric settings.  While she acknowledges that pediatricians are not child psychiatrists, Dr. Lia believes that pediatricians have the skills to address common mental health disorders including ADHD, anxiety and depression, and to do it well.  She emphasizes the need to be mindful of suicide risk and to screen regularly for suicidal ideation, especially in patients with mental health disorders.  And, always consider trauma when assessing for mental health and behavior concerns.  When it comes to prescribing medications, get comfortable with a few SSRI’s and both stimulant and non-stimulant ADHD treatments, and before switching from one psychotropic to another, she advises maximizing dosing titration while simultaneously monitoring for side effects.  Remember that in your role as a primary care provider, you have an incredible opportunity to impact the stability and quality of life for children facing mental health struggles.  For more tips, expert advice and in-depth knowledge, don't hesitate to explore all of the resources available at pediatricmeltdown.com. Know better, do better!

[01:26 -03:50] Understanding the Role of Medication
Primary care providers don't need to be psychiatrists but should be equipped to prescribe SSRIs.
Familiarize yourself with a few SSRIs such as fluoxetine, escitalopram, and sertraline and understand their characteristics.
It’s vital to maximize doses carefully before switching between medications and to be aware of side effects.

[03:51 - 06:18] Navigating ADHD Medication Challenges
Not all cases of ADHD are straightforward; comorbid conditions can complicate diagnosis and treatment.
Stimulant medications can quickly indicate effectiveness; doses should be carefully adjusted based on response.
Monitoring for side effects such as appetite loss, weight changes, and sleep disturbances is necessary.

[06:19 - 10:44] Managing Complex Cases and Atypicals
Always explore the possibility of trauma influencing behavioral symptoms, as it can mimic various conditions.
Exercise caution when inheriting a patient on multiple medications; consult specialists rather than abruptly stopping treatment.
Monitor physical health markers when prescribing Atypicals like hemoglobin A1C, lipids, and prolactin levels, considering adjunctive treatments like Metformin.

Links to resources mentioned on the show

Episode #44 with Dr. Jeffrey Strawn. Anxiety Disorders in Children: Treatment Options https://pediatricmeltdown.com/44-anxiety-disorders-in-children-treatment-pearls/

Episode #37 with Dr. Lisa Horowitz. Screening For Suicide Risk Using the Ask Suicide Screening Questions Tool
https://pediatricmeltdown.com/37-screening-youth-for-suicide-risk-using-the-ask-suicide-screening-questions-tool/

Episode #132 with Dr. Brooks Keeshin. Psychopharmacology: Considerations Before Prescribing

190. Recognizing Burnout in Healthcare: Strategies for Self-Care

Wed, 17 Apr 2024 09:00:00 +0000

Hey, Healthcare Heroes, are you neglecting this critical aspect of your life?" In this episode of Pediatric Meltdown, host Dr. Lia Gaggino, teams up with the renowned psychologist Dr. Karen Doll to discuss the mental health strategies essential for every healthcare worker. This conversation is a game-changer as they talk about the systemic neglect that is pushing healthcare professionals to the brink, and the institutional changes urgently needed to address this perilous oversight. The impact of psychological fitness on both our personal and professional lives can no longer be an afterthought. Empowering medical professionals to not just survive, but thrive, is a cause we are passionate about here at Pediatric Meltdown. As we navigate the complex world of pediatric care, it's essential to remember that taking small steps towards improving our mental health can lead to significant changes in how we thrive at work. Are you ready to take those crucial steps to transform your daily routine into a journey to mental resilience with transformative effects on your professional and personal life? Don't leave your well-being to chance—discover the simple yet powerful techniques that can lead you to thrive.

[02:33 -16:05] Understanding the Mental Health Continuum
The significance of shifting from surviving to flourishing in the healthcare industry is stressed.
Psychological fitness and well-being are recognized as essential for personal and professional success.
navigating patient mental health concerns within the constraints of a busy healthcare practice.
the lack of slack in the healthcare system, putting additional pressure on practitioners.

[16:06 - 24:45] Strategies for Promoting Well-Being in the Healthcare Industry
Implementing strategies to manage work-related stress to prevent burnout.
Enhancing mental health and resilience through psychological fitness.
The importance of institutional changes and individual practices for healthier work environments.
Balancing life for healthcare professionals by managing energy and encouraging flexible work schedules.

[24:46 - 33:51] Combating Healthcare Burnout
Caregivers need to evaluate their own mental health to determine the most effective resilience-building strategies
AI tools must reduce administrative work and boost job satisfaction to better patient outcomes
Emphasizing the importance of feeling valued and having an impact on patients' lives.
Positive effects of cultivating calm and stability through mindfulness, meditation, and exercise are discussed.

[33:52 - 42:57] Empowering Healthcare Professionals
Fostering a sense of community and purpose as key to longevity and well-being
Flexibility Is crucial for future workspaces; organizations risk losing talent if they don't adapt.
Science-based mental exercises for enhancing mental health beyond standard wellness strategies are explored.
Healthcare professionals can promote agency by seeking collective support and managing energy and focus.

[42:58 - 49:16] Closing segment Takeaway

You can contact Karen
Instagram: @‌buildpsychologicalfitness
LinkedIn: https://www.linkedin.com/in/karendecesaredoll/

Links to resources mentioned on the show
Karen Doll Licensed...

189. Fetal Alcohol Spectrum Disorders: Recognition Matters

Wed, 10 Apr 2024 09:00:00 +0000

Are you unwittingly overlooking a silent epidemic affecting newborns right under your nose? This game-changing episode of Pediatric Meltdown will redefine everything you thought you knew about molding young minds. We delve deep into the world of FASD (Fetal Alcohol Spectrum Disorders) and the critical need for timely screening at newborn visits. Hosted by Dr. Lia Gaggino, we dive into the transformative world of the oft-missed signs of fetal alcohol spectrum disorders and the life-altering implications they hold. Uncover the resources every parent and pediatrician should have at their fingertips, the surprising truth about the plasticity of the brain, and the lifeline that support groups offer to families navigating this challenging journey. It’s clear that understanding and addressing ND PAE requires ongoing effort and awareness. The valuable insights shared in this episode are bolstered by the wealth of resources and guidance provided by organizations such as the American Academy of Pediatrics (AAP). Through Pediatric Meltdown, we aim to bring this critical information to the forefront, equipping practitioners and families with the know-how to usher in positive change.
Tune in to hear how this episode promises to reveal a groundbreaking approach recommended by the AAP that could turn the tide in the ongoing battle against pediatric mental health challenges. Don't miss out – your next step in pediatric care innovation could be just one listen away!

[05:30-12:44] Understanding FASD and Its Impact
Definition and prevalence of FASD, including the sobering statistic that it affects 1 in 40 children.
Prenatal alcohol exposure significantly affects the brain, especially the hippocampus and amygdala, causing developmental challenges.
A look at the physical features associated with FAS, highlighting the preventability of this condition.
Recognizing FASD early is crucial for intervention and leveraging the brain's adaptability for better outcomes with help.

[12:45-22:14] Screening and Prevention Strategies
The necessity of nonjudgmental surveillance questions at newborn visits to screen for ND PAE.
discussing alcohol use with patients before and during pregnancy to avoid guilt and stigma affecting truthful disclosure.
The roles of obstetricians and pediatricians in fostering ongoing dialogues about the risks of alcohol consumption.
Prevention measures and education for adolescents and women of fertility age, aiming to mitigate the prevalence of FASD.

[22:15-34:09] Resources for Clinicians and Parents
Information on available resources from AAP, NOFAS, CDC, and NIMH for diagnosis and parental support.
Recommendations for referring to developmental behavioral pediatricians or child psychiatry access programs.
The utility of early intervention services for children with suspected ND PAE.
Advocation for parent support groups as a means of providing guidance and comfort

[34:10 - 50:48] Medications and Interventions
Discussion on medications used for FASD, with particular emphasis on ADHD and mood-stabilizing medications.
The debated effectiveness of non-stimulant medications like alpha agonists for children with ND PAE.
Tips on prescribing medications appropriately, with support from programs like ECHO.
Insights into the specific challenges faced by children with FASD, including attention to detail issues and difficulty with self-soothing.

[50:49 - 59:11] Closing segment Takeaway

Links to resources mentioned on the show
AAP Toolkit:

188. Teenage Pregnancy: Supporting Moms and Babies

Wed, 03 Apr 2024 09:00:00 +0000

Think teen pregnancy rates are an unsolvable crisis? Think again! In this episode you’ll hear about the plummeting teen pregnancy statistics with the insight of pediatric veteran Dr. Pat Flanagan. With rates dropping a staggering 70% since the '90s, we unravel the intricate web of education, contraception, and internet resources that made this decline possible. Host, Dr. Lia Gaggino and Dr. Pat Flanagan, dive deep into the transformative power of integrated behavioral health within pediatric practice. It's evident that when we support early relational care and address social determinants of health, we can make a significant positive impact on the youngest members of our society. By providing teen moms and parents with the necessary resources, from social workers to family specialists, we foster resilience and pave the way for a healthier next generation. Don't miss out on the heartening stories of change and progress. Brace yourself for an all-inclusive conversation on the strategies that are shaping a new generation of informed, empowered young individuals–This episode serves as a beacon of hope - prepare yourself to be spurred into action.
[07:58 -12:44] Pediatric Behavioral Health Integration Strategies
Importance of identifying and addressing challenges before they become diagnosable conditions.
Screen for depression, anxiety, substance use, and social-emotional issues in teens and children.
Prioritizing toddlers' and preschoolers' social-emotional development for improved outcomes.
Recognizing the significance of maternal depression and its impact on pediatric care.

[12:45 - 18:22] Learning from Young Mothers: Lessons in Resilience and Capacity
Describes the inspirational aspect of watching young parents overcome challenges.
Paints a picture of the young mothers' journey from uncertainty to empowerment through their children.
Talks about the ability of young mothers to persevere despite difficult circumstances.
Reflects on the capacity of these mothers to manage their responsibilities and find happiness.s introduced.

[18:23 - 27:52] Funding and Sustainability of Pediatric Behavioral Health Services
Mental health care in pediatric practices relies on a hybrid funding model.
Billable diagnosis like substance use and mental health issues only fund a fraction of services.
Pediatric practices face more billing limitations compared to adult settings.
Funding issues aside, integrated behavioral health is crucial for comprehensive pediatric care.sitive outcomes.

[27:53 - 37:32] Integrated Behavioral Health Strategies in Pediatric Care
Integrated behavioral health is crucial, with an emphasis on prevention and early intervention.
Funding for integrated care is a common struggle, underscoring the need for sustainable models.
Major hospitals can back social workers despite hurdles.
The AMA's series on integrated behavioral health is an informative tool.

[37:33 - 44:04] Closing segment Takeaway

Links to resources mentioned on the show
Care Transformation Collaborative – Rhode Island (CTC-RI) https://ctc-ri.org
DULCE – Developmental Understanding and Legal Collaboration for Everyone https://cssp.org/our-work/project/dulce/
AAP Mental Health Practice Tools and Resources:

187. New Challenges, New Directions: Designing Better Mental Health Systems

Wed, 27 Mar 2024 09:00:00 +0000

Step into a world of innovation and growth as we delve into a special episode of Pediatric Meltdown, featuring our host, Dr. Lia Gaggino. The seasoned primary care pediatrician takes the helm as she embarks on a new direction in her endeavors to enhance pediatric mental health care. In this solo episode, she shares insights and challenges listeners to join her in a transformative journey. She’ll ask you to embrace the call to action as she reveals her upcoming projects designed to revolutionize pediatric mental health care. Let this solo episode serve as a rallying cry for pediatric clinicians to rise to the challenges of children's mental health. From insightful discussions with experts to the exciting new limited series podcast and companion workbook, she's shaping the future of pediatric mental health care and empowering clinicians to take their practices to the next level. So, I ask you…. are you ready to level up your practice and be part of this transformative journey?

[00:01:24] Challenges in Pediatric Mental Health
Increasing demands on children's mental health
Impact of social determinants of health
Rise of complex emotional issues such as cutting
Effects of social media on children's mental health

[01:25 - 04:43] Professional Growth and Mastery
Importance of continuous learning and professional growth
Overcoming challenges in adolescent mental health
Evolution of mental health treatment approaches
Using integrated behavioral health for improved patient care

[04:44 - 10:23] New Projects Announcement
Introduction to the limited series podcast: "Pediatric Mental Health: Building Better Workflows"
Details about the companion workbook accompanying the podcast
Opportunity for a 1 on 1 deep dive consultation
Sign-up for a discovery call to discuss pain points and strategies

[10:24 - 12:41] Closing Remarks and Podcast Information
Contact information for feedback and ideas for future podcasts
Website and social media links to stay connected
Gratitude for listeners and encouragement to share the episode
Special thanks to podcast contributors

Links to resources mentioned on the show
Lia’s Website:
https://www.PediatricMeltdown.com

Other episodes you may like:
https://pediatricmeltdown.com/episodes
180. Social Media and Kids: The Big Picture
176. ACES and the Power of Positive Relationships
172. Burnout Prevention: A 15-Minute Game Changer

Key quotes for Twitter:
"My first presentation was called mad, bad, and sad girls, and I should have thrown in glad because so many girls are happy too."... Dr. Lia Gaggino on challenges in adolescent mental health
"And for those of us who have been doing this work for a long time, mental health has always been an issue. But it seems like now more than ever, the kids and their families need us." … Dr. Lia Gaggino on mental health crisis in youth

THANK YOU FOR YOUR SUPPORT!
Pediatric Meltdown was listed as a Top 20 Pediatric Podcast on FeedSpot.
If you’d like to connect with me, you can Tap the “What Are Your Thoughts” button at the top of the notes or you can find me on

186. Immigrant Children and Families: Health Policy and Advocacy

Wed, 20 Mar 2024 09:00:00 +0000

Think health inequity doesn't affect you? Think again! This week's Pediatric Meltdown podcast tackles a topic that's more relevant than ever in today's diverse society. Host Dr. Lia Gaggino is joined by Dr. Julie Linton, a champion of health equity and a leading voice on child immigrant welfare. together, they will unravel the complex web of health care challenges for children of immigrant families. It's clear that Dr. Linton’s compassion and education are key in addressing the challenges faced by children in immigrant families. Her expertise underscores the importance of understanding the various aspects of immigration, from DACA to Temporary Protected Status, and how these legal designations impact access to healthcare. Tackling everything from the intricacies of asylum to the vital role of Federally Qualified Health Centers, we're reminded that every child deserves the opportunity to thrive, regardless of their background. Above all, the episode drives home the need for building workflows that support our diverse pediatric population with empathy and respect. Are you ready to become an advocate for change?
Don’t miss out on the opportunity to learn more by subscribing to the "Pediatric Mental Health Building Better Workflows Podcast" – because your next step in making a difference is just one listen away.
  [06:25 -13:54] Systems and Advocacy for Young Newcomers
Highlights the wide-ranging complexities of immigration across the U.S., not just southern border issues.
Underlines the importance of robust data for grasping immigrant children demographics and needs.
Recommends utilizing the Casey Foundation's Kids Count data center for local immigrant family insights.
Accentuates the imperative of compassionate healthcare and the duty of providers to aid and champion immigrant families.

[13:55 -23:29] Food Assistance and Support Programs
Emphasizing the need to address basic necessities such as food for well-being.
Considering the direct link between health and access to adequate nutrition.
State-specific resources and support systems designed to assist in food provision.
Acknowledging the unequal availability of resources and the value of local insights for securing food aid.

[23:30 - 29:40] Legal Challenges in Mixed-Status Families
Eligibility for food aid programs can vary widely based on a family's immigration status.
The array of immigrant statuses affects the types of assistance open to children and families.
In areas with different funding, medical-legal partnerships are pivotal in providing necessary legal aid at no cost.
Legal aid limitations signify systemic hurdles impacting children's health rights.

[29:41 - 45:25] Healthcare Access for Immigrant Children
Highlights the barriers immigrant families face in accessing healthcare and insurance coverage.
Emphasizes the critical need for compassionate care specifically catered to the needs of immigrant families.
Outlines resources available to assist uninsured and mixed-status families in obtaining healthcare services.
Addresses the vital role of healthcare practitioners in advocating for policies that support the health of immigrant children.

[45:26 - 53:58] Closing segment Takeaway

Links to resources mentioned on the show

AAP Policy Statement, Providing Care for Children in Immigrant Families:

185. Cultural Competency: Health Equity and Outcomes

Wed, 13 Mar 2024 09:00:00 +0000

Think you know the secrets to pediatric mental health care? Well, this week’s episode will make you think again! Your host, Dr. Lia Gaggino, will dive deep into the nuanced world of cultural sensitivity in pediatric healthcare with the inspiring psychiatrist, Dr. Farah Abbasi. As an advocate for minorities and newcomers, Dr. Abbasi unpacks the layers of health disparities and speaks to the heart of cultural competency. Learn how to navigate the complex tapestry of identities you encounter in your practice and why understanding each child's background is crucial for effective treatment. By revealing her journey as an immigrant healthcare professional, and the challenges that come with assimilating into American culture, Dr. Abbasi highlights the significant need for a more inclusive and culturally nuanced approach to patient care. As we prepare for the launch of a new limited series podcast focused on revolutionizing mental health delivery, this dialogue with Dr. Abbasi is like obtaining a key to unlock the potential of culturally responsive care that honors the diversity of the young souls we serve. Get ready to unravel the secrets to cultivating a truly inclusive healthcare environment – your blueprint to becoming the healthcare provider of the future is just one click away!

[00:33 -10:54] Understanding Cultural Competence in Pediatric Mental Health Care
Respect and responsiveness to the whole person are highlighted as central to the concept of cultural competence.
A major challenge is how healthcare providers can develop cultural competence in their practice.
Cultural competence is more than just an understanding; it's about respecting and responding to every aspect of a patient’s identity.
There is a need for healthcare workers to recognize and address health disparities that stem from a lack of cultural competence.

[10:55 - 18:42] Cultural Humility in Pediatric Mental Health Care
Acknowledging that parenting beliefs and values can differ significantly, even within the same country.
The importance of understanding that cultural norms may vary widely among families.
Cultural humility involves checking one's biases and preconceptions at the door.
Recognizing that not every family seeks the traditional 'American Dream' and may have different aspirations.

[18:43 - 25:07] Enhancing Healthcare Inclusivity for Diverse Patient Backgrounds
It’s important that healthcare professionals approach each patient with an open mind and a respectful attitude towards the patient's entirety.
The effect of spirituality and faith on the healing and recovery process of patients.
Don’t assume a universal approach to parenting and healthcare that might not align with the cultural practices of all patients.
There are complexities and challenges faced by immigrants as they navigate a new healthcare system and the need for provider awareness.

[25:08 - 38:24] The Impact of Cultural Competence on Health Outcomes
Check your implicit bias and cultural blind spots in creating disparities in health outcomes.
Healthcare providers need to consider patients' complete cultural identity, including ethnic, religious, and immigration status.
Practical advice on how respect for cultural practices, like dietary preferences and religious beliefs, can improve patient experiences.
There is a need for connection and recognition of diverse cultural beliefs within healthcare, especially highlighted by global challenges such as pandemics.

[38:25 - 43:27] Closing segment Takeaway

Other episodes you may like:

184. Reach Out and Read: Building Positive Childhood Experiences

Wed, 06 Mar 2024 09:00:00 +0000

Are Your Kids Being Left Behind in the Literacy Race? Find Out How Equitable Access to Reading Can Change the Game! Every child deserves a fair start in life, but the stark reality is that not every youngster is on an even playing field when it comes to early literacy. In this week's episode of Pediatric Meltdown, we dive into the revolutionary work of Reach Out and Read, a program determined to break down barriers and bring equitable access to reading materials to children across the nation. It's clear that the mission of Reach Out and Read reaches far beyond the pages of the books they distribute. Their dedication to fostering early literacy development and relational health within communities—especially those that are under-resourced and underserved—speaks volumes about their commitment to societal change. Lia’s discussion with Marty has highlighted the integrative approach of the program, merging healthcare visits with moments that fortify the bonds between parents and children. It is a poignant reminder that access to books is not a luxury, but a fundamental right that nurtures the mind and the heart. In a world where disparities define the future of so many young lives, Reach Out and Read serves as a beacon of hope, guiding families towards a horizon where every child's potential can be reached. Let's stand with them, as they turn the page on illiteracy and inequity, ensuring that no child is left behind in the vital narrative of their own education.
[03:20 -07:38]Reach Out and Read's Mission and Expansion
Aims to provide equitable access to children's books, focusing on underserved communities
Goal to reach 50% of all children under 5 in the United States by 2030
Over 8 million books distributed, reflecting the diversity of served communities
Special efforts for non-English speaking and rural areas to access healthcare and educational materials.

[07:39 - 19:51] The Role of Healthcare Providers in Early Literacy
Approximately 35,000 trained clinicians including pediatricians, family doctors, and nurse practitioners
Clinicians aid in bonding and developmental processes through well child visits.
Marty underscores the organic growth due to passionate healthcare providers
Training and opportunities for involvement available via the website and state affiliates.

[19:52 -31:23] Overcoming Challenges in Children's Literacy and Development
Emphasis on meeting specific community needs with a multi-pronged approach.
Discusses book banning and the necessity for diverse books appropriate for age 5 and under.
Use of TikTok series by pediatricians to provide educational materials in various languages.
Evidence indicating a positive effect on early brain development and preparing for school.

[31:24 - 42:09] Positive Impact and Future Goals of Reach Out and Read
Focus on building meaningful parent-child moments and strengthening relationships
Potential research partnership with Columbia University's School of Pediatrics
Program adjusts to support relational health and positive childhood experiences
Addresses health equity and contributes to lifting children out of poverty by empowering parents

[42:10 - 47:44] Closing segment Takeaway

You can reach Marty Martinez
Facebook: @reachoutandread
X (formerly Twitter): @reachoutandread
LinkedIn:

183. Healthy Social Media Use: A Doctor's Perspective!

Wed, 28 Feb 2024 09:00:00 +0000

Are you worried about your kids' social media use? In this episode of Pediatric Meltdown, Dr. Lia Gaggino weighs in with her insights, thoughts and suggestions. From tackling the prevalence of smartphones among teens to navigating the digital world as a non-digital native, she presents practical strategies for parents and pediatric professionals. By being curious, nonjudgmental, and seeking to understand our children’s digital experiences, we can build trust and open lines of communication. Together, let's work towards creating a safer digital environment for the kids. Take a listen for more insightful content, and let's empower each other to make a positive difference in the digital world!

[01:34 -04:15] Navigating the Digital Landscape: Children's Online Behavior and Risks
Emphasizes the need for adults to understand and engage with what kids are doing online.
Explores the potential risks of social media use, including mental health implications.
Advocates for awareness and strategies to address sensitive topics like sexting.

[04:16 - 07:01] Literacy and Responsible Behavior: Educating the Youth
Suggesting that kids show the cool and positive aspects of their digital life to adults to bridge understanding.
Discussing the impact of social media on the mental well-being of children as a public health concern.
Promoting the idea that parents and caregivers should be role models for responsible digital behavior.

[07:02 - 09:57] Social Media Education and Resources for Family Safety
Social media can support educational and collaborative learning activities for children.
Online educational materials offer valuable, easily accessible information tools.
Resources are available to help families support children with ADHD through educational content.

[09:58 - 12:59] Navigating Digital Parenting Challenges
Recognize the necessity for parents to engage with their kids about their online activities.
Highlight the risk of normalizing mindless scrolling and unnecessary screen time.
Stress the significance of setting a good example by avoiding phones during family interactions

You can reach Dr. Gaggino
Facebook: Facebook
Instagram: @pediatricmeltdown
Website: PediatricMeltdown.com

Other episodes you may like:
https://pediatricmeltdown.com/episodes
Ep 182. Social Media Dangers: Protecting and Educating Youth
Ep 181. Social Media: Guidance for Youth and Families

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MC3 Clinical Pearls Video Series
https://mc3michigan.org/clinical-pearls-video-series/

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182. Social Media Dangers: Protecting and Educating Youth

Wed, 21 Feb 2024 09:00:00 +0000

Do you know what lurks behind every click and scroll in your child's digital playground?? Join host, Dr. Lia Gaggino and guest expert Dr. Ashvin Sood as they expose the alarming rise of cyberbullying among children. Where a simple 'like' can shape a child's self-worth, and a 'share' might lead to a spiral of anxiety. They’ll talk about the fine line between connection and addiction in the age of snaps, tweets, and likes, and find out how you can help your child navigate this complex landscape. Listen in as they do a deep dive into the intersection of social media and youth mental health, it's clear that there is a delicate balance between connection and caution. The concept of an electronic contract represents a pivotal step in managing our teens' screen time and setting clear boundaries. By facilitating an open dialogue and setting mutually agreed upon parameters, both parent and child can navigate the digital landscape with a shared understanding of what is acceptable online behavior. Make sure to catch Dr. Ashvin’s top strategies for harm reduction that every parent needs to know – it could be the conversation that changes everything for you and your teen.
[00:33 -10:26] Social Media's Influence on Youth Mental Health
Discusses the pervasive nature of social media and its role in the formation of adolescent identity.
Features the developmental and psychological needs shaping youth identity within online platforms.
Highlights possible mental health risks for children and teens from more online presence.
Notes how social media shapes young individuals' self-identity through creative outlets.

[10:27 - 19:04] Strategies for Safe Social Media Usage
Addressing delicate issues calls for tact to maintain open communication with youth.
The dialogue about harm reduction should focus on safety and informed decision-making rather than abstinence.
Creating a space where teenagers can talk openly about their experiences and questions regarding sex is crucial.
These talks prepare teens to responsibly handle risks linked to sexual behavior.

[19:05 - 28:55] Impact of Cyberbullying on Teen Mental Health
Discussed intense scenarios of cyberbullying leading to suicides among teenagers.
Analyzed a common form of cyberbullying: exclusion and group message targeting.
Considered the emotional toll on a teen waiting for peers' responses in a group chat.
Addressed the silent suffering and anticipation for social validation.

[28:56 - 40:34] Managing the landscape of Mental Health in the Digital Age
The child's online behaviors and the context of their chats were analyzed.
Specific concerns were picked out for discussion to address potential mental health issues.
The discussion offered strategies to lessen social media's harmful effects.
Specialized tools for assessing children's social media use in psychiatry were featured.

[40:35 - 46:19] Closing segment Takeaway

You can reach Dr. Ashvin Sood
akingControlz TikTok: https://www.tiktok.com/@takingcontrolz?is_from_webapp=1&sender_device=pc
PsychChild: https://www.psychchild.com/

Links to resources mentioned on the show
AACAP Screen Media Resource Center

181. Social Media: Guidance for Youth and Families

Wed, 14 Feb 2024 09:00:00 +0000

Are your kids glued to their screens? Discover the shocking effects of unlimited social media! Pediatric Meltdown is giving a wake-up call to parents navigating the treacherous waters of their children's online presence. This is the second installment of our series on social media and your children. Host Dr. Lia Gaggino and guest expert Dr. Jane Harness tackle the urgent matter of social media safety, sharing eye-opening insights and actionable advice. Jane's experience in child and adolescent psychiatry shines a light on not only setting digital boundaries but equipping our kids with the skills to surf the web with wisdom. This collaborative approach is not just about setting boundaries, but about building bridges between parents and children in the digital age. This episode will leave you with key insights on the vulnerabilities of the developing brain and social media. The conversation underscores the subtleties of cyberbullying and its potential grave consequences, reiterating the need for open, honest discussions to forge a safer digital landscape for our younger generation. From the importance of parents modeling healthy media use to leveraging reputable sources for combating misinformation, the discussion covers critical territories in a parent's finding their way through the social media maze. Remember that your approach to discussing media use with your children could change everything—it’s time to find out the cyber secret your kids might not even realize they're hiding.

[00:33 -12:21] Impact of Social Media Use on Youth Mental Health
Different types of social media platforms can have varying effects on the mental health of young people.
Social media use may contribute to feelings of anxiety, depression, and low self-esteem among youth.
The constant exposure to curated and idealized representations of others' lives on social media can negatively impact youth mental health.
Cyberbullying and online harassment are significant risks associated with social media use, leading to adverse psychological outcomes.

[12:22- 22:55] Understanding the Impact of Social Media on Youth
Kids have a good understanding of social media use and its effects on them.
Social media can be addictive and lead to loss of control if not used responsibly.
Unhealthy content consumption can have negative consequences on mental and emotional well-being.
Research shows that children are aware of the potential pitfalls of social media, including cyberbullying.

[22:56 -40:21] Insights from Text-Based Study on Youth Perspectives
Consider the importance of authenticity when using social media platforms
Discuss the potential consequences of oversharing personal information online
Explore the impact of social media on mental health and well-being from a youth perspective
Provide resources and guidance for new users to navigate social media safely and responsibly

[40:22 - 52:05] Strategies for Managing Social Media Use and Mental Health Impact
Setting shared goals to redirect focus away from excessive social media use
Acknowledging the importance of communication with friends and finding alternative ways to connect
Implementing limits and boundaries to ensure a healthy balance between online and offline activities
Recognizing the role of limits in creating a sense of safety for youth

[52:06 - 58:40] Closing segment Takeaway

Links to resources mentioned on the show
Here is the MyVoice study
"Youth Insight About Social Media Effects on...

180. Social Media and Kids: The Big Picture

Wed, 07 Feb 2024 09:00:00 +0000

Are social media algorithms secretly manipulating what your kids see online? Pediatric Meltdown brings you an exclusive conversation with Dr. Jenny Radesky, where she sheds light on the alarming influence of social media algorithms on children's online experiences. Host Dr. Lia Gaggino and Dr. Radesky unravel the complexities of kids' tech use, from the dangers of unmonitored content to the pivotal role of parents in fostering digital literacy. Dr. Radesky presents compelling evidence about how digital platforms shape children's online experiences while advocating for greater parental awareness and legislative action. She highlights the urgent need for a healthier social media environment for kids and emphasized the significance of ongoing, open conversations about technology with children. Join us for an eye-opening exploration of social media's effects on youth mental health and the actionable steps we can take to create a safer online environment for kids.

[00:33 -12:40] Social Media's Role in Childhood Well-being and Online Safety Standards
The role of social media in shaping the health and development of children.
Consideration of social media design in terms of children's requirements and interests.
Acknowledgment of a need for universal best practices for social media platforms regarding youth.
Mention of a recent report highlighting the importance of social media guidelines to protect youth mental health

[12:41- 23:23] Social Media's Role in Youth Mental Health Concerns
Discussed the significant conversation happening around social media's impact on mental well-being.
Addressing the narrative that social media contributes to depression and anxiety among users.
Strategies to adjust settings and alter feeds to foster a more positive social media experience.
Highlighted the potential negative influence of dominant narratives widely accepted about social media.

[23:24 -33:47] Enhancing Online Safety for Children Through Legislation and Parental Involvement
Discusses laws aimed at regulating children's content and data collection
Highlights the importance of digital literacy and parental oversight for child safety online.
Explores the conflict between content regulation and free speech principles in the U.S.
Details the AAP's efforts to enhance children's online privacy and protection.

[33:48 - 41:52] Legislative Momentum for Children's Digital Safety
Potential legislative progress for child online safety laws, including COSA and updated COPPA regulations.
Explores public concern and political attention on social media's impact on children.
Highlights the uncertainty surrounding the enactment of new laws focused on children's digital privacy and safety.
Highlights broad support for legislative efforts addressing social media company concerns.

[41:53 - 42:57] Closing segment Takeaway

Links to resources mentioned on the show

www.aap.org/socialmedia (Center of Excellence website)

www.healthychildren.org/mediaplan (Family Media Plan tool)

American Psychological Association Health Advisory on Social Media Use in Adolescence (apa.org)

179. Teen Dating Violence: The Role of Pediatric Clinicians

Wed, 31 Jan 2024 09:00:00 +0000

Did you know that 1 in 3 young people in the US have experienced or survived dating abuse? In a candid and crucial conversation on Pediatric Meltdown, host Dr. Lia Gaggino is joined by guest Dr. Lenore Jarvis to tackle the sensitive issue of adolescent relationship abuse (ARA). From identifying red flags to discussing prevention strategies and resources, this eye-opening episode provides essential insights for parents, educators, and healthcare professionals working with adolescents. Dr. Jarvis will take a deep-dive into the different types of ARA, the power dynamics at play, and the impact of abuse on mental and physical health will highlight the importance of documentation, trauma-informed care, and healing-centered engagement, emphasizing the holistic experience of addressing trauma. With the imperative need for universal screening and education, and the complexities of navigating disclosures and mandatory reporting, our episode provided essential guidance for healthcare professionals. This episode is another example of Dr. Gaggino’s never ending dedication to unravel critical issues affecting pediatric care, empowering clinicians to make a positive impact on the lives of young people.

[00:33 -15:23] Understanding the Impact of Adolescent Relationship Abuse (ARA) on Teen Health
Adolescents experiencing ARA are at an increased risk of contracting sexually transmitted infections (STIs).
Victims of adolescent relationship abuse may suffer from mental health issues, including depression.
There is a notable link between ARA and suicidality in teenagers, potentially leading to life-threatening situations.
Adolescent relationship abuse often leads to increased school dropout rates, affecting education

[15:24 - 27:55] Strategies for Healthcare Professionals to Support Teens in Abusive Relationships
ARA strategies must respect a teen's comfort and safety in sharing, not always certain in a clinic.
Adolescents' confidentiality is vital, needing careful management by healthcare workers.
Feelings of isolation and shame can deter teens from seeking help or revealing abuse.
Offering ARA resources during visits offers consistent support, regardless of disclosure.

[27:56 - 42:08] Effective Approaches to Adolescent Relationship Abuse Disclosure
Providers encourage teens to report abuse by discussing common issues.
Healthcare pros must immediately validate a teen's ARA disclosure.
Careful measures protect intimate violence reports in patient records.
Keeping the abuser from patient files is vital to the teen's safety and privacy.

[43:09 - 55:59] Implementing Early Educational Strategies for Healthy Relationships
Elementary education focuses on identifying traits of positive and negative friendships.
Teaching young kids about good relationship dynamics prepares them for future romantic talks.
Talks on healthy romance in adolescence build on earlier friend relationship lessons.
Early healthy relationship education equips children to handle teen romantic challenges.

[56:00 - 01:07:08] Closing segment Takeaway

Links to resources mentioned on the show

Healing Centered Engagement:
The Future of Healing: Shifting From Trauma Informed Care to Healing Centered Engagement
Local Resources
State Coalitions:

178. Transforming Trauma: The Power of Trauma-Focused CBT

Wed, 24 Jan 2024 09:00:00 +0000

What is Trauma-Focused CBT?? Discover the Transformative Power of Trauma-Focused Therapy for Children in this Latest Pediatric Meltdown episode! Learn how Dr. Judith Cohen and her groundbreaking approach are revolutionizing children's mental health and trauma treatment. Delve into the impactful narrative of Trauma-Focused Cognitive Behavioral Therapy (TFCBT) as Dr. Cohen shares this expertise and the critical components of this life-changing therapy. From identifying trauma reminders to transferring agency to the child and parents, this episode is a must-listen for anyone passionate about pediatric mental health and trauma care. Join us as we unravel the intricacies of trauma therapy, uncover the key components of TF-CBT, and uncover the invaluable insights shared by Dr. Cohen in this enlightening discussion.
[00:33 - 32:48] Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Explained
TF-CBT is a specific treatment developed for children and their families to overcome the impact of trauma.
It encompasses 9 components, encapsulated in the acronym 'PRACTICE'.
Practice of resiliency skills by children and their caregivers is emphasized outside therapy.
Resiliency skills are reinforced through consistent practice within therapy for children and families

[32:49 - 42:24] Supporting Trauma Therapists: Coping with Client Traumas
Therapists' personal trauma experiences can shape their treatment methods.
The burden of processing many children's trauma narratives weekly is challenging.
Therapists navigate their emotional health and children's varied trauma recovery stages.
Self-care and a compassionate medical community culture are crucial for therapists' longevity.

[42:25 - 50:43] Evidence-Based Psychotherapy as First-Line Treatment for Childhood Trauma
Trauma experiences directly influence the choice of treatment, with TF-CBT being the frontline option.
Prescribing medication is not recommended until a sufficient trial of psychotherapy has been conducted.
A good clinician will reassess and adapt TF-CBT techniques to suit each child's individual circumstances.
Psychotherapeutic intervention aims to resolve trauma-related difficulties stemming from the child's experiences.

[50:44 - 59:40] Advancements in Trauma Therapy Accessibility for Children
The national certification for TF-CBT practitioners enhances accessibility to qualified therapists.
The availability of certification sites as an important development over time.
Bridging the gap between pediatric care and specialized trauma therapy.
The integration of therapy directories into care plans makes it easier for clinicians to make informed referrals.

[59:41 - 1:05:03] Closing segment Takeaway

Links to resources mentioned on the show
National Child Traumatic Stress Network:
https://www.nctsn.org/interventions/trauma-focused-cognitive-behavioral-therap

The NCTSN Secondary Traumatic Stress are available here: https://www.nctsn.org/trauma-informed-care/secondary-traumatic-stress/nctsn-resources

Locate TF-CBT certified therapists here: https://tfcbt.org/therapists

Locate PCIT therapists...

177. Traumatic Stress: Screening and Targeted Intervention

Wed, 17 Jan 2024 09:00:00 +0000

Get ready to unravel the complexities of childhood trauma as Pediatric Meltdown brings you an insightful episode featuring expert guests Dr. Brooks Keeshin and Dr. Jessica Griffin. Host Dr. Lia Gaggino will dive into the shifting paradigms from disease to trauma models, and the vital role of pediatricians in identifying and addressing traumatic stress in children. Uncover groundbreaking strategies for supporting children through trauma in this latest episode. prepare to dive deep into trauma-focused care and the 'three r's' approach to help pediatric clinicians navigate the complexities of children’s mental health. From the SEEK screen to evidence-based trauma treatments, you'll explore practical interventions and insightful discussions on addressing traumatic stress in pediatric care settings. Join us as we unravel the impactful dialogue between these esteemed experts and enter the world of child trauma and resilience to enhance your understanding of pediatric mental health.

[00:33 -18:47] The Role of Pediatricians in Early Trauma Intervention
A referral system to evidence-based treatment for traumatized children is described.
Despite systematic efforts, timely access to treatment for kids remains a challenge.
Pediatricians' interactions with families present chances for mental health education and support
Pediatricians play a critical role in the timely identification and management of child trauma.

[18:48 - 29:20] Supporting Child Resilience in Pediatric Mental Health
Pediatricians should focus on resilience for moderate symptoms.
Tailored mental health support benefits children with moderate symptoms.
Mental health support for non-severe symptoms underlines prevention.
Interventions for moderate symptoms bolster resilience and trauma management.

[29:21 - 40:07] Trauma-Informed Pediatric Care Strategies
Pediatricians can offer vital support to weary parents.
Trauma-informed care addresses child and caregiver needs holistically.
Employing 'three Rs' is crucial in caregiver engagement.
Normalizing caregiver experiences improves pediatric care's impact.

[40:08 - 53:45] Interventions and Resources for Pediatric Trauma Care
Pediatricians might refer to TFCBT without understanding its elements
Short-term methods are advised for mild trauma symptoms.
The Academy is creating pediatrician and caregiver resources.
Focus is on accessible support tools for children facing trauma.

[53:46 - 01:00:00] Closing segment Takeaway

Contacting Dr. Griffin:
Website: www.drjessica.com
Twitter: @TheDrJessica
Instagram:@dr.jessicagriffin
Facebook: Facebook
Books by Dr. Jessica Griffin
Childhood Trauma and Resilience, A Practical Guide

176. ACES and the Power of Positive Relationships

Wed, 10 Jan 2024 09:00:00 +0000

In a world where pediatricians hold the key to promoting healthy relationships and emotional well-being, this latest episode delves into the transformative power of recognizing and addressing toxic stress in children. Join Dr. Lia Gaggino and renowned pediatrician, Andy Gardner, expertly navigates the terrain of primary prevention and the crucial role pediatricians play in shaping the future of our youth. This episode will uncover the secrets to safeguarding children's mental health and well-being. Lia as she explores Andy's insights on primary prevention, emotional management, and the profound impact of nurturing relationships. Discover how this episode sheds new light on the crucial role pediatricians play in building a foundation for children's long-term resilience and well-being.

[00:33 -15:01] The Importance of Primary Prevention in Child Development
Holistic public health must embrace both primary prevention and specific interventions.
Preventing toxic stress in kids is achievable with primary preventive measures.
Proactive public health advocates for relational health.
Preventing toxic stress and promoting relational health in public health are linked.

[15:02- 26:34] Building Trust in Pediatric Relationships
Trust in pediatric care involves the triad of parent, child, and healthcare professional.
Pediatricians must grasp family dynamics to offer thorough care.
Pediatricians juggle clinical record-keeping with fostering therapeutic bonds.
Trust is essential for effective treatments and a child's positive developmental path.

[26:35 - 46:17] Fostering Emotional Resilience in Parent-Child Dynamics
Encourage parents to engage with their child's emotions to minimize defensive actions.
Use trauma-focused CBT techniques to help children's emotional needs and behaviors.
Emphasize empathy and understanding in caregiving before immediate behavior correction.
Highlight the lasting advantages of parental emotional presence for a child's development.

[46:18 - 59:20] Enhancing Child Growth with Positive Parenting
Pediatricians champion positive reinforcement to enhance child strengths.
'Catching children being good' boosts positive behavior and self-worth.
Aiming for ten praises per criticism sustains a positive parent-child bond.
Emphasizing children's strengths fosters better development and emotional control.

[59:21 - 01:05:17] Closing segment Takeaway

Links to resources mentioned on the show
AAP Preventing Childhood Toxic Stress Policy Statement - https://pediatrics.aappublications.org/content/148/2/e2021052582
AAP Trauma Informed Care in Health Systems Policy Statement - https://pediatrics.aappublications.org/content/148/2/e2021052579
Trauma Informed Care Clinical Report - https://pediatrics.aappublications.org/content/148/2/e2021052580
Thinking Developmentally by Andrew Garner and Robert Saul - https://shop.aap.org/Thinking-Developmentally-Paperback-en.aspx
ACES Anda/Felliti -

175. Beyond Trauma: Strengthening the Caregiver-Infant Dyad

Wed, 03 Jan 2024 09:00:00 +0000

Join Dr. Lia Gaggino on Pediatric Meltdown in welcoming her guest, Dr. Ed Tronick. This episode unveils the transformative power of non-verbal communication between infants and caregivers, as explored through the lens of the 2-minute Still Face Experiment. Discover how Dr. Tronick's lifetime dedication to understanding these silent dialogues has reverberated, influencing fields as diverse as therapy and law enforcement. As they dive into the choreography of connection and disconnection between child and adult, you’ll gain an insight into how these foundational moments shape emotional health and interpersonal skills. Find inspiration in the poignant discussion that explores the very heart of childhood development and carries the promise of healthier futures through stronger relationships. Join us in acknowledging a legacy that continues to guide and inspire.

[00:33 -09:46] Adverse Childhood Experiences (ACEs) and Infant Mental Health
Explaining the types of adverse experiences that can impact infant and early childhood development.
How chronic stress can disrupt neural pathways and affect a child's emotional and physical health.
Strategies for caregivers to build resilience in infants facing adverse experiences.
The value of pediatricians in screening for ACEs and guiding caregivers to prevent toxic stress in infants.

[09:47 - 17:46] Exploring the Still Face Experiment and Infant-Caregiver Bonding
BSignificance of Early Interaction: How Caregiver Engagement Shapes Development
Repairing Broken Bonds: Responding to Infant Signals Post-Disruption
Decoding Infant-Caregiver Communication: Agency and Intent in Early Years
Strengthening Attachment: The Role of Positive Caregiver Behaviors in Secure Bond Formation

[17:47 - 27:59]Addressing ACEs and Toxic Stress in Early Childhood
Building a Supportive Network: The Critical Role of Pediatricians in ACEs Recognition
Empowering Caregiver Capacity: Tools for Mitigating Toxic Stress in Infancy
Resilience in the Wake of Adversity: Supporting Healthy Coping Mechanisms in Infants
Crafting a Secure Future: How Quality Infant-Caregiver Interactions Counteract Toxic Stress

[28:00 - 50:13] Advancing Development Through Caregiver-Infant Interaction Repair
The Dynamics of Emotional Recovery: Techniques for Reestablishing Secure Attachments
Encouraging Parental Agency: Empowering Caregivers in the Art of Interaction Repair
Breakthrough via Repair: The Crucial Role of Mending Disrupted Bonds in Infant Development
The Still Face Paradigm: Insights into Resilience and the Capacity for Relationship Repair

[50:14 - 56:31] Closing segment Takeaway

Links to resources mentioned on the show

Still Face Experiment Video:
Love Sense: from Infant to Adult (Sue Johnson and Ed Tronick) (youtube.com)

National Institute of Health article:
A Still-face Paradigm for Young Children: 2½ Year-olds’ Reactions to Maternal Unavailability during the Still-face - PMC (nih.gov)

Other episodes you may like:
https://pediatricmeltdown.com/episodes
142 Difficult Childhood Behaviors: Meeting the Challenges of Parenting
134 Early Childhood Education: Empowering Parents
112...

174. Reflections of 2023

Wed, 27 Dec 2023 09:00:00 +0000

Listen to Dr. Gaggino reflect on 2023 and the journey that Pediatric Meltdown has led her on. As we come to the end of this episode, she wants to express her deepest gratitude to all the listeners who have been a part of the Pediatric Meltdown community. The magic of caring for kids and the belief that we can do better drives us forward. Your involvement in this podcast is invaluable, so keep tuning in, sharing, and downloading. Let's make 2024 a year of empowerment and growth for pediatric mental health. Together, let's make a lasting impact and create a world where every child's emotional well-being is valued and nurtured. Dr. Gaggino wants to thank you for being a part of this journey.
[00:33 -04:00] Reflections on 2023
Gratitude for vaccines and treatments
Recovery from COVID-19
Impact on children's mental health
Isolation's impact on children

[4:01 - 05:46] Insights and Adventures
Updates on family and grandchild's arrival
Enjoying time with daughter in Denver
Cherished memories from family parties
Travel adventures to New Orleans and Florida

[05:47 - 08:13] Cherishing Relationships
Coping with family health challenges
Acknowledging life's challenges and joys
Expressing gratitude for loved ones
Finding strength in family and friendships

[08:14 - 09:18] Podcast's Evolution and Future Plans
Introduction of a new website and merchandise
Introduction to the book club
Engaging with audience and listeners
Encouraging interaction and feedback

[09:19 - 12:05] Closing segment Takeaway
Anticipation for thought-provoking social media series
Announcement of new podcast mini-episode series
Overview of upcoming consulting opportunities

You can reach Dr. Lia Gaggino
Email: gagginol@gmail.com
Facebook: Facebook
Instagram: @PediatricMeltdown
LinkedIn: linkedin.com/in/lia-gaggino-md-faap-80322a31

Here are the 4 most downloaded episodes of 2023
https://pediatricmeltdown.com/episodes
#1. 170 Bioethics in Pediatrics: Finding Your Way Through the Grey Areas

#2. 171 Pharmacogenetics: Guiding Psychotropic Medication Rx

#3. 173. Neurodivergent Youth: What Support Looks Like

#4. 169 Parenting the Neurodivergent Child: What Pediatric Clinicians Need to Know

Key quotes for Twitter:
"I am really grateful to science and those incredible people who created this vaccine."... Dr. Lia Gaggino
"We need to elect adults who behave like adults. The adults we want our kids to be, not bullies, but instead thoughtful, fair, honest humans who want the best for each other."...Dr. Lia Gaggino

THANK YOU FOR YOUR SUPPORT!
Pediatric Meltdown was listed as a Top 20 Pediatric Podcast on FeedSpot.
If you’d like to connect with me, you can Tap the “What Are Your Thoughts”...

173. Neurodivergent Youth: What Support Looks Like

Wed, 20 Dec 2023 09:00:00 +0000

Are you tired of sifting through endless articles for helpful tips on managing neurodiverse conditions like ADHD and autism? Look no further, as this episode of Pediatric Meltdown brings you a game-changing discussion on practical strategies for symptom control and fostering independence in neurodiverse children. In this episode, host Dr. Lia Gaggino and her guest, Noreen Russell, PhD shake up the conversation by debunking misconceptions, highlighting invaluable resources, and advocating for a more nuanced understanding of neurodiversity. Say goodbye to quick fixes and unattainable expectations as you dive deep into a comprehensive discussion on embracing individual needs. Get ready for a fresh perspective that challenges traditional approaches and empowers parents and professionals alike! Noreen's emphasis on avoiding blame and shame, normalizing neurodiversity, and promoting equity in addressing the needs of neurodiverse children resonates deeply. The emphasis on understanding, flexibility, and individualized approaches is crucial for supporting these children and their families. Her words remind us that it's crucial for professionals and parents alike to listen, acknowledge, and adapt when supporting these children. As we continue on this journey of advocating for neurodiversity, let's remember Noreen's words: "It's about doing the best we can and acknowledging the complexities of neurodevelopmental disorders, with empathy and understanding as our strongest tools.
[00:33 -12:17] Understanding Neurodiversity in Children
Definition: Explaining what it means to be neurodivergent.
Identifying Traits: Recognizing neurodiversity in behavior and learning.
Therapies and Interventions: Overview of effective treatments and strategies.
Inclusive Education: How schools adapt curricula to meet neurodiverse needs.

[12:18 - 26:59] Beyond "Quick Tips": Comprehensive ADHD Care
Multimodal Treatment: Combining therapy, medication (if necessary), coaching, and lifestyle changes.
Emotional Support: Prioritizing emotional well-being alongside behavioral management.
Educative Engagement: Teaching kids about their ADHD to foster self-awareness and self-management.
Community Resources: Leveraging support groups and educational resources for ongoing support.

[27:00 - 36:50] Achieving Balance: Week-to-Week Wellness Strategies
Cumulative Health: Examining how consistent health habits affect week-to-week performance.
Mental Health Awareness: Recognizing signs of stress or depression and taking timely action.
Nutritional Balance: Choosing foods that enhance cognitive function and mood stability.
Sleep Hygiene: Prioritizing restful sleep as a foundation for daily productivity.

[36:51 - 51:36] Maximizing Dedication with the 5-Minute Golden Rule
Quality Over Quantity: Understanding the benefits of short, meaningful connections with each child.
Individualized Attention: Tailoring weekend plans to cater to the unique interests of each child separately.
Parent-Child Bonding: Strengthening relationships through dedicated one-on-one time.
Daily Application: Using the golden rule beyond weekends for homework help or bedtime routines.

[51:37 - 56:35] Closing segment Takeaway

You can reach Dr. Noreen Russell
www.Facebook: Facebook
LinkedIn:

172. Burnout Prevention: A 15-Minute Game Changer

Wed, 13 Dec 2023 09:00:00 +0000

As the holiday season approaches, it's crucial to address the emotional well-being of healthcare professionals. Host Dr. Lia Gaggino sits down with Ariel Lucas, a pediatric nurse practitioner, who shares her journey into the field and her personal struggle with exhaustion and emptiness. She opens up about the physical and emotional toll it took on her and how it affected her interactions with patients and loved ones. As a pediatric professional navigating personal and professional challenges, Ariel found solace and motivation during her cycling workouts, which ultimately led to a positive transformation in her mental health and outlook on life, not to mention her personal and financial stress, ultimately reclaiming her strength and vitality. Listen in as Ariel talks about her experience at a wellness retreat and the valuable lessons she learned about prioritizing self-care and kindness.This episode is a reminder for all healthcare professionals to take care of themselves so they can better care for others. Join Dr. Gaggino as she explores Ariel's journey from exhaustion to empowerment, and discovers the profound impact of self-care and physical activity on her personal and professional life.

[00:33 -07:28] The Importance of Self-Care
Defining what self-care actually means and busting common misconceptions about it being selfish.
Exploring different methods of self-care tailored to individual needs and lifestyles.
Discussing how caring for oneself provides the energy needed to help others effectively.
Tips for consistently incorporating self-care into your daily schedule without feeling guilt.

[07:29 -12:24] Striking a Work-Life Balance

Communicate boundaries to colleagues and stick to them.
Prioritize tasks to maximize productivity during work hours.
Integrate short breaks throughout the workday to reduce stress.
Ensure leisure activities are part of your weekly routine for relaxation.

[12:25 - 19:53] Inspiring Others by Example
Ariel serves as an example that even busy people can add wellness habits
She does weekly lunch workouts with some of the providers at her office
She goes on bike rides with some of the students she works with
Her openness to wellness has directly inspired a few people at her office

[19:54 - 29:17] Embracing Selflessness

Simple ways to incorporate selfless acts into everyday life.
The impact of volunteering and being part of collective goals.
How understanding and responding to the needs of others enhances personal growth.
Ensuring self-care to avoid burnout while helping others.

[29:18 - 34:35] Closing segment Takeaway

Links to resources mentioned on the show
Books Mentioned in the Episode

Choosing Wellness: Unconventional... by O'Grady, Eileen T (amazon.com)

171. Pharmacogenetics: Guiding Psychotropic Medication Rx

Wed, 06 Dec 2023 09:00:00 +0000

Discover some eye-opening exploration of genetics, medication choices, and evidence-based practices in pediatric psychiatry! Join host Dr. Lia Gaggino and guest Dr. Lisa Namerow as they navigate the intricate world of pharmacogenomic testing, the impact on prescribing behavior, and the crucial relevance of genetic panels for pediatric patients. From the evolving landscape of pharmacogenomics to the challenges of interpreting genetic findings, this discussion sheds light on the pivotal role of nonpharmacologic options and the need for validated guidelines in treating pediatric anxiety and depression. The conversation between Dr. Gaggino and Dr. Namerow has shed light on the challenges and opportunities associated with pharmacogenomic testing in pediatric psychiatry. With the complexity of interpreting results and the risk of inappropriate medication choices, the field faces a critical juncture in the responsible adoption and implementation of genetic information. However, the lack of clear guidelines and the risk of misinterpretation highlight the need for caution in prescribing decisions. As we navigate this landscape, it is essential for providers to prioritize the validation of guidelines and the responsible use of genetic information to ensure the safe and effective treatment of pediatric anxiety and depression. Together, we can work towards a future where genetic testing enhances the care of pediatric patients facing mental health challenges.

[00:33 -12:41] The Conundrum of Genetics in Psychiatry
Genetics play a complex role in determining the right treatment for psychiatric conditions.
Non-specialists may struggle to fully comprehend the intricacies of genetic information.
The science of genetics in mental health treatment is fast evolving.
Genetic information can significantly alter clinical decisions in unexpected ways.

[12:42 - 28:33] Understanding Clinical Pharmacogenetics
Learn what pharmacogenetics is and how it impacts drug efficacy and patient safety.
Identify common drugs with known pharmacogenetic interactions.
Understand the importance of integrating pharmacogenetic information into clinical practice.
Stay updated on emerging research and its implications for personalized medicine.

[28:34 - 33:05] Moving Beyond the Binning Concept in Data Analysis
Embrace new frameworks for interpreting genetic testing results.
Develop a nuanced understanding free from oversimplified categories.
Foster continuous learning and adaptation in data evaluation methods.
Integrate complex data sets for a more personalized approach to healthcare.

[33:06 - 44:13] Utilizing Sequence to Script in Clinical Practice
Streamline patient information intake by inputting data into Sequence to Script.
Enhance patient interactions by leveraging generated scripts for more effective communication.
Document clinical reasoning meticulously when selecting treatment options based on script suggestions.
Improve the accuracy of allergy identification and management with advanced Sequence to Script outputs.

[44:14 - 51:44] Closing segment Takeaway

Links to resources mentioned on the show
Sequence 2 Script: www.sequence2script.org
Pharmacogenomics: An Update for Child and Adolescent Psychiatry

170. Bioethics in Pediatrics: Finding Your Way Through the Grey Areas

Wed, 29 Nov 2023 09:00:00 +0000

Are you ready to dive deep into the Bioethical challenges that pediatricians encounter on a daily basis? Host, Dr. Lia Gaggino, talks with guests Dr. Lauren Azevedo and Dr. Naomi Laventhal about the difficult decisions and moral dilemmas that arise in outpatient and inpatient settings. From controversial topics like vaccine hesitancy and substance abuse to the delicate balance between autonomy and parental involvement, this episode leaves no ethical stone unturned. They’ll take you through their day as they navigate the treacherous terrain of consent, confidentiality, and decision-making in both outpatient and inpatient care. You’ll hear about scenarios of child abuse and custody disputes. It’s clear that navigating ethical challenges in pediatric care requires clear communication, and a commitment to finding common ground. By acknowledging the good intentions of all involved and embracing emotions as part of the decision-making process, we can work towards the best outcomes for our patients and their families. Remember, in the midst of the chaos, everyone is on the same team, fighting against disease, advocating for what is right, and ultimately delivering the best care possible. Stay strong, stay compassionate, continue to meet these challenges with empathy, integrity, and a commitment to the well-being of all patients.
[00:33 -18:25] Ethical Challenges in Pediatric Practice
Ethical dilemmas in divorce and custody disputes
Medication decisions when parents have opposing views
Navigating conflicting parental preferences
Creating a safe plan for the patient's well-being

[18:26 - 28:51] Effective Communication Techniques
Clarifying questions: asking for further information or examples to ensure understanding.
Empathy: showing understanding and validation of the speaker's emotions.
Non-verbal cues: using body language and facial expressions to convey interest and engagement.
Reflective responses: paraphrasing what the speaker said to confirm comprehension.

[28:52 - 38:38] Ways to Promote Independence in Children Without Disabilities
Foster critical thinking and decision-making in children.
Develop self-sufficiency by giving children responsibilities.
Build confidence and autonomy through involvement in decision-making.
Teach effective time management through scheduling and goal-setting.

[38:39 -55:16] Institutional Guidelines
Specific protocols and procedures for handling ethical issues within your institution
Information on who to contact and when for guidance and support
Training materials and resources for healthcare professionals
Case studies and examples of ethical dilemmas in your institution

[55:17-1:02:56] Closing segment Takeaway

You can reach Dr. Lauren Azevedo
LinkedIn: www.linkedin.com/in/azevedo6915

You can reach Dr. Naomi Laventhal
LinkedIn: www.linkedin.com/in/naomineoethics

Links to resources mentioned on the show

AAP statements from the Committee on Bioethics

169. Parenting the Neurodivergent Child: What Pediatric Clinicians Need to Know

Wed, 22 Nov 2023 09:00:00 +0000

In a heartfelt conversation, host Dr. Lia Gaggino is joined by Julius Towers, a remarkable father and advocate who opens up about his personal journey raising twins with autism. From highlighting the importance of early testing to addressing equity and stigma, this episode sheds light on the realities faced by families of children with special needs. It’s clear that the journey of parenting a child with autism is filled with challenges and uncertainties. Pediatricians have a crucial role to play in supporting families dealing with autism. By providing clear and compassionate communication, offering guidance and resources, and advocating for their patients, they can make a lasting impact on the lives of these children and their families. Together, we can build a world that celebrates neurodiversity. Let us remember that every child deserves access to early intervention and support, and it is up to each one of us to ensure that no child with autism is left behind.

[00:33 -19:47] Early Identification is Key for Child Development
Early identification allows for timely access to necessary resources and therapies.
Parents should be encouraged to observe their child's developmental milestones and seek professional guidance if any concerns arise.
Early intervention services can significantly improve a child's overall development and future outcomes.
Building awareness about the importance of early identification can lead to better support systems for children and their families.

[19:48 - 30:02] Challenges Faced by Minoritized Populations
Underdiagnosis issues in minoritized populations
Reasons for missed or dismissed diagnoses
Impact of underdiagnosis on health outcomes
Addressing disparities in healthcare through awareness and education

[30:03 - 43:26] Managing overwhelming emotions
Acknowledge the emotional whirlwind that comes with seeking services
Try not to get caught up in thinking too far ahead into the future
Establish some emotional boundaries to prevent feeling overwhelmed
Seek out counseling or support groups to help navigate the journey

[43:26 - 59:24] Steps for Early Diagnosis and Support
Screen for developmental delays or disorders in children.
Provide prompt referral to early intervention programs and specialized services.
Educate parents and caregivers about available resources and support networks.
Continuously monitor and track progress to ensure appropriate interventions.

[59:25 - 1:05:48] Closing segment Takeaway

You can reach Julius Towers
Email: j.y.towers@gmail.com
LinkedIn: www.linkedin.com/in/juliustowers

Links to resources mentioned on the show
Autism Speaks Parent Guide: https://www.autismspeaks.org/tool-kit/parents-guide-autism
CDC ADDM Network Community Report : https://www.cdc.gov/ncbddd/autism/addm-community-report/index.html
Autistic Self Advocacy Network parent guide: https://autisticadvocacy.org/book/start-here/
The...

168. Professional Transition and Reinvention: Taking the Leap

Wed, 15 Nov 2023 09:00:00 +0000

Struggling with the pressures of a demanding medical career while balancing personal well-being and family life? In this compelling episode of Pediatric Meltdown, host Lia and guest Elise Fallucco dive deep into the challenges and triumphs of stepping away from clinical care. From the challenges of finding personal fulfillment amidst professional pressures to the profound impact of career decisions on reputation, this discussion provides a rare glimpse into the emotional rollercoaster of being a healthcare professional. They’ll talk about the impact of external judgments on the importance of aligning personal passions with professional choices. This conversation offers valuable wisdom for anyone seeking balance in their professional and personal lives. Their candid discussion about identity crises, career transitions, and the importance of aligning work with personal values resonates deeply. In a field where ambition often competes with personal well-being This episode of Pediatric Meltdown reminds us that prioritizing our own well-being is not only necessary but also courageous. The journey to understanding our own needs and making tough decisions may be daunting, but it's a vital step towards a fulfilling and sustainable career in medicine. Remember, finding joy outside of work is just as crucial as achieving professional success. Your well-being is non-negotiable, and prioritizing it is an act of strength and resilience.

[00:33 -16:09] Need for Self-reflection and Change
Not appreciating the opportunities and relationships
Difficulty in recognizing personal limitations and burnout
Realization that a change is necessary for personal growth
Encouragement and support from spouse to make a change

[16:10 - 26:11] Transitioning to New Opportunities
Smoothly transitioning from one position to another
Embracing the excitement of change and new challenges
Considering personal growth and development in career choices
Finding fulfillment in pursuing something wonderful elsewhere

[26:12 - 37:32] Struggles with Behavioral Health Work
Exhaustion from seeing a significant number of patients per day
Dealing with emotionally challenging narratives from patients
Lacking sufficient support in the field
Recognizing that the journey to success is rarely a straight line

[37:33 - 52:05] Elevating Physician Voices
Sharing Experiences: Gives pediatricians a platform to share their personal experiences
Impactful Discussions: Engages in conversations about factors that influence healthcare
Screenings and Resources: Offers screening tools, dosing cards, guidelines, and resources for healthcare professionals
Easy Access: Provides resources at the click of a button for immediate implementation in practice

[52:06 - 55:51] Closing segment Takeaway

You can reach Dr. Fallucco
Instagram: PsychEd4Peds (@psyched4peds) • Instagram photos and videos
Website: PsychEd4Peds.com
Podcast: PsychEd4Peds: child mental health podcast for pediatric clinicians (or wherever you find your podcasts!)

Other episodes you may like:

167. Gender Affirming Care: A Mother’s Story

Wed, 08 Nov 2023 09:00:00 +0000

Prepare to be thoroughly moved and enlightened in this groundbreaking episode of Pediatric Meltdown, as we unravel the deeply personal journey of a Mother and her daughter, exploring the intricacies of gender affirming care. From initial confusion and grief to unwavering support and acceptance, their story will challenge your preconceptions and inspire you to embrace empathy and understanding. Step into the shoes of this multiracial, adopted teenager who fearlessly stands tall amidst the challenges of living her true self. As they navigate through complex healthcare settings to championing understanding within conservative communities, their story will challenge your perspectives and ignite a flame of compassion within your heart. Join Dr Lia Gaggino as she takes us on this extraordinary exploration of gender identity, expanding your knowledge and empathy, one step at a time, above all, the unequivocal power of love in the face of adversity. In a world where the politicization and ignorance surrounding transgender identity and gender-affirming care persist, it is more important than ever for professionals in healthcare, mental health, and education to step up and provide the support and understanding that these individuals and their families so desperately need. Education, empathy, and open-mindedness are the key to dismantling the barriers and prejudices that stand in the way. Let us stand together, united in our commitment to acceptance, and ensure that every child has the opportunity to live as their true selves, free from judgment and harm. Together, we can make a powerful impact on the lives of transgender individuals and contribute to a more inclusive and compassionate society.
[00:33 -8:51] Early Signs of Gender Identity
Recognizing and supporting a child's exploration of gender identity from a young age
Understanding the developmental appropriateness of dress-up and self-expression
Lack of available information and resources for parents navigating gender identity discussions
The emotional journey of parents when their child begins to voice their gender identity
The importance of creating a safe and supportive environment for children to express their true selves

[8:52 - 15:33] Misconceptions about Hormone Treatment and Surgery for Transgender Youth
The misconception that all questioning children should immediately start hormone treatment
Addressing the false belief perpetuated by anti-trans voices
The importance of a thoughtful and informed approach to hormone treatment
The recognition that surgery is not the immediate goal for all transgender youth
Acknowledging progress made by clinicians in understanding transgender healthcare needs over the past decade

[15:34 - 26:46] Effects of the Politicization of Gender Affirming Care
Frustration and fear due to lack of understanding
Generalizations and ignorance surrounding transgender issues
Feeling marginalized and targeted
Access to gender affirming care and support
Psychological and emotional impact on the child and family

[26:47 - 39:21] Letting Your Child Be the Guide
A clinician in Chicago advised parents to let their child be the guide in their gender identity journey.
This approach may initially feel counterintuitive for parents, but it emphasizes the importance of listening to and supporting the child's self-discovery.
Many individuals identify as non-binary, which may not fit into traditional gender categories, but it is essential to validate their feelings and experiences.
Gender identity is not a trend but a deeply personal and authentic expression of...

166. Chronic Illness and Mental Health: The Roadmap Project

Wed, 01 Nov 2023 09:00:00 +0000

Discover the untold stories of resilience, uncertainty, and emotional turmoil in the latest episode of Pediatric Meltdown! host Dr. Lia Gaggino is joined by The Women of the RoadMap Project; Dr. Carol Lannon, Dr. Lori Crosby, Robin Kinebrew, and Meghan Didier as they dive deep into the struggles and triumphs of parents navigating the complexities of their children's chronic diseases. From navigating hospital admissions to tackling the daunting tasks of missed homework, these parents courageously share their journeys of finding strength amidst the chaos of mental health. This episode will highlight how crucial it is for medical sub-specialists to care about the topic of mental health in pediatric patients with chronic illnesses. They’ll talk about the responsibility the sub-specialists have to recognize the connection between physical and mental health and to incorporate holistic approaches into their practice. By taking the time to listen, understand, and connect them with appropriate resources, sub-specialists can play a vital role in supporting their mental health journey. The Roadmap Project reminds us to strive to enhance our competence and confidence in addressing this important aspect of care because every child deserves comprehensive support, not just for their physical health, but for their Mental Wealth as well.
[05:21-21:07] The Origin of the Road Map Project
Initiated after a conversation with the American Board of Pediatrics in 2016
A collaborative effort between patients, families, and clinicians
Aims to improve the emotional health of patients and families with chronic conditions
Published using Google Docs and updated automatically every 5 minutes

[21:08 - 35:10] Subspecialty Responsibility and Competence in Addressing Mental Health
Approximately two-thirds of respondents believe that addressing mental health is the responsibility of their subspecialty.
Only 20% of graduating subspecialty fellows feel competent enough to address mental health.
Competence levels vary among different subspecialties, with cardiology and nephrology showing the lowest confidence levels.
The focus is on acknowledging, validating, and connecting individuals to appropriate mental health resources when needed.

[35:11 - 43:06] The Therapeutic Power of Asking
How the normalize-ask-pause-connect approach can enhance patient care
How asking can contribute to healing and understanding
The role of asking in therapy and self-reflection
The potential benefits of asking in various life situations

[43:07 - 1:01:45] Importance of Raising Awareness
Clinicians reporting significant changes in their practice approach
Creating a culture of continuous learning and professional development
Increasing awareness of the impact on patient care and outcomes
Empowering clinicians to prioritize emotional health in their practice

[1:01:46 - 1:09:00] Closing segment Takeaway

Links to resources mentioned on the show

You can reach The Roadmap Project
Website: Roadmap For Emotional Health
YouTube: The Roadmap Project - YouTube

Videos:
The impact of being Black while living with a chronic condition: Inpatient perspectives

Normalize+Ask+Pause+Connect by...

165. Pediatric Perspectives: Musings, Insights and Encouragement

Wed, 25 Oct 2023 09:00:00 +0000

From Measles to Mass Epidemics: This episode is dedicated to a pediatrician's journey through medical challenges and advocacy. Join host Dr. Lia Gaggino this week, as she features heartfelt conversations with renowned pediatricians, Dr. Bravo and Dr. George Rogu. Listen in as they share personal stories from their medical careers and highlight the importance of preventive care. From preventing infectious diseases to the struggles of combating mental health crises, they stand at the frontline of pediatric care. Pediatricians feel their call of duty is to advocate for the health and wellbeing of their young patients. But pediatricians will say “we must never lose sight of why we chose this path in the first place. Our purpose is greater than any obstacle, and our dedication to the health and wellbeing of children is unwavering”. So, as they continue to stand strong, united in their mission, always remember that the impact that just one pediatrician can make extends far beyond the confines of a podcast episode, and together, their voices will be heard.
[00:33 -24:56] The Winding Path of Personal and Professional Growth
Herb's unconventional career path with unexpected turns
Motivation to create their own narrative
The dare that led to starting the podcast
Overcoming the challenge of being unheard and finding a voice

[24:57 - 33:14] Mental Health Crisis and the Need for Support
The rising rates of mental health issues among individuals, including children
Importance of early intervention and access to mental health services
Strategies for promoting mental well-being and resilience in families
Addressing the stigma surrounding mental health and promoting open conversations

[33:15 - 39:23] Addressing Pediatric Healthcare Challenges
Allocate budget to pay off pediatricians' student loans.
Provide financial aid to hospitals with pediatric beds.
Improve public health outcomes, not shift funding constantly.
Invest in pediatric healthcare to reduce respiratory illness risks and worries for families with young children.

[39:24 - 45:00] Importance of Pediatrician Voices at the Table
Pediatricians provide expertise on child health and development in decision-making.
They ensure children's unique needs are considered in policy and decision-making.
Pediatricians promote evidence-based practices for children's health and well-being.
Pediatricians educate parents and the public about child health issues.

[45:01 - 50:55] Closing segment Takeaway

You can reach Dr. Bravo and Dr. Rogu
Podcast: The Pediatric Lounge (buzzsprout.com)
LinkedIn: The Pediatric Lounge: Overview | LinkedIn
Instagram: @the_pediatric_lounge
Facebook: https://www.facebook.com/ThePediatricLounge
Substack: Pediatric Executive Development System | Substack

Links to resources mentioned on the show

Pediatric Lounge...

164. Protecting Innocence: Talking to Children About War

Wed, 18 Oct 2023 09:00:00 +0000

The world weeps as innocence crumbles amidst the madness of war in Gaza and Israel. This is an impromptu episode based on the conflict in the middle east. Dr. Lia Gaggino unravels the profound impact on children who bear no responsibility for the conflict yet suffer its horrifying consequences of human depravity. She also shares the powerful guidance of renowned pediatric associations on how to soothe children, families, and ourselves amid the chaos and tragedy. As the world witnesses the horrors of armed conflicts and the devastating effect on innocent lives, we must pause and reflect. Dr. Lia offers indispensable insights and coping techniques to protect children's mental health worldwide. So, brace yourself for an emotionally charged discussion that demands our attention and humanity. Prepare to be moved, inspired, and called to action. Remember, together, we can heal, rebuild, and create a safer, more compassionate future for every child.

[00:33 -04:23] The Impact of Trauma on Children
Trauma bonds and the need for emotional support during times of crisis
The fight, flight, freeze response and its manifestation in the current situation
The importance of adults being emotional containers for children

[04:24 - 08:33] Strategies for Coping and Self-Care
The significance of sleep in maintaining emotional well-being
The consequences of exhaustion on our ability to be our best selves
The importance of staying informed without becoming overwhelmed

[08:34 - 11:01] Protecting the Innocence and Ensuring Safety
Advocating for moments of humanitarianism amidst the chaos
The responsibility to allow innocent children to flee to safety
The collective failure if any child is left unprotected

[11:02 - 13:19] The Dangers of Dehumanization and Othering
The link between dehumanization and the ability to harm others
The power of seeing a child's soul in their eyes to prevent harm
The unimaginable nature of the atrocities committed against children

You can reach Dr. Lia Gaggino
gagginol@gmail.com

Links to resources mentioned on the show

AAP Resources:
Academy’s policy statement, “The Effects of Armed Conflict on Children
For guidance on how to talk with children about what is going on in Israel and Gaza, see this HealthyChildren.org article.
For families about how to shield their children from traumatic events in the news and on social media go here.

AACAP Resources
AACAP Facts for Families, "Terrorism & War – How to Talk to Children”

163. Period Poverty and the Tampon Tax: The Audacity of Advocacy

Wed, 11 Oct 2023 09:00:00 +0000

What if one conversation in a bustling New York City restaurant could spark a movement in menstrual equity? You’re about to hear a story of passion, dedication, and the audacity of advocacy. In this episode of Pediatric Meltdown, your host Dr. Lia Gaggino sits down with special guest Anusha Singh, a medical student at Ohio State who is harnessing a powerful force of change. Together, they explore Anusha's journey as a student-turned-advocate, from organizing a press conference that caught the attention of five presidential candidates to testifying in front of lawmakers to repeal the tampon tax. Her dedication to addressing period poverty and fighting for change serves as a powerful reminder that one person's voice can spark a movement. So, let us take her example to heart and use our own voices, stories, and actions to break down barriers, challenge societal norms, and create a world where every person has access to the period products they need. Together, we can dismantle the stigma, create lasting change, and empower every individual to live their lives with dignity and respect.
[00:33 -10:39] The Global Issue of Period Poverty
Definition and scope of period poverty worldwide
Discussion on the prevalence of period poverty in developing countries
Examples of initiatives and organizations working to address period poverty globally
Impact of period poverty on education, employment, and overall well-being

[10:40 - 19:53] The Hidden Reality of Poverty
Many people are unaware of the extent of poverty that exists, as they may live in comfortable neighborhoods with well-maintained surroundings.
Communities living in poverty may be located in close proximity to more affluent areas.
Personal experiences, such as missing school due to lack of access to period products, can shed light on the challenges faced by individuals in poverty.
Testifying before lawmakers, regardless of age or background, can make a significant impact in addressing these issues.

[19:54 -25:59] Amplifying the Issue through Social Media and Personal Networks
Social media helped students generate awareness and discussion on the issue.
Social media's impact highlights its influence in modern activism.
Dialogue and personal experiences made a substantial impact on public perception.
Creating "noise" through various channels attracted attention from influential figures and organizations.

[26:00 - 32:13] Finding Information on Tampon Tax in Your State
Utilizing period.org's map
Exploring Bill Track 50 for legislation status
Peoria Law's website as another resource
Awareness raised by organizations like the American Academy of Pediatrics

[32:14 - 36:39] Closing segment Takeaway

You can reach Anusha Singh
Instagram: @anusha_sing

Links to resources mentioned on the show
HERE is the link for the movie trailer!
HERE is the link to my TEDx talk!
www.period.org
Bill Track 50 https://www.billtrack50.com
Days for Girls:

162. Migraine Headaches: Assessment, Management and Relief

Wed, 04 Oct 2023 09:00:00 +0000

Attention all parents, caregivers, and medical professionals! Are you ready to take control of pediatric migraines? Then tune in to the latest episode of Pediatric Meltdown with your host Dr. Lia Gaggino, as she teams up with migraine specialists Dr. Sarah Dixon and Dr. Emily Foxen Craft. From debunking common misconceptions to exploring the power of cognitive behavioral therapy, they have all the information you need to effectively manage migraines in children. The Pediatric Headache Echo program is not just a training program, but a game-changer in the world of pediatric headache and migraine care. By equipping primary providers with the knowledge, skills, and confidence to effectively treat and evaluate pediatric headache patients, they are revolutionizing access to high-quality care. In a world where medication and lifestyle modifications often take center stage, it's time to acknowledge the hidden potential of psychology in the pediatric headache and migraine area. By providing information, ideas, and referrals to trusted partners, healthcare professionals can tap into a rich resource that offers holistic support and complements existing treatment options. Let's shift the narrative and embrace psychology as an essential component of comprehensive care. Together, we can unlock the true potential within each patient, empowering them to live their lives free from the shackles of chronic pain. It's time to harness the power of psychology and make a lasting impact on the lives of children and teens with migraines.

[00:33 -13:55] Effective Communication Strategies
Importance of using visuals to demonstrate the treatment plan
Utilizing metaphors and analogies to enhance understanding
Step-by-step approach in explaining the treatment process to families
Addressing concerns about primary and secondary causes of headaches

[13:56 - 27:03] Understanding the Importance of Medication in Headache Management
Each treatment plan is individualized, considering factors such as age and other health considerations.
The approach to medication involves a more rigorous attention to pain hygiene, which may not always be prioritized in regular clinic visits.
Understanding the patient's barriers to making small lifestyle changes is a key part of the medication management process.
Follow-ups and referrals to specialized providers can help patients manage their medication more effectively.

[27:04 - 40:09] Benefits of Specialized Training in Pediatric Headache Treatment
Empowers participants to become experts in their own centers or communities
Increases confidence and competence in evaluating and managing pediatric migraines
Enables healthcare professionals to be the go-to person for headache-related concerns
Improves access to high-quality care for children and teens in their own communities

[40:10 - 47:27] Resources for Migraine Education and Support
Explore the American Migraine Foundation for comprehensive information
Utilize the timeline infographic to educate families about migraine headaches
Consider partnering with organizations to expand awareness and support
Share online tools for medication management and tracking

[47:28 - 54:20] Closing segment Takeaway

You can reach Dr. Emily Foxen Craft
DrEmily@pediatricpainbehavioralhealth.com

Links to resources mentioned on the show
International Classification of Headache Disorders (ICHD): https://ichd-3.org/1-migraine/
American Migraine Foundation...

161. Menstrual Equity Changes Lives: The Power of Days

Wed, 27 Sep 2023 09:00:00 +0000

Imagine a world where menstruation is not a taboo topic, but rather a catalyst for empowerment, education, and change. In this episode of Pediatric Meltdown, join host Dr. Lia Gaggino as she interviews Celest Mergen, a passionate advocate for menstrual equity and the founder of Days for Girls. Prepare to have your preconceptions shattered as Celeste reveals the transformative power of simply listening and inviting others to be part of the solution. From engaging communities worldwide to reinterpreting past traumas, every moment is an opportunity for change. Days for Girls is not just a movement for girls, but for everyone willing to stand up and make a difference. By providing sustainable menstrual care solutions and education, they are changing lives, breaking down barriers, and empowering individuals all around the world. Celeste's talks about her experience in Kenya, where conversation and understanding led to the laying down of knives and the preservation of rich traditions without harm. As we think about applying her methods to other world problems, the positive outcomes are endless. Together, let's listen, learn, and create a world where every voice is heard and every individual is empowered to make a difference.

[00:33 -22:42] Days For Girls: Breaking Menstrual Taboos
Introduction to Days For Girls: Days For Girls provides menstrual care products and education, giving women and girls access to menstrual equity, dignity, and opportunity.
Global Impact: It addresses the pervasive issue of menstruation taboos, affecting over 500 million people worldwide, by providing essential products and starting conversations.
The Power of Conversations: By breaking the silence around menstruation, Days For Girls helps eliminate stigma and empowers women and girls to manage their periods with confidence.
Design Evolution: Days For Girls continuously improves its washable pads, involving those they serve in the design process, holding two patents, and expanding their impact globally.

[22:43 - 37:11] Changing Culture
Recognize the need for change: Understand that cultural practices may be deeply rooted and ingrained in a community.
Avoid making people wrong: People resist change when they feel criticized or judged, so refrain from telling them they are wrong.
Invite participation: Encourage people to be part of the solution rather than imposing change on them.
Find common ground: Identify shared values or aspects of the culture that everyone can agree on

[37:12 - 46:22] Impact on Girls' Lives
Empowerment through writing articles and letters to magazines about body image representation.
Positive influence of American Girl magazine's focus on stories rather than body image.
The transformative effect of providing hygiene kits to girls in need.
Stories of girls experiencing newfound confidence and freedom with hygiene products.

[46:23 - 54:12] Availability of Menstrual Products
The Isle organization offers washable menstrual products
Cups and washable products are widely available online
Washable products can be found at various stores
Various options for washable menstrual products online

[54:13 - 57:49] Closing segment Takeaway

You can reach Dr.Celeste Mergen
Insta: https://www.instagram.com/celestemergens/rgens/
Facebook:...

160. Youth Suicide Prevention: What About the Parents?

Wed, 20 Sep 2023 09:00:00 +0000

Welcome to Pediatric Meltdown, the podcast where we discuss the unique challenges parents face when it comes to their child's mental health. Host Dr. Lia Gaggino teams up with guest Dr. Cynthia Ewell-Foster to tackle the pressing issue of suicide prevention and support for families. Learn how parents can better navigate this challenging terrain as they uncover the importance of community engagement, clear communication, and empowering parents to implement discharge recommendations effectively. You’ll hear about the vital role of caregivers, the role of firearm safety, and the remarkable impact of a supportive network in times of crisis. It is crucial for parents to be vigilant and proactive when it comes to their child's mental health. By utilizing the resources available, such as the toolkit provided by the Macomb County crisis center and participating in support groups like NAMI Washtenaw County parents group, parents can navigate the challenges with more confidence. Let's take action, reduce stigma, and create a world where every child feels heard, supported, and loved. Together, we can make a difference and save lives.
TRIGGER WARNING: Please note that this episode contains a discussion of suicide, self-injurious behavior, depression and/or reference of other mental health disorders that may act as triggers.
[05:34 -15:13] Building Self-Efficacy and Capacity in Suicide Prevention
communication between systems create a seamless environment for providing comprehensive care to at-risk children.
initiatives should prioritize empowering parents, healthcare professionals, and stakeholders in suicide prevention.
Suicide prevention requires a multi-system approach involving emergency departments, therapists, and pediatricians.
Efforts should focus on building self-efficacy and capacity in different systems to address suicidal ideation in children.

[15:14 - 25:13] Cultivating Confidence and Empowerment within the Family Unit
Provide clear directions and support to help families believe in themselves
Encourage families to have confidence in their abilities to overcome challenges
Offer resources and tools to assist families in achieving their goals
Promote self-belief and resilience in families facing difficult situations

[25:14 - 37:25] Importance of Emotional Support for Parents After a Suicide Crisis
Establish a network of trusted adults who can provide emotional support to parents on a regular basis.
Encourage open communication and create a safe space for parents to express their feelings and concerns.
Provide resources and information about coping strategies and self-care to help parents navigate the emotional aftermath.
Offer professional counseling or therapy services to parents to address their own mental health needs.

[37:26 - 48:24] Strategies for Clinicians to Promote Safety and Mental Health
Secure firearms or remove them from homes.
Address medication safety and storage.
Manage access to dangerous objects.
Help patients connect with mental health professionals.

[48:25 - 57:27] Closing segment Takeaway
Links to resources mentioned on the show
Holding On To Life Toolkit: https://medicine.umich.edu/sites/default/files/content/downloads/macomb-county-cmh-holding-on-to-life-toolkit.pdf
NAMI support group:

159. Youth Suicide Prevention: Safety Planning and Lethal Means Safety Counseling

Wed, 13 Sep 2023 09:00:00 +0000

TRIGGER WARNING: Please note that this episode contains a discussion of suicide, self-injurious behavior, depression and/or reference of other mental health disorders that may act as triggers.
Welcome to the Pediatric Meltdown podcast, where Dr. Lia Gaggino will take you into the world of pediatric care to tackle the most important topics that impact the well-being of our little ones. In today's episode, Dr. Gaggino and her guest, Dr. Alejandra Arango, explore the critical role of safety planning in preventing child suicides. Their heartfelt conversation takes a deep dive into the intricacies of safety planning within various settings, highlighting the effectiveness of individualized plans, coping strategies, and community crisis resources. Creating a meaningful safety plan in just 20 minutes is not only realistic, but essential in a primary care setting. By involving all staff, from doctors to nurses to administrators, we can truly make a difference in the lives of our children. Standardized screening protocols and readily accessible safety plans in medical records make the process more feasible. Remember, a safety plan is part of a comprehensive suicide prevention approach that includes screening, assessment, evidence-based interventions, and crisis support. A unified team will provide the support and resources needed to guide our young ones through the darkest times. So, grab your headphones and get ready to learn invaluable insights that will empower you to create safe environments for our young ones, ensuring their well-being and building a brighter future.
[05:58 -17:27] Importance of Tailoring Safety Plans to Individuals
The effectiveness of a safety plan is enhanced when the person themselves contributes ideas on how to distract or cope with distressing thoughts.
Safety plans should go beyond simply checking off boxes and should encourage open discussions about strategies for managing difficult situations.
Providers should actively engage with patients to understand their unique warning signs and triggers.
Safety plans should be regularly updated and revised to ensure they remain relevant and effective.

[17:28 - 28:24] Specificity in distraction strategies
Consider options like watching videos of cats, playing a specific video game, or listening to a certain song
Encourage team members to be specific about what engages them personally
Highlight the importance of finding activities that pull the brain's attention
Suggest coloring or other activities that require focus and concentration

[28:25 - 43:57] Safe Storage of Firearms and Medications
Proper storage methods for firearms, such as gunlocks or safes
Separating ammunition from firearms and keeping them in secure locations
Educating families on safe storage practices
Discussing potential barriers and feelings associated with safe storage
Including over-the-counter medications in safe storage practices

[43:58 - 55:06] Integrating Safety Plans into Medical Records
Standardized screening and assessment protocols for providers
Incorporating safety plans into the medical record system
Easy accessibility of safety plans for healthcare professionals
Streamlining the process of pulling up safety plans during consultations
Ensuring safety plans are readily available for problem-solving with the youth

[55:07 - 01:04:09] Closing segment Takeaway

Links to resources mentioned on the show
Stanley Brown Safety Plan Template:

158 Preventing Youth Suicide: Risk Assessment and Management

Wed, 06 Sep 2023 09:00:00 +0000

https://swiy.co/WhatAreYourThoughts
TRIGGER WARNING: Please note that this episode contains a discussion of suicide, self-injurious behavior, depression and/or reference of other mental health disorders that may act as triggers.
In this thought-provoking episode, Dr. Lia Gaggino invites Dr. Lisa Horowitz back to the mic to discuss important aspects of suicide prevention programs and validation studies. They specifically focus on the role of pediatricians in identifying and supporting young people who may be at risk. They introduce the Brief Suicide Safety Assessment (BSSA), a tool that can help in these situations. Dr. Horowitz emphasizes the importance of using appropriate language when discussing suicidality with parents, offering a valuable perspective that can change how we approach this sensitive topic. This episode serves as a reminder of how crucial it is for caregivers to provide guidance, support, and reassurance to children, and to make them aware of available resources when facing challenges. Just like we talk to our children about topics such as safe sex or drugs and alcohol, discussing resilience should also be an ongoing conversation. Caregivers must equip children with coping mechanisms rooted in resilience to prepare them for the future. So together, let's create a community where children feel safe to ask questions, without fear of judgment or stigma. By investing time today in building resilient kids, we can nurture a generation capable of overcoming any hurdles they may encounter tomorrow.
[02:37 -12:30] Screening Practices and Feasibility Studies
Several studies demonstrate the feasibility of screening practices.
Screening can be effective in identifying acute and non-acute cases.
The fifth question in the screening process determines the acuity of the situation.
Comprehensive toolkits provide scripts and guidance for medical professionals.

[12:31- 23:41] Brief Suicide Safety Assessment (BSSA)
Specifically created with pediatricians in mind to aid in suicide risk assessment.
Aims to remind pediatricians about essential elements of the BSSA.
Serves as a middle step in the pathway of suicide screening programs.
Offers a triage of the screening process to further assess and prioritize patients.

[23:42 -31:52] Practical Next Steps
Determine urgency: Assess immediate need for intervention based on the frequency and severity of the thoughts
Provide support: Offer a listening ear and a calm presence to help the individual express their feelings and thoughts comfortably.
Safety measures: Talk about the importance of safety, including lethal means safety, especially when firearms are involved, to prevent any potential harm.
What’s next: Based on the assessment and discussion, determine the appropriate disposition or action plan to address the individual's needs effectively.

[31:53- 39:49] Importance of Taking Action and Finding Support
Emphasize the difference between doing nothing and doing something.
Stress that it is acceptable for plans to change if the initial approach is not working.
Assure individuals that there is a process and plan in place to keep them safe.
Offer the option for a follow-up call from your staff to inquire about their well-being, providing a sense of reassurance and support for parents.

[39:50 - 48:05] Closing segment Takeaway

Links to resources mentioned on the show
NIMH ASQ Toolkit:

157: Celebrating 3 Years: Reflecting on Pediatric Meltdown's Journey

Wed, 30 Aug 2023 09:00:00 +0000

https://swiy.co/WhatAreYourThoughts
In this abbreviated episode of Pediatric Meltdown, Dr. Lia Gaggino celebrates 3 years of the Pediatric Meltdown podcast and opens up about the challenges and uncertainties that come with transitioning from a daily pediatric practice. Join her as she explores the psychological grief and identity crisis she faced when stepping away from patient care. Dr. Gaggino shares the realization that being a pediatrician goes beyond simply seeing patients in an office, reminding us that purpose and impact can take various forms. From her involvement with the American Academy of Pediatrics to her role as a consultant in a Child Psychiatry access program, she finds new avenues to make a difference in children's lives, and last but never least, this podcast that has reached listeners worldwide. The Heart of Pediatric Meltdown is the passionate conversations with all the high-profile experts that share time with Dr. Gaggino. They remind us that even in the face of uncertainty, we can find purpose, make a difference, and bring hope to the lives of our children. Dr. Gaggino wants to thank you so much for joining her on this incredible journey, and together, let's continue to create a world where every child's mental and emotional well-being is prioritized.
Other episodes you may like:
For all episodes, go to Pediatric Meltdown
107 Suicide Prevention That Works: The Zero Suicide Framework
114 Palliative and Hospice Care: A Conversation on Grief and Joy
Key quotes for Twitter:
"Not that I love social media so much, but I really want to spread the word about pediatric meltdown, and I hope you can help me do that.".... Dr. Lia Gaggino on the challenges of social media
"I want this podcast to be for all of you who take care of children."... Dr. Lia Gaggino on who would get the most out of the podcast.

THANK YOU FOR YOUR SUPPORT!
Pediatric Meltdown was listed as a Top 20 Pediatric Podcast on FeedSpot.
If you’d like to connect with me, you can Tap the “What Are Your Thoughts” button at the top of the notes or you can find me on LinkedIn, Facebook, Instagram, and Twitter, or email me at gagginol@medicalbhs.com or gagginol@yahoo.com. To learn more about me visit https://www.medicalbhs.com/
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156. Trauma-Informed Primary Care: Changing Culture

Thu, 24 Aug 2023 09:00:00 +0000

https://swiy.co/WhatAreYourThoughts
In this thought-provoking episode of Pediatric Meltdown, host Dr. Gaggino welcomes special guest Dr. Polly Y. Gipson Allen as they do a deep dive into the world of trauma-informed care and its impact on primary care settings. Reflecting on personal experiences and societal awakenings brought about by the pandemic, they shed light on the psychological, physical, and spiritual effects of racial trauma and discrimination. From trauma-informed care to enhancing organizational capacity, the duo explores the various strategies and policies that can be implemented to create a culture of soul and self-care not only in clinical facilities, but also in schools as well. Join them as they share insights on building resilience, integrating mental health support, and the role of integrated care models in providing holistic patient care. It is time to prioritize the mental wellbeing of our patients and students and ensure that they have access to the resources and support they need. Let us be the voice that advocates for school-based mental health services and screenings, because every child deserves a caring and nurturing environment where they can thrive and grow. Together, we can transform our primary care settings into spaces that heal not just the body, but also the soul.

[00:33 -13:07] Trauma Prevalence and the 5 R's of Trauma Informed Care
The 1st R: Realizing the widespread impact of trauma and the potential paths for recovery
The 2nd R: Recognizing the signs and symptoms of trauma in patients and families
The 3rd R: Responding by integrating trauma knowledge into policies, practices, and procedures
The 4th R: Resisting re-traumatization within primary care settings
The 5th R: Promoting resilience and the ability to cope, adapt, and recover from trauma and stress

[13:08- 21:28] Identifying Trauma in Primary Care Settings
Assign champions within the clinic to facilitate the implementation of trauma screenings.
Ask a question like "Since the last time I saw you, has anything really scary or upsetting happened to you or your family?" to initiate the conversation on trauma.
Conduct brief screenings that take around 5 to 10 minutes to identify traumatic exposure or stress symptoms.
The purpose of universal screening is to guide clinical decision making and determine if further trauma assessment is required.

[21:29 -32:19] Integrated Care Models
Collaborating with clinical colleagues, behavioral health professionals, and social workers
Warm handoff process for seamless care transitions
Identifying primary care or behavioral health as the initiator of the brief screen
Focusing on holistic well-being and integrating mental and physical health

[32:20 - 43:30] Engaging the Community
Organize focus groups or community events to gather input and feedback on improving care
Collaborate with community members and leaders to form a planning committee for implementing changes
Address barriers to access such as transportation or lack of resources
Leverage community traumatic events to bring people together, raise awareness, and promote community support and resilience

[43:31 - 47:45] Closing segment Takeaways

Links to resources mentioned on the show
Resources:
https://www.nctsn.org/
https://seekwellbeing.org/

155. Surveying for ACES in Primary Care: A Pediatrician’s Experience

Wed, 16 Aug 2023 09:00:00 +0000

https://swiy.co/WhatAreYourThoughts
Get ready for another thought-provoking episode of Pediatric Meltdown, the podcast that explores the untold stories and groundbreaking developments in pediatrics. Host Dr. Lia Gaggino sits down with Dr. Wendy Hunter, a remarkable pediatrician who has revolutionized the way pediatric care is delivered. Reflecting on Wendy's inspiring journey, we are reminded of the profound impact that social determinants of health have on pediatric patients' lives. As healthcare professionals, it is our duty to not only treat their physical symptoms but also understand their unique experiences and address the underlying issues. By incorporating trauma screening and fostering community partnerships, we can create a healthcare system that truly supports the holistic well-being of our patients. Let Dr. Hunter's story be a call to action for all of us to champion, change and prioritize the social determinants of health in our own practices. Let us all be inspired to make a difference in our own professions, and remember that even amidst the chaos, there is incredible power in staying true to our passions and values.
[00:33 -17:40] Community Outreach Programs on Trauma Awareness
Community-based organizations as partners in spreading health literacy and trauma information.
Bringing pediatricians to low-income housing communities, homeless shelters, and maternity shelters.
Using interactive sessions with families to discuss health topics and model reading practices.
Breaking down communication barriers and fostering trust by engaging with families in their own communities.

[17:41- 26:51] Training and Preparation for Asking ACEs Questions
Presentation on ACEs and specific scripting for introducing and discussing the screener
Utilization of Epic EMR with smart phrase scripting for easy reference during conversations
Orientation and training for office staff by the training staff
Front office trained on patient self-administered ACEs questionnaire on tablets or mobile devices

[26:52 -37:45] Workflow Process for Screening a Four-Year-Old
Introduce the pearls questionnaire as part of the routine well visits for children at the appropriate age.
Ensure the questionnaire is integrated into the EMR system to streamline the process.
Provide a comfortable and confidential environment for the family to fill out the questionnaire.
Use identified scores to facilitate a discussion with the family, providing appropriate guidance and support.

[37:46 - 45:34] Managing Wellness and Work-Life Balance
Importance of having a basic level of competence in mental health for everyone
Grant opportunities for physicians to receive training in managing ADHD, anxiety, and depression
The Pediatrician Next Door podcast as a platform to educate and entertain families and pediatricians
Personal values and rituals as a guide for managing well-being and making decisions

[45:35 - 50:59] Closing segment Takeaway

You can reach Dr. Wendy Hunter
Website: www.drwendyhunter.com
Facebook: Dr. Wendy Hunter | Facebook
Instagram the_pediatrician_next_door
Twitter:...

154. The Joys and Challenges of Pediatrics: Gather Your Spoons!

Wed, 09 Aug 2023 09:00:00 +0000

https://swiy.co/WhatAreYourThoughts
Welcome to the Pediatric Meltdown podcast, where we delve into the challenges and triumphs of pediatric healthcare. Today, host Lia Gaggino has the pleasure of introducing her guest, (and self-proclaimed “superfan” of Pediatric Meltdown), Dr. Alisa Minkin, a trailblazing pediatrician and host of the JOWMA Podcast, a show dedicated to health education for the Orthodox Jewish community. In today’s episode, Dr. Minkin shares her inspiring journey as a pediatrician and her unwavering commitment to mental health awareness. Drawing from her experiences as a parent to a child with special needs, as well as her advocacy for mental health screenings, Dr. Minkin's story is one of passion, resilience, and making a difference in the lives of children and families. Despite the barriers of time and limited resources, she has embraced telehealth as a double-edged sword and implemented crucial mental health screenings in her practice. Her desire to hear more voices of lived experiences, particularly from autistic and neurodivergent individuals and family partners, reminds us of the importance of inclusion and diverse perspectives in approaching pediatric care. Her journey serves as an inspiration for healthcare professionals and parents alike. With her passion and determination, she is indeed a true mental health warrior. So, grab your headphones and tune in to this episode – you don't want to miss this thought-provoking episode.
The Spoons Theory: The spoon theory is a metaphor describing the amount of physical and/or mental energy that a person has available for daily activities and tasks, and how it can become limited. It was coined by writer and blogger Christine Miserandino in 2003 as a way to express how it felt to have lupus; explaining the viewpoint in a diner, she gave her friend a handful of spoons and described them as units of energy to be spent performing everyday actions, representing how chronic illness forced her to plan out days and actions in advance so as to not run out of energy.
The metaphor has since been used to describe a wide range of disabilities, mental health issues, forms of marginalization, and other factors that might place an extra and often unseen burden on people living with them. From Spoon theory - Wikipedia
[03:10 - 09:01] Barriers to meeting mental health needs
Limited time for pediatricians to address mental health concerns during appointments.
Lack of resources, especially for those who accept insurance or Medicaid.
Challenges in finding qualified therapists and mental health resources.
Disparities between Medicaid and private insurance coverage for mental health services.

[09:02 - 14:24] Training Programs and Resources
Case reviews and phone calls as part of the Reach program
Utilizing Project Teach, a child psychiatry access program
Listening to podcasts, including the Joma and Pediatric Meltdown podcasts
Learning from personal experiences and emotionally resonant stories

[14:25 - 22:34] Personal Reflections and Advocacy
Highlighting the importance of suicide prevention and her sister's experience with it.
Discussing the journey of implementing suicide prevention screening in her practice and allied supergroup.
Expressing gratitude for the support received from experts in the field.
Describing the introduction of combined ASQ Gad and PHQ screening tools in her practice.

[22:35 - 32:47] The Importance of Advocacy and Creativity in...

153. Caring for Children in Military Families: What Pediatricians Need to Know

Wed, 02 Aug 2023 09:00:00 +0000

https://swiy.co/WhatAreYourThoughts
Welcome back to Pediatric Meltdown. In this week’s episode, host, Dr. Lia Gaggino welcomes Dr. Lee Beers and Dr. Binny Chokshi, where they discuss the often-overlooked topic of military families and the unique challenges they face. As a military pediatrician, Dr. Beers shares her personal journey and experiences taking care of military-associated families. Dr. Chokshi, a civilian pediatrician who provides care to military families, also shares her role in researching the impact of military life on children's mental health and overall well-being. Together, they highlight the importance of understanding the demographics and specific stressors of military families, such as parental deployments, frequent moves, and potential injuries or PTSD. They also emphasize the strengths and resources available to military families, including the strong sense of community and access to specialized support services. The subject of military children and mental health can no longer hide in the shadows. These extraordinary young individuals sacrifice so much in service to our nation, so let us continue to advocate, educate, and empower our military families so that they receive the care, understanding, and support they truly deserve.
[00:33 -17:03] Opportunities for Pediatricians in the Military
Military scholarships available that cover medical school expenses and provide additional funds.
Unique clinical opportunities, such as working with military families in Guantanamo Bay.
Opportunities for leadership roles within the armed forces and military treatment facilities.
Ability to serve an important group of children and families while practicing medicine.
Access to resources and support specifically tailored to military families.

[17:04 - 23:16] Considerations for Caring for Military Children and Families
Asking specific questions to understand the stress and uncertainty of deployments
Recognizing the strength and support from military communities
Being creative in helping families navigate disruptions caused by deployments
Utilizing innovative programs like video calls for deployed service members and their children
Addressing the challenges of living in the moment due to uncertainties and stressors

[23:17 - 36:44] Impact on Mental Health of Children in Military Families
High prevalence of mental health struggles among military children
Factors impacting mental health moves, deployments, transitions, and caregiving for injured parents
Importance of recognizing and addressing the mental health needs of military children
Protective factors: positive childhood experiences, peer support, and a sense of community
Collaborative efforts to provide support for hidden helpers and families of injured service members

[36:45 - 46:50] The Role of Pediatricians
Pediatricians can advocate for military families, recognizing and addressing their unique challenges and life stressors.
Pediatricians can play a role in normalizing the act of seeking help and support for military kids and their families.
Pediatricians are in a unique position to support military families, utilizing their knowledge and expertise in pediatric care.
Serving as a military pediatrician offers opportunities for growth, leadership, and learning in the field of pediatrics.
Pediatricians can deepen their gratitude towards military families and appreciate the sacrifices they make for the nation.

[46:51 - 51:01] Closing...

152 The Mysteries of Abdominal Pain: Disorders of the Gut-Brain Interactions

Wed, 26 Jul 2023 09:00:00 +0000

https://swiy.co/WhatAreYourThoughts
Welcome to this week's Pediatric Meltdown Podcast, where host Dr. Lia Gaggino invites guests Dr. Bruno Chumpatazi and Dr. Amanda Deacy to unravel the mysteries behind chronic symptoms in children. Together, they delve into the complexities of post infectious IBS, highlighting the multifaceted causes that contribute to these symptoms. From altered pain perception and processing to the potential role of inflammation, the experts leave no stone unturned. Discover how food sensitivities, the microbiome, and seasonal allergies come into play in shaping the experience of chronic symptoms. Join us as we explore the multidisciplinary treatment plans, focusing on non-pharmacological interventions like relaxation training and cognitive behavioral therapy. It's time to gain a better understanding and listen, learn, and advocate for the multidisciplinary support and resources that these children and their families desperately need. Together, we can make a profound impact on their journey towards wellness.
[09:24 -21:07] Impact and Contributing Causes
Disorders of gut-brain interactions (DGBI) affect 25% or more of school children worldwide.
Early life events, such as being born prematurely or having a nasogastric tube placed, can increase the risk of developing DGBI.
Sensitizing medical events, like inflammation or infection, can trigger or exacerbate DGBI symptoms.
Psychosocial factors, including depression, anxiety, family stress, and abuse, can also contribute to the development and severity of DGBI symptoms.

[21:08 - 34:35] Preliminary testing for evaluating abdominal pain
Acknowledge that the symptoms are real and not imagined
Avoid dichotomizing symptoms as either physical or psychological
Emphasize the biopsychosocial nature of the condition
Avoid giving families the impression that medication is a quick fix
Inform families that the treatment may take time and require attention and coping strategies

[34:36 - 48:43] Golden Rules in DGBI Treatment
Acknowledge that the symptoms are real and not imagined
Avoid dichotomizing symptoms as either physical or psychological
Emphasize the biopsychosocial nature of the condition
Avoid giving families the impression that medication is a quick fix
Inform families that the treatment may take time and require attention and coping strategies

[48:44 - 01:02:02] Non-pharmacological interventions for pediatric abdominal pain
Importance of attention and cognitive processing in pain management
Gradual physical rehabilitation to improve strength and stamina
Relaxation training as a mechanism to decrease overall nervous system activation
Various techniques under relaxation training, including hypnotherapy and biofeedback training
Educating adults (parents, teachers) on therapeutic approaches to influence the child's environment

[1:02:03 - 01:08:11] Closing segment Takeaway

You can reach Dr. Bruno Chumpatazi
Twitter: @‌Dr_BrunoC

You can reach Dr. Amanda Deacy
Twitter: @‌ADeacyPhD

Links to resources mentioned on the show

Hyams J et al. Functional Disorders: Children and Adolescents
Gastroenterol 2016; 150:1456-1468. PMID: 27144632

151 American Indian/Alaskan Native Youth: Beyond Adversity

Wed, 19 Jul 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
As the only pediatrician in her Native American community, Dr. Empey’s insights and first-hand experiences offer a valuable perspective on the need for better representation and improved healthcare access. Dr. Gaggino and Dr. Empey urge all of the listeners, (especially all you early career physicians), to step up and take leadership roles at every level within the medical community. We cannot afford to ignore the health inequities faced by marginalized populations, including American Indian and Alaska Native children. Let us learn from the historical traumas that have shaped their communities and continue to impact their well-being. Through cultural competency, collaboration, and advocacy, we can prioritize their unique needs and ensure that their voices are heard. It is our call to action to dismantle systemic barriers and work towards healing and justice. The journey may be challenging, but the rewards of creating a more equitable and inclusive healthcare system for all are immeasurable. Together, we can pave the way for a brighter future, leaving no child behind.
[03:20-10:21] Challenges and Strengths of American Indian and Alaskan Native Children and Youth
Many pediatricians may not realize they have children from tribal communities in their practices
Consider the cultural, religious, and spiritual practices of these children and their families in providing care
Majority of American Indian and Alaskan Native population live off reservations, in urban centers
Urban population seeks care at children's hospitals due to limited IHS or tribal facilities
Language, cultural, and historical diversity among different tribes need to be acknowledged and respected

[10:22- 16:14] Historical Trauma and Health Inequities
Contextualizing health inequities within the historical traumas faced by American Indian and Alaskan Native communities
Impact of colonization, diseases, boarding schools, termination of tribes, and relocations on communities
Examples of personal and intergenerational traumas, such as the Trail of Tears and Indian boarding schools
Loss of culture, language, and family connectedness due to boarding school experiences
Effects of relocations on access to traditional foods, opportunities for employment, and increased poverty levels

[16:15 -21:25] Health Outcomes and Concerns for Kids
Mental health concerns, including an increased risk of suicide
Obesity and type 2 diabetes
Cardiovascular risk factors and hypertension
Lack of safe places for kids to play in some communities
Limited access to fresh fruits and vegetables due to food deserts

[21:26 - 27:17] Methods for Stress Reduction
Practicing mindfulness and meditation
Engaging in regular physical activity
Socializing and spending time with loved ones
Engaging in hobbies and recreational activities
Seeking professional help or therapy when needed

[27:18 - 31:44] Closing segment Takeaway

Links to resources mentioned on the show
AAP Caring For American Indian and Alaskan Native 2021 Policy Statement:

150 Integrating Behavioral Health: PCP Transformation!

Wed, 12 Jul 2023 09:00:00 +0000

Welcome to Pediatric Meltdown, the podcast dedicated to exploring the complexities and challenges of pediatric care. Today, host Dr. Lia Gaggino and guest speaker Dr. Marian Earls tackle the concepts of mental health competencies and integrated behavioral health. As pediatricians, it is crucial to have a multifaceted understanding of mental health and offer the necessary support to children in need. From debunking myths surrounding SSRIs to advocating for policy and payment support, Lia and Marian offer valuable insights into the integration of mental health into pediatric practice. By incorporating evidence-based therapies and working collaboratively with mental health specialists, pediatricians can effectively address mild to moderate mental health issues within their scope of practice. Pediatricians, with their long-standing relationships with families, have a unique opportunity to identify and address these issues early on. Together, we can break down the barriers and stigma surrounding mental health, ultimately improving outcomes and nurturing the emotional well-being of our future generation.
[03:18 -19:09] Overcoming Barriers and Promoting Mental Health
Helping pediatricians understand the tools they already have
Recognizing activities that promote mental health, such as reading with children
Understanding the role of psychiatrists in co-management
Discussing the panic and misconceptions regarding mental health assessment

[19:10 - 25:21] Collaboration and Advocacy for Improved Mental Health Services
Advocacy efforts by AAP at the national level to promote integrated mental health care
Need for engaged Chapters to build relationships with Medicaid programs and private payers
Recognition of the significant benefits of integrated care, including reduced stigma, improved access, and better outcomes
Ability to expand capacity and reserve referrals for children with more complex needs through effective management and collaboration with schools and community mental health services

[25:22 - 33:29] Overcoming Barriers and Promoting Mental Health
Helping pediatricians understand the tools they already have
Recognizing activities that promote mental health, such as reading with children
Understanding the role of psychiatrists in co-management
Discussing the panic and misconceptions regarding mental health assessment

[33:30 - 46:29] AAP Resources for Mental Health Support
Podcasts on psychopharm with experts discussing anxiety meds, SSRIs, and aggression
Understanding and managing medications for children on psychotropic drugs
Guidelines and resources for managing ADHD and depression
AAP's endorsement of Glad PC for identifying and managing depression in kids

[46:30 - 51:19] Closing segment Takeaway

Links to resources mentioned on the show
AAP Mental Health Initiatives: https://www.aap.org/en/patient-care/mental-health-initiatives/
AAP Mental Health Practice Readiness Inventory: https://downloads.aap.org/AAP/PDF/PracticeReadinessInventory.pdf?_ga=2.52822312.1802788953.1685034173-313239514.1676996324
Hunter and Goodie Integrated Behavioral Health in Primary Care:

149 Management of Youth Depression: Beyond Medications

Wed, 05 Jul 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Youth mental health is a pressing issue that often goes untreated, but in this episode of Pediatric Meltdown, Dr. Lia Gaggino and Dr. Rich Dopp shed light on effective strategies for addressing this challenge. Dr. Dopp's expertise in treating adolescents with depressive disorders shines through as he discusses the use of SSRIs and the significance of understanding family history. The episode also highlights the importance of gathering information from multiple sources and utilizing various measures and questionnaires to assess depression in younger children. From recognizing the benefits of exercise in improving mood to discussing the importance of tailored treatment plans, they provide valuable insights for both healthcare professionals and caregivers. With practical advice and a personalized approach, this episode equips listeners with valuable insights to navigate the complexities of youth mental health.

[00:33 -14:52] The Rising Prevalence of Depression in Children and Adolescents
The increasing incidence of major depressive episodes among youth
The potential underestimation of depression rates in certain situations
The lack of access to treatment for the majority of affected youth
The impact of social media, sleep deprivation, traumatic experiences, and negative political climates on depression rates

[14:53 - 26:17] The Importance of Sleep for Mood
Sleep as a vital factor for mood regulation
Lack of sleep as a symptom of depression
Sleep disturbance and its impact on mental health
Strategies to support better sleep: removing electronic devices, reducing overhead lights, guided meditation, and breathing exercises

[26:18 - 43:30] Tailoring Therapy to Meet Individual Needs
Identifying goals is an important first step in tailoring therapy to meet individual needs
Social skills and problem solving exercises can lead to early gains in functioning
Therapy can be tailored to an individual's interests and hobbies
Changes in functioning can be easier to identify and foster than changes in feelings when treating depression

[43:31 - 56:11] Benefits and Effectiveness of SSRIs
Proven efficacy in treating depression and reducing symptoms
Effective in reducing anxiety symptoms in some individuals
Can help regulate sleep patterns and improve sleep quality
May enhance cognitive function and improve concentration

[56:12 - 01:02:25] Closing segment Takeaway

Links to resources mentioned on the show
AAP Guidelines for Adolescent Depression Glad PC 1 https://publications.aap.org/pediatrics/article/141/3/e20174081/37626/Guidelines-for-Adolescent-Depression-in-Primary?autologincheck=redirected

AAP Guidelines for Adolescent Depression Glad PC 2. https://publications.aap.org/pediatrics/article/120/5/e1313/71096/Guidelines-for-Adolescent-Depression-in-Primary

AACAP Facts for Families – Depression

148 Mental Health Leadership: AAP President Dr. Sandy Chung’s Journey

Wed, 28 Jun 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
This episode of "Pediatric Meltdown" features an insightful conversation with Doctor Sandy Chung, the 2023 president of the American Academy of Pediatrics. Dr. Chung joins host Dr. Lia Gaggino to discuss the importance of investing in children's mental health. The AAP is a national organization that represents over 67,000 pediatricians and aims to promote the health and well-being of children. Dr. Sandy Chung's advocacy work through VMAP and AAP has been instrumental in shaping the discourse on children's mental health and providing access to mental health care. While policymakers need to understand the need for long-term investment in children's mental health, it is also the responsibility of every individual to prioritize mental health and create supportive environments for young people. Let us all work towards prioritizing the mental health of children and building a brighter future for coming generations.
[00:33 -18:39] Being the First Chinese American President of the AAP
Overcoming barriers and inspiring change
Importance of breaking stereotypes and categories
Encouraging individuals to pursue leadership roles
Finding the right group of like-minded professionals

[18:40 - 27:11] Making Mental Health Care Sustainable and Accessible
Implementing group therapy appointments, integrated behavioral health, brief interventions, and collaborative care to make mental health care more accessible and affordable
The AAP is actively working on making mental health care a top child health priority and advocating for sustainable funding and support
AAP aims to raise awareness about the value of pediatricians in early mental health intervention and promote the importance of prevention and resilience-building in children.
It is crucial for individuals, government, employers, and society as a whole to prioritize and support mental health care to ensure healthy and productive adult outcomes.

[27:12 - 35:13] Challenges in Addressing Mental Health in Healthcare
Lack of awareness and understanding of the importance of mental health in healthcare
The need for momentum and improvement in addressing mental health
The broader conversation of investing in children's well-being
Short-term perspective in healthcare financing and the need for a long-term investment approach

[35:14 - 41:19] Embracing Opportunities and Making a Difference in Pediatric Practice
Letting go of future worries: Embracing the uncertainty of life and career progression
Seizing opportunities: The power of taking chances and making a positive impact
Making a difference, big or small: Recognizing the potential to create change in everyday practice
Preventing future hardships: Harnessing the experiences of pediatric care to improve outcomes for children and families

[41:20 - 46:17] Closing Segment Takeaway

Links to resources mentioned on the show
National Network of Child Psychiatry Access Programs – find one near you!
www.nncpap.org/map

Other episodes you may like:
https://302.buzz/LinkToAllEpisodes
112 Schizophrenia: Recognizing the Early Symptoms
  96 AAP Blueprint for Youth Suicide Prevention: A Roadmap
  91 Youth Mental Health...

147 Racial Discrimination and Black Infant Morbidity and Mortality: Systemic Change Starts with You

Wed, 21 Jun 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Unless you’ve been a victim of Healthcare Disparity and systemic racism, you may not be aware that such a thing exists, and that’s exactly why this episode of “Pediatric Meltdown” is especially important for you to hear. Host Dr. Lia Gaggino and her guest Dr. Terri Major-Kincade, discuss the structural barriers that exist in hospitals and Dr. Terri will give some practical advice on being empathetic and listening to patients' concerns. From Dr. Terri’s expertise in racial health disparities to Dr. Lia's wisdom in pediatric mental health, this episode represents a step towards understanding and addressing the root causes of these issues. It's clear that change is required to overcome the challenges in our healthcare system and provide equitable care for all. You’ll also hear about some creative ideas, everything from an Uber delivering breast milk to converting a convenience store into a Farmer’s Market. It’s solutions like these that tell us conversations around this issue must continue and more voices need to be heard to create the momentum required for change. We must recognize that health disparities are not only a moral issue but also an economic one that affects our entire society. By working together towards an overall change, we can create an equitable healthcare system that benefits everyone, regardless of their gender, race or socioeconomic status.

[00:33 -21:44] Disparities in Infant Mortality Rates
Infant mortality rates in certain zip codes in New York City for black infants were higher than some third world countries.
Black women with a college degree are still two times more likely to have an adverse birth outcome compared to white women with a GED in the United States
Poverty and lack of prenatal care are not the only factors contributing to these disparities
SES status (socioeconomic status) does not protect black women from experiencing adverse birth outcomes
The way in which the healthcare system intersects with black women is a contributing factor to disparate care.

[21:45 - 37:29] Impact of Stress on Pregnancy and Childbirth
Women who experience chronic stress have an increased likelihood of preterm birth
Chronic stress can lead to remodeling of the cervix and womb, causing challenges during pregnancy
Stress during pregnancy can also increase the risk of hypertension in children
Normalizing the act of asking for help and saying no can help break the cycle of stress
Chronic stress can also impact telomeres and shorten them, potentially leading to health issues

[37:30 - 50:26] Supporting a Grieving Family
Offer condolences and express your willingness to help
Listen actively and without judgment
Use the child's name and ask about their memory
Maintain eye contact. Let them know that you hear them, you see them
Respect the family's wishes and boundaries, and avoid offering unsolicited advice or opinions

[50:27 - 57:21] Vision for a Better Future
A future where conversations about race, color, and culture are unnecessary, but diversity is celebrated
Emphasizing cultural humility can help us see people's humanity rather than their circumstances
Allocating more resources to preventive health and normalizing mental health services can lead to significant improvements
Partnering with communities and addressing social determinants of health can help reduce health disparities
Recognizing our own biases and being open to learning and growth can lead to positive change for...

146 Racism, Medicine, and Transformation: Eliminating Health Disparities and Systemic Inequities

Wed, 14 Jun 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
The adverse effects of racism in healthcare have increasingly become a topic of discussion among medical professionals worldwide. In this episode of the Pediatric Meltdown, host, Dr. Lia Gaggino, is joined by Dr. Joseph Wright, Chief Health Equity Officer of the University of Maryland Medical System, to discuss the role of race consciousness in addressing systemic and structural inequities in healthcare delivery. Dr. Wright talks about how we can no longer ignore the impact of racism on child development, which can have long-term consequences for their health and well-being. It is the responsibility of pediatricians to advocate for a society that values diversity and promotes equity, and to continue learning about the science of resilience and epigenetic impacts of racism. We must push ourselves to confront and address systemic racism in our healthcare systems, and work towards a future where all children have equal opportunities for health and success. The path towards healing and transformation begins with acknowledging the truth of our past, and taking action to create a better future. If we commit ourselves to this work, together, we can create a brighter and healthier future for all children.
[00:33 -15:26] Racial Disparity and Inequities
Racial disparities and inequities are deeply embedded in society and history
Historical events like the murder of Emmett Till and church bombings highlight the violence against black people
The sacrifice of children in pivotal events in the civil rights era should not be forgotten
Tackling racial disparities and inequities requires collective effort and ongoing momentum

[15:27- 29:16] The Impact of Adversity on Child Development
Personal experiences can have a significant impact on a child's development and shape their worldview
Exposure to adverse experiences, such as racism and discrimination, can shape a child's worldview and impact their health outcomes
Stressors can sow the seeds for chronic diseases in children who experience adversity
Understanding the impact of exposure to racism and adverse experiences is crucial for child health professionals in promoting the well-being of children

[29:17-38:57] Factors affecting childhood development
A safe and secure community also plays a significant role in children's well-being
Small details such as self-care products that work for ethnic hair can also impact a child's perception of inclusivity and acceptance
Words, both big and small, can have powerful effects on a child's growth and development
Acknowledging and addressing racial disparities in healthcare can make a significant difference in child health outcomes

[38:58- 51:07] The significance of challenging systemic inequities in healthcare
The healthcare system benefits some groups while ignoring others, impacting the health of vulnerable children.
All children deserve to be healthy, and efforts should be made to ensure that those who have been left out are not forgotten.
It is necessary to challenge structural and systemic inequities to create a level playing field for all.
Addressing healthcare disparities requires a race-conscious approach that acknowledges the role of race and racism in differential experiences.

[51:08 - 55:46] Closing segment Takeaway

Links to resources mentioned on the show

145 Youth Opioid Use Disorder: What Primary Care Needs to Know

Wed, 07 Jun 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Despite ongoing efforts to combat the opioid crisis, there has been a steady increase in the number of individuals struggling with substance use disorder. This trend has left healthcare providers and parents searching for effective ways to address the problem. In this episode of Pediatric Meltdown, Dr. Lia Gaggino and Dr. Deepa Camenga delve into the impact of the opioid epidemic on children and teenagers. They also discuss strategies for screening, identifying, and treating substance use disorder in pediatric patients. One of the primary challenges faced by clinicians is maintaining confidentiality. It is crucial to ensure that teenagers feel heard and respected, as this is instrumental in building trust and facilitating necessary treatment. Simultaneously, parents play a vital role in initiating open conversations with their children about substance use and addiction. By proactively managing addiction at an early stage, teenagers can lead healthy and fulfilling lives, thereby avoiding the long-term consequences associated with addiction. If you know anyone who might be battling with this issue, please share this very important episode.
[00:33 -14:14] Opioid Use Disorders in the US
Approximately 2.7 million people in the US have an opioid use disorder
The numbers of teens and young adults with opioid use disorder are smaller but may be underestimated
The age of first use of opioids has risen from adolescence to just above 18 years old
The AAP recommends validated screeners for substance use such as the S2BI, B-STAD, and CRAS

[14:15 - 27:24] Strategies for Supporting Youth with Substance Use
Build a trusting relationship with the youth
Use open-ended questions to encourage conversation
Listen actively and reflectively to what the youth is saying
Avoid using judgmental language or tone

[27:25 - 38:59] Confidentiality in Adolescent Substance Use
Gray area in breaking confidentiality for substance use
Breaking confidentiality for fentanyl and heroin use is necessary
Clinical judgment needed for vaping and cannabis use
Be prepared for uncomfortable conversations with parents about breaking confidentiality

[39:00 - 48:06] Resources for Treating Substance Use in Teens
Child psychiatry access programs are expanding across the US
Family medicine providers can be valuable resources for treatment referrals
The Provider's Clinical Support System offers resources on medications for opioid use disorder
The AAP provides buprenorphine trainings and echoes for pediatric clinicians

[48:07 - 55:45] Closing segment Takeaway

You can reach Dr. Deepa Camenga
www.linkedin.com/in/Deepa-Camenga.

Links to resources mentioned on the show
--AAP News Article: Fentanyl a rising threat to child health: What pediatricians should know
https://publications.aap.org/aapnews/news/22634/Fentanyl-a-rising-threat-to-child-health-What
--Resources for Parents Partnership to End Addiction drugfree.org
--Provider...

144 Self-Injurious Behaviors in Youth: Assessment and Management

Wed, 31 May 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Mental health is a crucial aspect of our lives, yet it's often neglected and stigmatized. Dr. Lia Gaggino and her guest, Dr. Carol Chen, will discuss the delicate subject of self-harm and how it pertains to mental health in this episode of Pediatric Meltdown. They examine the numerous causes of young people's self-injury as well as the risk factors and comorbidities that go along with it. You'll learn about Dialectical Behavioral Therapy (DBT), a successful therapy, and how parents can help their kids who engage in self-harming behaviors. For parents, educators, and mental health professionals who want to address self-harm in a helpful and constructive way with advice on coping methods, particularly for adolescents struggling with self-injurious behaviors, this episode will provide significant insights and tools. as technology develops. However, it's crucial to be knowledgeable about mental health concerns and recognize the symptoms of distress in our loved ones and in ourselves. It is essential to establish a forum for open discussion and greater knowledge of the resources accessible. By addressing the underlying causes of self-harm, we can assist teenagers in developing healthier coping strategies and enhance their general wellbeing. So let's all work together to end the stigma associated with mental health problems, get those who need it some care, and encourage one another as we go through this healing process.
[00:33 -11:15] Blurring the Lines: The Challenge of Identifying Self-Injury Intentions
Self-injurious behavior is an umbrella term for actions that result in physical injury to oneself, including suicidal and non-suicidal behaviors
Non-suicidal self-injury specifically refers to behaviors where harm is intentionally caused to one's body for reasons not socially recognized or sanctioned, without the intention of ending one's life
Examples of non-suicidal self-injury include cutting, scratching, burning, hair pulling, and punching objects
It's important to differentiate between suicidal and non-suicidal behaviors for proper risk assessment and intervention, but the distinction can be blurry at times.

[11:16 -20:08] Understanding the Psychological Underpinnings of Self-Harm
Self-injurious behaviors have diverse reasons and psychological functions
Some teens may self-harm to rebel or seek attention, while others do it out of desperation or depression
Self-harm is often used as an unhealthy coping mechanism to deal with difficult emotions and to feel in control
Some use it to distract themselves or to feel something, as they may feel numb in their daily lives

[20:09 -28:50] Childhood Trauma and Self-Harm: Understanding the Link and its Implications for Treatment
Self-injury is associated with mental health disorders like anxiety, depression, eating disorders, substance use disorder, PTSD, and personality disorders
Childhood trauma, especially sexual abuse, is linked to an increase in cutting behavior
Borderline personality disorder includes self-harm as one of its nine criteria
Teenagers may exhibit borderline personality traits, including cutting, but are not diagnosed with personality disorders due to their developing personalities

[28:51-40:50] How Medications Can Help Heal Trauma and Unleash Inner Happiness
SSRIs can be used to treat anxiety and depression
Alpha agonists like Guanfacine or Clonidine can be helpful for impulsivity and trauma response
Naltrexone can be used for repeated self-injurious...

143 Moral Injury and Well-being: Channeling Mr. Rogers

Wed, 24 May 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Psychological safety is crucial and cannot be undervalued in the continuing and challenging process of addressing physician burnout and prioritizing well-being. Dr. Gaggino's guest, Karen Horneffer-Ginter, PhD, discusses how organizations and institutions can start to acknowledge and deal with the systemic problems causing burnout by creating a space where clinicians can openly express concerns without fear of retaliation or condemnation. Individuals must prioritize their own self-care and wellness in addition to organizational and institutional reforms. Karen Horneffer-Ginter believes It's time to change the way healthcare is perceived and to value the humanity of people who care for others. Yes, burnout is a complex problem that calls for all hands-on deck. And Dr. Lia Gaggino and Karen Horneffer-Ginter will explore the concept of promoting a "safe-place culture" and the concept that clinicians can and should work towards creating an environment where everyone thrives and feels valued.
[00:33 -13:55] The Evolving Landscape of Wellness and Well-being in Healthcare
Recognizing the Neglected Importance of Mental Health in Medicine
Wellness vs. Well-Being: Exploring the Nuances and Evolving Definitions in Healthcare
Adapting Language for Genuine Conversations: Addressing Burnout, Moral Injury, and Beyond
Personalizing Wellness: Moving Beyond Individual Responsibility and Addressing Organizational Interventions

[13:56- 25:06] Challenges in Maintaining Boundaries and Well-being in Healthcare
Healthcare professionals find themselves sacrificing their own well-being, time, and personal needs to attend to the needs of others, going above and beyond their duties.
A distinction between work and personal life can be facilitated through rituals, similar to Mr. Rogers taking off his jacket and putting on his sweater.
healthcare providers MUST regularly check in with themselves, assess their own well-being, and acknowledge their vulnerabilities.
Healthcare professionals are often in a mindset of providing help rather than seeking it, which can hinder their own self-assessment and well-being.

[25:07 -39:20] Organizational Interventions and Advocacy for Well-being
Profit: The need to ensure financial sustainability and keep the lights on in the business of medicine.
Wellness: healthcare professionals taking care of their own well-being and finding a balance between personal and professional life.
Organizational interventions: Call centers, hospitalist services, and neonatal nurse practitioners could address workload and provide support.
Documentation and electronic health records: Dealing with the challenges and demands associated with electronic records and finding ways to improve efficiency and reduce administrative burdens.

[39:21- 49:53] The Importance of Self-Care and Support
Prioritizing personal needs and seeking professional help when necessary
Overcoming the stigma of seeking for professional help
Taking intentional breaks from the work-related responsibilities with apps, family time, alone time, etc.
Scheduling time for restorative activities and unplugging

[49:54 - 54:36] Closing segment Takeaway

You can reach Karen Horneffer-Ginter
Linked In: @Karen Horneffer-Ginter

Links to resources mentioned on the show
From Triple to Quadruple Aim:

142 Difficult Childhood Behaviors: Meeting the Challenges of Parenting

Wed, 17 May 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
If you're a parent, you know that there's nothing quite as challenging as dealing with difficult childhood behaviors. Tantrums, potty training, and biting are just a few of the challenges that parents face on a daily basis. Today, Dr. Lia Gaggino talks with pediatrician Dr. Arthur Lavin and Therapist Susan Glaser who have not only authored several books on parenting But are the hosts of the highly acclaimed podcast Parent Talk that offers practical parenting tips and expert insights on everything from child development to managing conflicts with your kids. The explain how “Potty mastery” a significant milestone in a child's development is and should be approached as a partnership rather than training. With patience and understanding, parents can celebrate their child's achievements and encourage them to reach new milestones. So, whether you're a new parent or an experienced pro, this episode is for anyone looking to become a better parent.
[00:33 -15:50]Tips for Successful Parenting: Insights from the Parent Talk Podcast
Designed for parents of children of all ages
Provides practical strategies to manage conflicts with children
Offers insights into child development to help parents understand their behavior
Focus on “Mastery” vs “Training”

[15:51- 25:52] How to Navigate Potty Training: Tips from an Expert
Potty mastery can be a toddler task, ideally started around age two
Parents should set up the environment with potty seats and lots of underwear”
Start around age two when they have enough language and physical ability?
Pullups are not recommended, as they are essentially just diapers without tabs
Logical consequences reinforce potty training, such as having the child clean up their mess

[25:53- 39:43] Toddlers and Tantrums: Understanding the Big Bang of Consciousness
The big bang of consciousness occurs between 15-18 months of age when children begin to develop a sense of self-awareness.
Prior to this development, infants have no sense of self and react only to their immediate surroundings.
The sudden realization of self often leads to toddlers asserting their independence and saying "no" more frequently.
Tantrums can be a common response to frustration as toddlers learn to navigate their new sense of self and assert their desires
Parents should focus on providing a safe environment and positive reinforcement rather than punishing or shaming their child during a tantrum

[39:44 - 52:07] Strategies for Helping Children with Autism and Preschool Biting Behaviors
Occupational therapy and sensory-based strategies can help address behavior issues in preschoolers
Early intervention for children with autism spectrum disorders is crucial
Biting is a typical behavior among preschoolers, often triggered by inner turmoil rather than an intent to hurt others
Environment and class size can influence behaviors; lowering class size and having extra teachers can help address biting incidents
Understanding the root cause of constant biting can help address the behavior.

[52:08 - 57:35] Closing segment Takeaway

Links to resources mentioned on the show
Guests Susan Glaser and Dr. Arthur Lavin co-authored two books.;
Who’s the Boss: Moving Families from Conflict to Collaboration

141 HIV Screening and Education: We Need to Do Better

Wed, 10 May 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
When you think of HIV, do you breathe a sigh of relief thinking “well, at least we don’t have to deal with THAT anymore”? Has it completely fallen off your radar as a medical issue that is “under control”? Well, then it’s important that you listen to this episode. Dr. Gaggino talks with Dr. Julia Rosebush and Britt Hodgdon, LCSW. Together they dive into the topic of HIV and trauma recovery. They’ll share insights on how to support individuals living with HIV and overcome stigma, as well as discussing the concept of undetectable equals untransmittable and how it impacts communication and relationships. You’ll also hear about the role of trauma recovery and somatic therapy in destigmatizing HIV and promoting self-perception. This is a powerful conversation on how to thrive with HIV and befriend it.
[00:33 -18:52] Addressing HIV Stigma
HIV stigma still exists despite advances in treatment and prevention.
Stigmatizing attitudes can negatively affect the mental health and well-being of those living with HIV.
HIV stigma can lead to discrimination in healthcare and other areas of life.
Advocacy and education can help decrease HIV stigma and empower those living with the virus.
Language also plays a role in HIV stigma, and using non-stigmatizing terminology is important in reducing stigma.

[18:53- 33:22] HIV and Undetectable Viral Load
Undetectable viral load means untransmittable HIV to sexual partners
Years of research have solidified the undetectable equals untransmittable concept.
Youth should not be afraid of transmitting HIV if they achieve an undetectable viral load.
Normalizing conversations about HIV and reducing stigma surrounding the virus
Encouraging youth to prioritize their sexual health and seek appropriate medical care if needed.

[33:23 -46:07] Communicating about HIV Status: Language and Approaches for Young People
Importance of confidentiality and privacy when discussing HIV status
Strategies for building trust and rapport with young people when discussing HIV.
Highlighting the effectiveness of antiretroviral therapy for managing HIV
Encouraging young people to take ownership of their health and prioritize self-care.
The role of healthcare professionals in educating and supporting young people living with HIV

[46:08 - 54:38] Improving Conversations about Sexuality, Identity, and Gender with Young People
Professionals need to be fluent in “young-person-speak” to have effective conversations about sexuality, identity, and gender.
Assumed binaries should be avoided, and young people should be asked to name who they are and how they want to be referred to.
Centering young people in conversations about their bodies can be a relief for the medical field and benefit young people.
There is room for growth among professionals in this space.
Rethinking the way we talk to young people about sexuality, identity, and gender is ultimately necessary for caring for young people and families.

[54:39 - 1:00:03] Closing segment Takeaway

You can reach Dr. Julia Rosebush
LinkedIn: Julia Rosebush, DO, FAAP | LinkedIn
Hashtags: #hivprevention #hivawareness #gettingtozero...

140 Eating Disorders: Avoidant/Restrictive Food Intake Disorder (ARFID)

Wed, 03 May 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Do you have a picky eater in the house? Then this is the episode you’ve been waiting for. Dr. Lia Gaggino’s guest this week is Dr. Natalie Prohaska where they’ll discuss avoidant, restrictive food intake disorder (ARFID), which was previously referred to as feeding disorder of children. They will break down the three different types of ARFID and discuss how they affect children's psychosocial and nutritional functioning. As the COVID-19 pandemic continues to affect our daily lives, mental health concerns such as eating disorders have seen a resurgence. Whether it's a fear of choking or contamination, this episode will provide valuable insight on how your clinician properly diagnoses and treats ARFID in order to improve the overall health and well-being for the child.
[00:33 -13:37] Understanding Avoidant Restrictive Food Intake Disorder (ARFID)
ARFID is not related to body image distress, but rather caused by sensory sensitivity, lack of interest in eating, or fear of inversive events
ARFID can affect nutrition, weight, and psychosocial functioning, and can be seen in both children and adults
ARFID is characterized by three types of symptoms: sensory sensitivity, lack of interest in eating, and fear of inversive events.
ARFID can progress from one category to another and may require specific treatment for feeding-related anxiety or OCD.

[13:38- 25:54] How to Manage Picky Eating in Children: Strategies and Tips
Breaking down food into smaller portions and gradually adding ingredients can help make it more manageable for picky eaters.
Children with oral aversions, such as those who were in the NICU and had tube feedings, may benefit from occupational therapy.
Encouraging children to describe the appearance, texture, smell, and taste of food in non-judgmental language can reduce their disgust response.
Using a five question approach, children can approach new foods more like a scientist and think objectively about what they are experiencing.

[25:55 -37:14] Overcoming Fear of Food in Kids: The Step-by-Step Approach
Aversive events such as choking on food can lead to a fear of eating, which can be treated similarly to OCD.
Treatment involves creating a hierarchy of manageable steps in challenging fears, starting with softer or liquid foods.
Parents play a crucial role in this treatment, as they need to provide education, empowerment, and motivation to their child.
Children with intellectual disabilities or autism may require a different feeding program tailored to their unique needs.

[37:15 - 44:41] Understanding ARFID: Diagnosis, Comorbidities, and Resources for Families
ARFID is a distinct illness from anorexia, though picky eating can sometimes lead to anorexia later on.
ARFID patients typically have a limited diet high in dairy and carbohydrates, while anorexia patients prefer produce and proteins.
Comorbidities with ARFID include anxiety, ADHD, autism, and medical issues like reflux or celiac disease
Families can find helpful information and support through resources like FEAST, AED, and the book "ARFID: A Guide for Parents and Caregivers.

[44:42 -51:00] Closing segment Takeaway
Links to resources mentioned on the show
AAP Pediatrics article:
Classification of Children and Adolescents with Avoidant/Restrictive Food Intake Disorder

139 School Based Health: Literally Meeting Kids Where They Are!

Wed, 26 Apr 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
School-based healthcare centers (SBHC) are playing an important role in providing equitable access to healthcare for children who are not able to access a regular medical home. Today, host, Dr. Lia Giggino talks with Dr. Sara Bode about the benefits of a SBHC and the challenges they face in ensuring that every child has access to quality care. They discuss the challenges that school-aged children face in accessing healthcare, such as transportation issues, location, and competing priorities for parents. Dr. Bode emphasizes the importance of school health in providing a safety net for children and the need for collaboration between healthcare providers and educators to ensure that children receive quality healthcare and education. This episode highlights the benefits of a partnership between the health and education systems, demonstrating how working together can improve the overall health and well-being of students. If a school-based health center is something you want in your own community, you’ll hear information on exactly how you can make it happen.
[00:33 -15:08] The Benefits of Having an SBHC
They provide a safety net for kids who do not have access to a regular medical home due to various reasons such as transportation issues, location or access, and competing priorities for working parents
They can partner with primary care providers to provide comprehensive primary care to the underserved population of kids and connect them to a medical home for continued care
They offer opportunities for collaboration with specialty providers to provide better health outcomes for kids with chronic health conditions such as diabetes
They can help with wraparound care and observation to identify and address underlying health issues

[15:09- 22:07] How SBHCs Co-Manage Children's Health: Funding and Services
Students without an established medical home can receive care at the center
Partnership between school-based health centers and primary care providers can support medication management and follow-up care
School-based health providers have a unique understanding of social determinants of health for students
Funding for school-based health centers typically comes from traditional insurance sources such as Medicaid and private insurance

[22:08 -31:07] The Role of SBHCs in Addressing Mental Health Care Needs for Students
Lack of mental healthcare providers for students is a crisis in schools
School-based health centers can be a part of the solution to bridge the gap in services
Comprehensive primary care mental health services can be provided through school-based health centers
Telemedicine services, such as telepsychiatry, can be used to provide care and maintain appointment attendance
Advocacy and community pediatrics play a crucial role in transforming the systems of care provided to meet the needs of the community

[31:08 37:11] Opportunities for Pediatricians to Get Involved in School Health
The AAP Council on School Health provides resources for pediatricians to partner with schools, including working with school nurses and teachers.
The Council on Community Pediatrics offers opportunities for pediatricians to engage in advocacy and learn about community initiatives.
The Community Pediatric training initiative offers training opportunities for pediatricians interested in tackling issues like food insecurity in their communities.
It is important for pediatricians to keep their eyes...

138 Aggression in Youth: Assessment and Treatment

Wed, 19 Apr 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Aggression in children is a complex issue that can leave parents feeling helpless and desperate for a solution. Many turn to medication as a quick fix, but according to Dr. Lia Gaggino’s guest, Dr. Peter Jensen, multiple medications are not always the answer. It's important to assess the situation correctly and consider alternative approaches before turning to medication. In this episode, Doctors Gaggino and Jensen explore the various causes of aggression in children and provide tips on how to handle it effectively without resorting to excessive medication. Whether you're a parent, caregiver, or educator, the information provided in this episode can help you better understand aggression in children and how best to support them. Get your pad and pencils ready, you’ll be taking notes on this one.
[00:30 -27:46] Understanding the Different Types of Aggression in Children and How to Treat Them
The Importance of Assessing and Diagnosing before Prescribing Medication
Aggression in children can fall into different categories, such as chronically irritable and explosive or misinterpreting social cues
Diagnostic Skills Help in Identifying the Underlying Causes of Aggressive Behaviors in Children
Bipolar disorder and schizophrenia are unlikely causes of aggressive behavior in children

[27:47- 38:02] Understanding and Treating Aggressive Behaviors in Children
Treatment for ADHD should be maximized before turning to other medications
Resperidone and Aripiprazole have been approved by the FDA to treat aggression in children
Primary care providers need to get comfortable with atypical medications
Guidelines for treating maladaptive aggression in youth are available in the journal Pediatrics

[38:03 -48:14] Evaluating Medication for Children with Mental Health Disorders
Trauma should be considered when treating children with psychiatric medications.
Avoid the "pharmacotherapy of desperation," which involves adding multiple medications without clear rationale.
Deprescribing, or slowly decreasing medication use, can be helpful for children on multiple medications that may not be effective.
A thorough evaluation of the underlying disorder, using rating scales and input from multiple sources, is essential for choosing the right medication.

[48:15 - 57:06] Top Screening Tools for Child Mental Health
Vanderbilt Rating Scale is essential for monitoring ADHD in kids on stimulants
PHQ-9 is a quick and free depression scale that is recommended by the US Preventive Services Task Force and Academy of Pediatrics
SCARED is an effective tool for tracking and screening anxiety in children and can be given to parents or youth
PSC-17 is ideal for well-child visits as it has only 17 items and screens for inattention, ADHD, anxiety, and depression
Suicide specific tools like ASK Screening Questions and Columbia should be used alongside PHQ-9 for better screening of suicidal ideation and behavior; CRAFFT can be used to screen for substance use in teenagers.

[57:07 - 1:04:54] Closing segment Takeaway

You can reach Dr. Peter Jensen
Website: https://thereachinstitute.org/
LinkedIn:

137 Understanding Aggressive Behaviors: Who, What, Why, When and Where

Wed, 12 Apr 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Childhood can be a challenging time for many young individuals. As they try to navigate the world around them, they often display aggressive behaviors in different situations. But not all aggression is harmful, as it can be a normal part of development. Understanding what constitutes normal childhood aggression and identifying its triggers is essential for parents and clinicians alike to help children thrive. In this 2nd of a 3-part series on childhood aggression, Dr. Lia Gaggino talks with Dr. Elizabeth Wallis from the REACH Institute. They discuss the nature of childhood aggression, how parents and clinicians can identify its triggers, and how trauma can affect children's brains. By recognizing the signs of concerning behavior early on, parents and clinicians can intervene appropriately to help young individuals grow into healthy adults. Get ready for a thought-provoking conversation.
[00:33 -14:54] Understanding Normal Aggression in Children and Identifying When to Worry
Normal aggression is a part of development in children and can be seen in frustration, emotion dysregulation and communication difficulties.
Consider the scenario around aggressive behavior, including who, what, when, where, and why, can give insights into the causes of aggression.
Trauma and neglect can greatly affect a child's brain and make them more reactive to situations.
Trauma, neglect, and abuse can change children's brains and lead to hyperarousal and increased reactivity to situations

[14:55- 29:01] How to Address Aggressive Behavior in Children: Tips for Parents and Pediatricians
Teaching prosocial skills and positive reinforcement
Teach positive social skills and give positive reinforcement for good behavior
Implementing natural consequences for damaging behavior, such as having the child save up allowance to pay for damage
Discuss gun safety with families and ask about access to firearms in the home in a thoughtful manner.

[29:02 -37:23] Partnering with Schools and Mental Health for Resilience-Building in Children
The impact we can have on a child's life as mental health professionals
Approaching schools and mental health professionals with humility, compassion, and empathy
Being an advocate for the child when working with schools and mental health professionals
The need for communication and collaboration between mental health professionals, schools, and parents for the child's success

[37:24- 45:27] The Impact of Reach Program on Pediatricians
Reach Program helps pediatricians to realize that psycho pharm is a small part of things and communication skills matter a lot more.
The program reinforces the importance of motivational interviewing and negotiation skills.
The answer to all problems is not a pill; development, learning difficulties, environment, and trauma are also key factors.
Fresh perspectives from child psychiatrists can be helpful for complex cases, and resources like the Child Psychiatry Access Program are available for pediatricians.

[45:28 -51:24] Closing segment Takeaway

You can reach Dr. Elizabeth Wallis
Social Media:
REACH Website: https://thereachinstitute.org/
REACH LinkedIn: https://www.linkedin.com/company/the-reach-institute-resource-for-advancing-children-health/
REACH Facebook: https://www.facebook.com/REACHInstitute/
REACH Twitter:...

136 Youth Violence Prevention: Threat Assessment and Management

Wed, 05 Apr 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
This is the first of three episodes on aggression in youth and violence prevention.
Dr. Gaggino’s guest is Cindy Marble, who retired from the US Secret Service after 27 years, including two tours in the protective intelligence division. Cindy now trains individuals across various sectors on behavioral threat assessment and prevention, including K-12 schools, campuses, and private industry. In this podcast, she emphasizes the team approach to threat assessment, drawing on the insights of mental health providers, physicians, and local law enforcement. Cindy highlights that there is no single profile of a potential aggressor, and that prevention requires an understanding of the individual's behavior and circumstances. She underscores the role of physicians and mental health providers in identifying potential threats, as well as considering factors such as home environment and law enforcement history. Cindy emphasizes that understanding the "why" behind a person's behavior is critical to preventing violent acts
Many thanks to the AAP and the MIAAP for making these 3 episodes possible by funding guest honorariums and podcast editing costs. In full disclosure, I have not received any funding from either entity for this series.

First, some facts:
According to the Washington Post, there have been 376 school shootings since Columbine (1999)
348,000 students have experienced gun violence since Columbine shooting

[00:33 -12:57] Understanding the Pathway to Violence: A Multidisciplinary Approach
Threat assessment is a community process that requires a multidisciplinary team.
There is no specific profile of someone who carries out violent attacks.
It's essential to focus on a person's behavior rather than their traits.
Taking a multidisciplinary approach can help identify a pathway to violence and prevent violent incidents.
Threat assessment is a community process involving partnerships with healthcare providers, mental health professionals, and local law enforcement.

[12:58 -28:22 Key Indicators and Intervention Strategies
Warning signs may include a change in behavior, loss of interest or connections, and inappropriate interest in past mass violence attacks.
Capability, access to weapons, and mental and physical ability are all considered in the threat assessment process.
Assessing a person's capability to carry out an act of violence, along with their mental and emotional state, is crucial in determining the level of risk.
Interventions should focus on connecting the individual to support systems and responsible adults to prevent isolation and marginalization.
Punishment or disciplinary action may not be the most effective solution and may exacerbate behavioral issues. Instead, focusing on intervention and support can lead to positive outcomes.

[28:23 - 40:40] The Importance of a Collective Approach in Threat Assessment
Physicians cannot be expected to single-handedly assess and manage a threat
Building relationships with schools and law enforcement can lead to a more effective community-based threat assessment process
Understanding HIPAA and FERPA laws can provide comfort in sharing information for the safety of an individual
Threat assessment is a collective effort that shares liability and considers different perspectives to create a management plan
Best practice in threat assessment involves a systematic process of gathering information, documenting decisions, and creating a management...

135 Physician Wellness: Find Your ‘One Thing

Wed, 29 Mar 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Join your host, Dr. Lia Gaggino, on this episode of Pediatric Meltdown as she chats with Dr. Danny Mallen, a pediatric gastroenterologist and medical educator at Cincinnati Children's Hospital Center. Dr. Mallen talks about his interest in nutrition, the puzzle that is the gut, and his passion for helping children with celiac disease. He also discusses his article on finding your “One Thing” and how mentors and opportunities play a role in one's career. Burnout is real. We look to physicians to take care of us, but let’s make sure that your doctor is getting everything they need for their own wellness. Dr. Mallen’s insights on the importance of finding joy in your work will ring true for every profession and he continues his efforts to improve medical education for general pediatricians and fellows. Don't miss this fascinating conversation about the challenges and rewards of physician’s wellness!
[00:33 -12:42] Daniel's Journey to Pediatrics and Interest in Wellness
During his training, he found himself happiest and smiling more when working with children, ultimately leading him to specialize in pediatric gastroenterology.
Daniel is passionate about medical education and mentoring trainees, recognizing the importance of wellness in the medical profession.
Through his own experiences in training and becoming a parent, Daniel recognized the need for addressing physician burnout and is involved in research on the topic.
His interest in wellness came about through his own experiences with stress and recognizing the importance of self-care in the medical field

[12:43 - 24:32] Addressing Burnout in Medical Professionals: Insights from a Pediatrician
The culture of overworking and sleep deprivation has been prevalent in the medical field for a long time, with long shifts and being on call for extended periods being seen as a "badge of honor."
Institutional changes such as shorter shifts and better work-life balance policies are being implemented. However, progress is slow, and more needs to be done to sustain a healthy work environment for medical professionals.
Burnout is a real issue that can impact the quality of care medical professionals provide and their well-being. It is important for medical professionals to recognize the signs of burnout and take steps to address it, seeking taking time off to recharge, and finding hobbies or activities outside of work can all contribute to a healthier work life balance.
Personal experiences with burnout and overwhelm are common among pediatricians, and recovery often involves taking time off, seeking support from colleagues and loved ones, and practicing self-care.

[24:33 -40:17] Strategies for a Work-Life Balance in Academic Medicine: The Eisenhower’s Box Method
Importance and urgency are the key factors to consider while managing tasks
Urgent tasks with low importance can be delegated or automated
Restorative activities, even if they are not productive, can help reduce burnout
Tasks that are not important and not urgent can be avoided to reduce unnecessary stress.

[40:18 - 51:46] Creating a Supportive Environment for Healthcare Professionals: Strategies and Best Practices
Providing anonymous peer-to-peer support can make a significant difference in mental health for healthcare workers.
Critical Incident Stress Management (CISM) teams can be instrumental in helping individuals process traumatic events and feel less isolated in their experiences.
It's important

134 Early Childhood Education: Empowering Parents

Wed, 22 Mar 2023 09:00:00 +0000

As an educator and administrator, Meadow Nuyen acknowledges the challenges faced due to the pandemic, such as staffing shortages and virtual learning for early childhood education. Meadow talks about the importance of empowering parents and recognizing them as the first educators during a child's developmental years. She believes that parents should feel comfortable advocating for their child's needs and speaking up if they have any concerns. She stresses the importance of recognizing the family unit, (regardless of traditional family structures), and valuing their knowledge about their child's needs and development. Meadow’s passion for early childhood education and empowering parents shines through in this episode. She stresses the importance of providing high-quality pre-K experiences, monitoring children's milestones, and working together to support a child's development. You’ll walk away from this episode anxious to implement the “Parent-Teacher-Clinician” superpower that all kids deserve.
[00:33 -10:09] The Importance of Early Childhood Education
Parents should speak up if they have concerns and advocate for their child's needs.
The human brain develops most before age five, making early education a critical time for youngsters.
Youngest learners need the support and encouragement of role models from all walks of life.
Parents, educators and clinicians can share information to best support the child's development.
Children who experience separation anxiety during the transition into preschool require special attention.

[10:10- 22:22] Trauma-Informed Teaching and Supporting Families
Adverse Childhood Experiences (ACEs) study and understanding the impact of trauma on children's development.
Cultivating empathy and compassion for children and families who have experienced trauma.
Shifting perspective to ask "What happened to?" instead of "Why are you doing this?"
Listening to families and letting them talk to feel heard and validated.
Normalizing conversations about trauma and its possible effects to open communication and healing.

[22:23 -30:15] Combating Food Insecurity in Schools
Providing free meals for all enrolled students
Reducing stigma around receiving free meals
Addressing the issue of food insecurity in all communities, regardless of wealth
Acknowledging the impact of food insecurity on learning and health
Encouraging healthy eating habits and access to nutritious foods

[30:16 - 42:59] Assessment and Evaluation in Schools
The NWEA assessment is a standardized test that is administered nationwide.
The assessment is conducted three times a year in some districts and twice a year in others.
A 504 plan is a legal document that provides additional support to students with learning difficulties upon parental request.
An IEP is a more intensive individualized education plan given to children who have been evaluated and tested by a school district's psychologist.
The IEP team includes the special ed director, teacher, special education staff, principal, and family to create goals and interventions to support the child's needs.

[43:00 - 52:04] Some of the Takeaways include:
Children are all learners. The educator’s job is to identify struggles and to build skills and mastery.
Educators' best strategy for learning is to empower parents. They are the first teachers. They know their child best.
All adults can use the trauma-informed lens to support

133 Tantrums, Difficult Behaviors, “Red Alerts”: Using the “Smart Brain” for Problem Solving

Wed, 15 Mar 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Childhood trauma can have a lasting impact on mental health and well-being, but addressing it in therapy requires a careful and compassionate approach. In this episode, child psychologist, Conni Lutes, shares her unique strategies on working with young children who may be experiencing behavior issues or challenges related to autism. Your host, Dr. Lia Gaggino and Conni discuss the importance of using language and creative outlets, such as art and play therapy, to help kids express themselves and make progress. By taking these steps, practitioners can help children feel heard and supported. By creating a safe and comfortable environment and meeting children where they are, therapists can help children process their trauma and move towards healing.
[00:33 -15:56] Strategies for Working with Children in Therapy
Create a colorful and comfortable therapy environment with bean bag chairs, pillows, and other calming tools.
Encourage artistic expression and play to help children feel more comfortable and have a voice when they feel silenced.
Focus on the child's strengths first to build trust and establish a foundation for future therapy sessions.
Approach trauma and behavioral issues by first getting to know the child as a whole, not just focusing on the problematic behaviors or experiences.
Start sessions by focusing on the child's strengths, rather than immediately addressing any traumatic experiences or behavior issues.

[15:57- 30:41] Strategies for Supporting Children with Autism and Anxiety
Continually assess children to understand their behavior and the underlying factors that contribute to it.
The powerful role of art therapy in helping children with limited language skills
Using social stories and role-playing as effective strategies to help autistic children learn how to join and feel understood
The importance of understanding developmental stages and expectations in managing anxiety and worry in elementary-aged children
Introducing the concept of a "smart part" of the brain and "red alert" to teach children how to gain control over their feelings and move from a state of anxiety to a more rational, problem-solving state.

[30:42 -42:23] Promoting Collaboration between Doctors, Therapists, and Schools
Recognize the importance of all the adults in a child's life, including pediatric clinicians, schools, and therapists.
Emphasize a strength-based approach to working with children, focusing on their unique abilities and passions.
Encourage shared control between parents and children, giving children choices and opportunities to feel empowered.
Use strategies such as the five senses exercise to help children shift from reacting to thinking.
Facilitate cross-disciplinary communication and collaboration to ensure that everyone has a complete picture of the child's strengths and challenges.

[42:24 -51:46] Creating a Multidisciplinary Team: Tips and Strategies
The importance of multidisciplinary teams, involving OT, PT, and speech.
Humility is essential for physicians to recognize they are not aware of everything.
Teachers must understand that the child can behave differently in different settings.
Collaboration between therapists, clinicians, teachers, and parents is necessary.
Accepting the child's strengths alongside their weaknesses is fundamental.

[51:47 - 56:44] Closing segment...

132 Psychopharmacology: Considerations Before Prescribing

Wed, 08 Mar 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Brooks Keeshin, a triple-board trained child psychiatrist with a focus on trauma, shares his journey into child psychiatry, and discusses the idea of it being a subspecialty of pediatrics. The conversation leads to a discussion on the role of pediatricians in prescribing psychotropic medication and the importance of identifying and recognizing mental health concerns in children. Dr. Keeshin highlights the pitfalls of thinking about mental health as a catch-all, and reminds pediatricians to consider individual diagnoses to guide treatment options. He also points out that psychotherapeutic interventions are usually at the top of the list, and that medication is only one consideration. Get your pencils out…. You’ll want to take notes…
[00:33 -13:56] The Importance of Identifying Mental Health Concerns
Identifying mental health concerns should begin with listening to the family's concerns and the child's or adolescent's voice.
Using measurements such as universal screening or targeted screeners can help inform the differential diagnosis.
It is important to move away from the thinking that mental health is a catch-all, and instead focus on individual diagnoses that will guide treatment recommendations.
Early identification and treatment of mental health concerns can improve outcomes and prevent future problems.
Having a process to rule out other contributing factors to distress, such as adjustment disorders, can lead to more accurate diagnoses and effective treatment.

[13:57 - 26:01] Choosing Treatment Options for Pediatric Anxiety
The importance of getting a full picture of the child's symptoms, including using screeners such as SCARED
Considering evidence-based interventions for pediatric anxiety, such as anxiety-focused CBT or SSRIs
Combination therapy with psychotherapeutic intervention and SSRIs may offer the best chance of complete remission
SSRIs such as Fluoxetine, Sertraline, and Citalopram have the greatest evidence base and experience in youth
Assessing the level of impairment and degree of symptoms in making a decision about medication vs. psychotherapeutic intervention

[26:02 -38:10] Addressing Anxiety Symptoms in Traumatized Kids
Stepped approach involves addressing other contributing factors before using SSRIs
Ensure physical safety of environment before trauma-focused therapy
Address sleep first as chronic insomnia can drive anxiety symptoms
Maximize other interventions like social determinants of health and trauma therapy before giving SSRIs
Aggressively titrate SSRIs to effective doses for robust response

[28:11 - 51:33] Improving Access to Expert Child Psychiatric Care
Improving access to comprehensive psychiatric evaluations by child psychiatrists is essential for identifying children with severe psychiatric needs.
The limited number of child psychiatrists means better triage is needed to ensure the most severely impacted children receive the necessary care.
Educating child psychiatrists about the comfort levels and limitations of ongoing psychiatric treatment in primary care can be helpful in improving collaboration.
Consider outpatient programs or day treatment programs for kids after inpatient treatment to help them prepare for a return to their normal life.
Consider partnering with primary care if it would be more appropriate for the child in the long term.

[51:34 - 59:59] Closing segment Takeaway

Links to resources mentioned on the...

131 BONUS- ACES Narrative: Pediatric Trainee Voices

Fri, 03 Mar 2023 17:15:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
The American Academy of Pediatrics Section on Pediatric Trainees is an active group that offers a variety of leadership roles for medical students, residents, and fellows. Dr. Madeleine Norris shares her journey from child neurology to pediatric mental health and her involvement in the AAP. Your host, Dr. Lia Gaggino, a leader in the AAP, explains how trainees can submit abstracts to the SOPT Abstract Competition and become a member of the Section on Pediatric Trainees or the Section on Early Career Physicians. Madeleine also discusses her role as a Deputy Editor for the Feature in the journal Pediatrics. If you are or know someone who is a trainee, medical student or resident, make sure that you share this episode with them. They’ll thank you for it.
[00:33 - 6:11] Introduction to Madeleine’s Pediatric Journey
Madelyn is a PGY two resident in a categorical pediatrics tract at NYU.
Her initial interest in child neurology before switching to pediatric mental health.
Her future goal of becoming a triple boarded child psychiatrist.

[6:12-8:43] Her role with the AAP’s Section on Pediatric Trainees
Importance of getting involved in trainee leadership.
Opportunities for medical students and residents to join the section.
Various leadership roles available within the section
Encouragement for trainees to apply even if they don't feel fully qualified.

[8:44 -13:35] What her duties are as the Deputy Editor for the Pediatrics Journal Feature
Coaches and mentor's trainees in the developmental editing process
Focuses on education and encouraging trainees to write and share their perspectives.
Offers feedback and support to authors even if their piece is not accepted.
Three-year term for the Deputy Editor position

[12:36 -23:23] Details for Submitting Narrative Work for the Pediatrics Journal Feature
Essay competition offered in relation to the Races Against ACEs campaign.
Submissions open on March 3rd and close on April 14th.
Criteria for submission, word count and author number, can be found in show notes
All trainees are eligible to apply.

[23:24 - 27:08] Closing segment Takeaway.

You can reach Dr. Madeleine Norris.
Twitter: @Maddie__MD
Instagram: @maddie_.norris

Links to resources mentioned on the show
ACES Too High website: https://acestoohigh.com/
1998 ACES Study: https://pubmed.ncbi.nlm.nih.gov/9635069/
AAP Peds Trainees (On Twitter): @AAPSOPT Use #RacesAgainstACEs and #PedsPerks.
Submission Info for the 2023 Essay Competition: “Races Against ACEs”

130 Rapid Whole Genome Sequencing: Unlocking a Puzzle

Tue, 28 Feb 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
The medical world is accomplishing great things; for example - Rapid Whole Genome Sequencing. A cutting-edge concept that has cut diagnoses of rare diseases from weeks and months to days and hours. It’s called Project Baby Deer and it’s focused on implementing evidence-based precision medicine and pediatrics to facilitate rapid whole genome sequencing for sick inpatients, neonates and children across the state. The project was born out of a collaboration between Dr. Caleb Bupp, Dr. Andrea Scheurer and Dr. Joseph Fakhoury. Your host, Dr. Lia Gaggino talks with these 3 clinicians about this groundbreaking initiative that is helping to provide better care for children across the state. If you know someone who is in medical school, you’ll need to share this episode with them.
[00:33 -28:07] Intros / What is Rapid Whole Genome Sequencing?
Michigan’s “Baby Deer” project was designed after California’s “Baby Bear” project.
The genetic code is made up of billions of adenine (A), cytosine (C), guanine (G) and thymine (T)
Variations in the code is what makes us unique.
In the past, sequencing was expensive and slow, but technology has made it faster and cheaper.
Entire genetic code can be sequenced in hours with accurate results.

[28:08- 35:40] Benefits of Genetic Testing for Children
Genetic testing can provide important information about a child’s risk of developing a particular health condition in the future.
Genetic testing is faster and cheaper than ever before.
Genetic testing can help reduce the cost of care by providing more accurate diagnoses and treatments.
It can also help identify inherited traits and conditions that could affect a child’s health.
Knowing the cause of a medical issue helps make better decisions on how to treat it

[35:41 -46:04] The Benefits of Collaboration
Bronson and DeVos hospitals collaborated to develop a comprehensive consent process, as well as a system for sharing and analyzing the data.
The two hospitals have also developed a system for follow-up care, ensuring that any positive results are followed up on and that any negative results are discussed with the family.
The collaboration between Bronson and DeVos has made rapid WGS accessible to more families and has helped to improve the quality of care for those families.
Although the cost is a main barrier to expansion, the collaboration between the two hospitals will provide rapid WGS to patients in need.

[46:05 - 1:02:49] What is Rare Disease Day?
Rare Disease Day is the last day of February, the rarest day of the year.
It is a day to raise awareness and hope for the 300 million people worldwide who live with a rare disease.
It is a day to highlight the need for research, support, and advocacy for these diseases.
It has been happening every year since 2008.

[1:02:50 - 1:08:48] Closing segment Takeaway.

You can reach Dr. Joseph Fakhoury
Facebook: Joe Fakhoury | Facebook
Instagram: @jfakhoury.515
LinkedIn:

129 Adolescent Confidentiality: To Share or Not to Share

Wed, 22 Feb 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Patient Confidentiality is a complex subject and more times than not, the answer to the questions will begin with “Well, it depends….” Dr. Elizabeth Alderman, a pediatrician, shares her journey into pediatrics and how she has handled this issue in her own practice in the state of New York. Both Dr Gaggino and Dr. Alderman talk about the frustrations that healthcare providers face when they must decide on the best course of action to take, particularly when there are concerns about the safety and wellbeing of the adolescent patient. Listen in as they discuss navigating these complexities requiring a delicate balance between respecting a patient's confidentiality, ensuring their safety, and complying with legal and ethical obligations.
[00:33 -15:50] Opening Segment / Adolescents and the 21st Century Cures Act
The 21st Century Cures Act has provided adolescents more access to confidential healthcare
It has made it easier for adolescents to receive mental health services without parental consent
It has expanded access to contraception and sexual health services without parental consent
It has provided more protection for adolescents with chronic illnesses to be able to access care without parental consent.
It has also strengthened HIPAA protections for adolescents.

[15:51- 31:08] How can healthcare providers ensure confidentiality for adolescents?
Have a routine part of the visit that discusses confidentiality and set expectations between the healthcare provider and the patient.
Have a conversation with the parents or guardians about leaving the room if needed during sensitive conversations.
Read the After Visit Summary before giving it to the patient to ensure that no sensitive information is included that should not be seen by parents or guardians.
Work with the EHR vendor to set up rules around the patient portal that honor state law privacy exceptions.
Encourage patients to ensure that their own email is linked to the patient portal instead of a parent or guardian’s email.

[31:09 -42:16] Empowering parents in conversations with their teens
Recommending parents bring up topics like sex and drugs with their teens
Assessing whether parent involvement is appropriate in each situation
Discussing the limits of confidentiality
Role-playing conversations with parents

[42:17 - 50:37] How to Ensure Adolescents Receive Confidential Medical Care
Make sure to know what state laws you are working under related to birth control, STI testing, mental health and prescribing medication for mental health disorders.
Look for links and resources related to state laws and reproductive rights.
Look for handouts related to adolescent confidentiality from the Society for Adolescent Health, AAP or your state’s AAP chapter.
Always be mindful of how your words will be interpreted by a patient.

[50:38 - 59:26] Closing segment Takeaways

Don’t forget to sign up for Dr. Gaggino’s February 24th Beta Training
for Professionals who want to re-think the mental health services they offer
Up Your Game - Improving Kid's Mental Health Care

Links to resources mentioned on the show
State by State Variability in...

128 Trauma and Resilience: “Connect Before You Correct”

Wed, 15 Feb 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
The challenges of mental health in children are complex, to say the least. One of this podcast’s favorite guests, Dr. Mark Sloane is a long-time pediatrician with decades of experience in this field, returns to talk about the challenges of persuading primary care physicians to pursue additional education, the effects of trauma on children, and the demand for more training in medical school and residency. There’s also a discussion on the impact of screening on mental health and the use of SSRIs in children.
[00:33 -15:31] Opening Segment /Importance of Mental Health Treatment
We’re introduced to Dr. Mark Sloane, and we hear about how his journey into pediatrics.
Primary care doctors need more mental health training.
Pediatrics have evolved over the last 20-30 years and needs to be accepted.
The Authority Health Project is providing training to residents to integrate trauma-informed care into their practice.

[15:32- 29:12] Traumatic Stress and Mental Health
Serotonin genetics significantly increases the risk of PTSD with traumatic exposure.
Prenatal stress, especially from domestic violence, can increase the risk of anxiety disorders.
Epigenetic factors can be used to assess a newborn's risk for anxiety and other mental health issues.
Mental health medications are often seen as a last resort for treating traumatized children.
Trauma therapy is essential for treating underlying mental health issues in traumatized children.

[29:13 -49:31] Building Relationships and Connection: The Magic of the Room
The Power of Relationships- The importance of building relationships as the cornerstone to emotional wellbeing.
Going Beyond Compliance- Facilitating environments where kids feel safe and supported rather than simply compliant.
Adopting a Team Approach- Understanding the need for team effort and how it can help foster parents and staff to create successful outcomes.
The CTAC Model Evolves- Examining how the CTAC model has evolved over time to include physicals, fetal alcohol syndrome screens, and more.

[49:32 -58:45] Advice for the New Medical Professional
Focus on connection with patients
Meet the needs of the community
Listen to veteran doctors / Get a mentor
Build incentives for trauma screen completion

[58:46 - 1:05:22] Closing segment Takeaway

Don’t forget to sign up for Dr. Gaggino’s February 24th Beta Training
for Professionals who want to re-think the mental health services they offer
Up Your Game - Improving Kid's Mental Health Care

Links to resources mentioned on the show.
Bruce Perry
https://adoptioncouncil.org/publications/meeting-children-where-they-are-the-neurosequential-model-of-therapeutics/
Book: What Happened to You?
https://302.buzz/WhatHappenedToYou
Andrew Garner – Thinking Developmentally

127 From Hippie to Pediatrician: Getting to Know Your Host

Wed, 08 Feb 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
This is a very special episode where I (the Pediatric Meltdown producer) get to interview your host, Dr. Lia Gaggino. There are lots of great things happening in 2023 and we thought this would be a great way to tell you about all of it as well as getting to know your host a little bit better. We’ll talk about what made her fall in love with Pediatrics as well as her decision to step down from the practice. There is a sneak peak of some episodes coming up, an overview of the “Up Your Game” event she is planning at the end of February (the link to join is below). And we do a rapid-fire random question and answer game that gives you a little more info on the doctor… Do you like the same dessert????
[00:33 -05:39] Let’s start at the Beginning.
She went from “hippie” to intern.
She did her rotation in pediatrics and loved it.
And why she stepped down from practicing.

[05:40-11:07] Her involvement with the American Academy of Pediatrics
She’s served in several capacities on the AAP including president, vice president, and board member.
Lia talks about the AAP and their outreach to other countries.
The AAP policies that came about due to the pandemic

[11:08 –18:49] Lia Talk about the Podcast
We share our favorite episodes.
What kind of subjects we can look forward to hearing in 2023
Lia is “very picky” when it comes to choosing the guests for the show.

[18:50 - 28:33] Let’s hear about the new Newsletter and Event
The newsletter will go out twice a month and will highlight past and future guests, polls, articles of interest, etc.
The “Up Your Game” Event (02/28/23), is for clinicians to understand how they can help kids with mental concerns.
A quick game of “word association”

Sign up for Dr. Gaggino’s February 24th Beta Training
for Professionals who want to re-think the mental health services they offer
Up Your Game - Improving Kid's Mental Health Care

You can reach Dr. Lia Gaggino

Website & Newsletter: https://medicalbhs.com/
Facebook: Dr. Lia Gaggino | Facebook
Instagram: @pediatricmeltdown
Twitter: @gaggino
Linkedin: Lia Gaggino, MD, FAAP | LinkedIn

Links to resources mentioned on the show
American Academy of Pediatrics
Home (aap.org)

Other episodes you may like:
Episode #01
Words Matter-Talking about Weight & BMI

126 Body Grief and Ableism: Lived Experience

Wed, 01 Feb 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Ehlers-Danlos Syndrome…. Ever hear of it? Well, they say that it’s the most common illness that you’ve never heard of. Jayne Mattingly makes a return appearance and gives Dr. Gaggino an update on her health and life since she was last on the podcast. She will talk about how her condition has progressed and gives an honest account of what life is currently like for her. It’s emotional, it’s raw, and it’s real.
[00:33 -13:39] What is Ehlers-Danlos syndrome (EDS)?
It is the most common illness that you've never heard of.
There are 14 different types of EDS, the most common being hypermobile EDS.
It is a genetic condition and is becoming increasingly more common.
People with EDS may need to use mobility aids and make changes to their living space or lifestyle to accommodate their condition.

[13:40- 24:23] What Impact Has EDS Had on Jayne's Life?
She’s now a wheelchair user and has had to move into an accessible home.
She’s had 14 brain and spine procedures and surgeries.
She’s had to switch her focus from recovery coaching to training and educating professionals to become eating disorder recovery coaches.
Jayne created a nonprofit called the AND Initiative which gifts mobility aids and provides resources, education, and advocacy for those with disabilities and chronic illnesses.


[24:24 -32:10] What Are Some of the Difficulties Associated with EDS?
The world is not as accessible as one might think when one becomes disabled.
Grief is experienced with the small things, such as getting dressed in the morning or using a shower chair.
Navigating a world that doesn't understand can be isolating.
Loss of independence or having to rely on others for help.

[32:11- 39:09] What Are Some Ways to Support Those with EDS?
Educate yourself about EDS and learn about its symptoms and treatments.
Listen and ask questions about how you can help them manage their EDS.
Offer assistance but when the answer is “no thank you” .... Believe them.

[39:10 - 46:59] Closing segment Takeaway.

***Don’t forget to sign up for Dr. Gaggino’s February 24th Beta Training
for Professionals who want to re-think the mental health services they offer
Up Your Game - Improving Kid's Mental Health Care

Where to get in touch with Jayne
Instagram: @jaynemattingly
Twitter: @jayneimattingly
Linkedin:

125 Tic Disorders: TikTok Tics

Wed, 25 Jan 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Lia Gaggino asks pediatric neurologist Dr. Sarah Dixon some interesting questions about a phenomenon called “TikTok Tics”. Ever hear of it?? Yeah…. Me either. But it is, indeed, a real thing. We’ve all seen TV shows or movies where someone with Tourette’s spews out a string of curse words and many people think that is the definitive symptom of the disorder. It is more complicated than that. Dr. Dixon talks about the different types of tic disorders and offers up some good news for kids and their parents who are struggling with the challenges of tics that most tics will fade away.
[00:33 -19:24] Understanding Tik Tok Tics
They are commonly seen in older adolescents developing tics for the first time.
These movements have previously been referred to as "functional tics."
They fall under the larger umbrella diagnosis of "functional neurologic disorder" (FND)
FND is a subconscious habit-driven or learned behavior that causes distress or diminishes quality of life.

[19:25- 24:03] Understanding Functional Neurologic Disorder (FND)
FND is not associated with structural, chemical, or electrical neurologic disorders.
It represents an abnormally learned motor plan.
FND often affects children who are skilled at quickly learning motor or academic tasks.
Treatment includes cognitive behavioral therapy and multidisciplinary approaches.


[24:04 -27:47] Understanding the Different Types of Tic Disorders
Provisional Tic Disorder: characterized by one or more motor or vocal tics for less than a year.
Chronic Motor or Vocal Tic Disorder: characterized by one or more motor or vocal tics for more than a year.
Tourette Syndrome: characterized by two or more motor tics and at least one vocal tic for at least a year.
Tic disorders are thought to be a spectrum of conditions rather than unique disorders.

[27:48-37:59] When to Refer to a Neurologist for Tic Disorders
When the patient is bothered by the tics
When there is a suspicion of a comorbidity
When the examination findings are abnormal
When the tics have been present for more than a year or are increasing in frequency or complexity.

[38:00 - 46:10] Closing segment Takeaway

***Don’t forget to sign up for Dr. Gaggino’s February 24th Beta Training
for Professionals who want to re-think the mental health services they offer
Up Your Game - Improving Kid's Mental Health Care

Links to resources mentioned on the show
Tourette Association of American website -
https://tourette.org

TicHelper - Online, self-guided therapy program for tics:

124 Obesity in Children and Adolescents: Changing the Narrative

Wed, 18 Jan 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
When you hear Dr. Joey Skelton speak about his patients, it’s clear how deep his commitment runs. He looks beyond the numbers as he believes that each patient deserves to be treated like an individual being. Today's discussion is on childhood obesity. But don’t make the mistake of rolling your eyes and thinking “oh, yeah… it’s a problem” .... This is a different kind of discussion with a different kind of doctor. You’ll hear some things in this episode that you’ve never heard before. Dr. Gaggino asks some difficult questions and Dr. Skelton teaches us about another way to look at kids and obesity.
[00:33 -19:54] Opening Segment
Dr. Skelton quit his gastroenterologist practice to focus on obesity research and education.
He believes that understanding the entire family is important in addressing obesity and wants to dive deeper into research in this area.
His program is set up so that families can start when they are ready, and it takes into consideration that they may have a lot of other stressors in their lives.
Number one referral he makes is to a counselor for issues around anxiety or depression, and number two referral is to a mental health resource for parents who may be struggling with similar issues.
Our bodies are naturally inclined to gain weight as a means of preparing for potential famines or wars.

[19:55 - 35:37] A New Way of Looking at Obesity.
Recognizing the complexity of factors that can impact behavior change, such as access to food, work schedules, and lack of cooking skills.
Addressing obesity can be difficult when a parent is already overwhelmed with other stresses in their life.
Restricting or limiting portion sizes and encouraging certain foods can lead to negative outcomes, such as increased weight gain and conflicts over food.
BMI is a screening tool and should not be used as a definitive diagnostic tool for obesity.
Keeping the focus on the person, and behaviors related to preventing diabetes rather than just focusing on weight loss can be more effective.

[35:38 -46:07] HAES (Health at Every Size) fights against Preconceived Notions
Listening to podcasts and reading stories from writers in the movement can be emotional and eye-opening.
Writers such as Virgie Tovar and Aubrey Gordon share their personal experiences of how their weight affected their interactions with friends, the healthcare industry, and society as a whole.
It's important for healthcare providers to approach patients with a weight-neutral mindset, focusing on overall health rather than weight.
Creating a safe and non-judgmental environment for patients is crucial in weight-inclusive care.
Advocate for recognizing that people can be in larger bodies and still be healthy.

[46:08 - 53:37] Dr. Skelton’s recommendations
Screening labs should begin around age 10, taking into account risk factors such as family history and physical findings.
Look for opportunities to address issues of weight and health in a size-acceptance spirit.
A mindset shift is required to recognize that health behaviors are often influenced by social drivers and the environment.
The need for education, support, and understanding for patients, rather than using tests to scare families.

[53:38 - 59:24] Closing segment Takeaway.

Don’t forget to sign up for Dr. Gaggino’s February 24th Beta Training
for

123 Somatic Disorders and Medical Child Abuse aka Munchausen by Proxy: Guidance for Clinicians

Wed, 11 Jan 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Child abuse has long been a troubling and widespread issue, and sadly, it seems to be getting worse. Munchausen by Proxy (MBP), often known as somatic illnesses or medical child abuse, is one particularly nefarious kind of child maltreatment. Children's health and safety may be seriously impacted by this type of child abuse. Clinicians must be aware of the symptoms and warning signs of MBP in order to safeguard children against this condition. Dr. Nasuh Malas returns to the show to talk about this issue and give practical advice for clinicians.

[00:33 -11:27] Any New Findings Regarding Somatic Disorders and Munchausen By Proxy?
Somatic disorders, such as somatic symptom disorder, are characterized by physical symptoms that cannot be explained by a medical condition, and are often caused by stress or depression.
Studies have found that individuals with somatic disorders are more likely to engage in Munchausen by proxy behaviors than those without the disorder.
These findings have important implications for the diagnosis and treatment of both disorders, as well as for preventative measures against child abuse.
Early detection of somatic disorders in parents or caregivers is crucial in order to identify potential risk factors for Munchausen by proxy.
Mental health professionals should be aware of the link between somatic disorders and Munchausen by proxy when assessing patients for these conditions.

[11:28- 25:17] What the Psychiatrist can offer?
Psychiatric assessments are used to identify and diagnose the underlying psychological and emotional issues that may be driving the patient's symptoms.
Psychiatrists can also provide psychotherapy, which can help the patient better understand and cope with their symptoms, as well as explore the underlying causes of the disorder.
Psychiatrists may also recommend lifestyle changes or other forms of therapy to help the patient better manage their symptoms.
Collaborative care is often recommended for treatment of somatic disorders, as a team of healthcare professionals can provide comprehensive care for the patient.
Psychiatry is a crucial part of the treatment for somatic disorders, such as Munchausen by Proxy (MBP), as it offers a comprehensive approach to the diagnosis and management of psychiatric disorders.

[25:18 -34:57] Red Flags to Watch Out For
Red flags for Munchausen by Proxy include: disregarding medical advice, iatrogenic injury to the child, isolating the child from normal routine, fading or lying about symptoms, and meeting psychological needs through the child's illness
Children with somatic symptom and related disorders may develop an identity of being physically ill, which can be reinforced by their caregiver
Caregivers may selectively accept certain aspects of a child's evaluation and treatment and disregard evidence that does not fit their belief about the child's condition
It is important for healthcare professionals to be aware of these issues and engage with families in a way that addresses their concerns and promotes the well-being of the child
The continuum between somatic disorders and Munchausen by Proxy can be difficult to navigate, but it is essential to consider both physical and psychological factors in the evaluation and treatment of the child.

[34:58 - 43:32] Recommendations from Dr. Malas
Have handouts available for patients and families to learn more about somatic symptom disorders
Consider working with...

122 Happy New Year!!

Wed, 04 Jan 2023 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
As Dr. Gaggino looks back on her episodes over the past year, she gives out kudos to some of the standout guests of 2022. She also has some reminders of past episodes that you may have missed or may even be worth another listen, (just scroll down to get those links) and there’s a sneak peek at some of the exciting things to come in 2023. If you haven’t already, make sure to tap on that follow button and to ensure that you’ll never miss an episode, get that automatic download every Wednesday morning. Dr. Gaggino has been working hard to get some fantastic shows lined up for you. 2023 going to be an AMAZING YEAR…

[00:33 -2:11] Children's Mental Health and Depression
Children are struggling with mental health issues, and it is our responsibility as adults to support them
Building strong relationships and creating a sense of belonging can be healing for children and families
It is important to educate ourselves and seek out help from professionals when needed

[2:12- 3:04] Medications for Mental Health in Children
Dr. Jeffrey Strawn’s episode #44 discusses the use of SSRIs for children's mental health
It is important to feel comfortable with a few medications and seek guidance from a child psychiatrist if needed
The National Network of Child Psychiatry Access Programs (NNCPAP) can provide resources and support

[3:05 -3:26] Assessing Social Determinants of Health
Dr. Kofi Essel's episode #74 discusses the impact of food insecurity on children's mental health
Asking about food insecurity and advocating for resources can be a simple yet effective intervention
Other social determinants, such as housing and access to healthcare, can also impact children's mental health

[3:27-4:48] Psychoeducation for Children's Mental Health and Supporting our own wellbeing
Dr. Colleen Cullinan's episodes (such as episode 26 on anxiety and episode #71 on depression) provide valuable information on psychoeducation for children
Dr. Cullinan's four-part series on executive function and ADHD (episodes #88, #109, #119, and #120) is also helpful for understanding and supporting children with these conditions
Dr. Kemia Seraff's episode #108 and Dr. Miko Rose's episode #69 offer ideas for maintaining our own well-being as pediatric clinicians
It is important to take care of ourselves so that we can better support the children and families we work with

[4:49 - 10:57] Connecting with Others in the Field
The American Academy of Pediatrics (AAP) and state AAP chapters provide opportunities for connection and support with other pediatric clinicians
The AAP's policy statements, clinical and technical reports, and continuing education offerings are valuable resources for staying up to date on best practices in pediatric care
Joining a local or national pediatric group can be a great way to connect with others and find support in the field.

Links to resources mentioned on the show
Dr. Lia Gaggino’s Website https://www.medicalbhs.com/
NNCPAP.org :

121 ADHD Coaching: Moving the Success Needle

Wed, 28 Dec 2022 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Norrine Russell is the creator of a cutting-edge coaching approach for challenging children, such as those who are 2E, have ADHD, Autism, or Anxiety, as well as those who have learning disabilities. Since 2009, Connected Coaching has demonstrated success with hundreds of students. Dr. Russell is an expert in child development, learning styles, special needs, and effective parenting practices. She has twenty years of experience developing positive youth development and parenting education programs. She combines her expertise to give parents and students the full support and resources they require to develop and prosper. Listen in on the conversation between Dr. Lia Gaggino and Norrine Russell, PhD. This new concept could be groundbreaking.

[00:33 -13:41] Personal Journey from Academic Job to Youth Development
Her son’s diagnosis of ADHD and the Tampa Bay ADHD Parent support group
The success of Russell Coaching as the largest student coaching practice in the country
The coaching Process
Significance of multimodal treatment
Gathering coping mechanisms used in Therapy

[13:42- 29:35] Access of Quality Psychiatric Care
How coaching works differently than traditional psychiatry
Current insurance model is not tailored to diagnoses or treatments like coaching
How the symptom tracker helps in coaching
Difficulties pediatricians face in providing medical care
Possible partnership between psychologists and pediatricians

[29:36 -45:59] What the AAP says about ADHD
Understanding 504s and IEPs
Finding local and national resources
The impact of COVID19
Filling in the gaps of the education system
Improved parent/student relationship when students have a coach

[46:00- 55:57] Preparing for college could be a mental health transition
Looking ahead on what is needed for college life
The change of schedules, daily routines, and moving out of the home to independent living plays a part
Emotional Autonomy and the desire to do things on their own terms
Tips on how parents can effectively advocate for their child’s ADHD
A much more hopeful outlook on the next decade for those with ADHD

[55:58 - 1:16:00] Closing segment Takeaway

You can reach Dr. Norrine Russell
Facebook: https://www.facebook.com/drnorrinerussel
Instagram:@russellcoachingllc
Linkedin: Norrine Russell | LinkedIn
Pinterest: https://www.pinterest.com/russellcoaching/

Links to resources mentioned on the show
Website: https://russellcoaching.com
Book: Asking the Right Questions about ADHD Before, During, and After Your Child's Diagnosis
AAP Clinical Practice Guideline The Diagnosis, Evaluation and Treatment of children and adolescents with Attention-Deficit/Hyperactivity Disorder in Children and Adolescents:

120 ADHD: Part 4 Executive Function

Wed, 21 Dec 2022 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Cullinan is back to finish up this 4-part series on ADHD. There is an enormous amount of practical information and parenting tips in these 4 episodes. If you haven’t yet, be sure to pull up parts 1, 2 and 3. Here is some data from ADDA (American Deficit Disorder Association
WHAT IS ADHD?
Attention deficit hyperactivity disorder (ADHD) is a Neurodevelopmental disorder. It is one of the most common disorders of this kind diagnosed in children. ADHD often carries over into adulthood.
ADHD is a highly genetic, brain-based syndrome that has to do with the regulation of a particular set of brain functions and related behaviors.
These brain operations are collectively referred to as “executive functioning skills” and include important functions such as attention, concentration, memory, motivation and effort, learning from mistakes, impulsivity, hyperactivity, organization, and social skills. There are various contributing factors that play a role in these challenges including chemical and structural differences in the brain as well as genetics.

[00:33 -10:10] Finding an Effective Consequences
Logical Consequences Connected to Behavior
Explaining why an emotional lecture is ineffective
Kids and Manipulation
The complexity and sophistication of manipulation

[10:11-16:55] The role of parents in developmental milestones
Effectiveness of “Emotion Coaching” on Child Development
Necessary techniques/ practices for emotion coaching & emotion labeling
Definition of TLC (Task Limit Consequences)
Developmentally Matched Way to Communicate with Child

[16:56 - 30:40] Benefits of Reward Systems for Families
Improved Behavior & Increased Self-Discipline
Enhanced Motivation & Productivity Levels
Strengthened Parent/Child Relationship
Implementing the Raffle ticket strategy

[30:41-41:50] Leveraging strengths instead of consequence-based discipline strategies
Offering Choice and Freedom in Learning Processes
Acknowledging We Are a Team Working Toward Same Goals
Building People Up to Improve Executive Functioning Skills
Activities such as puzzles, art projects, reading can motivate kids to want to work on executive functioning skills

[41:51 - 46:53] Closing segment Takeaways

You can reach Dr. Colleen C. Cullinan
Twitter: @ColleenCullinan

Links to resources mentioned on the show
Dr. Ross Green Dr. Ross Greene (drrossgreene.com)

Other episodes you may like:
**Episode #88
ADHD: Strategies for Boosting Executive Function Pt I

119 ADHD Part 3: Executive Function

Wed, 14 Dec 2022 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Colleen Cullinan is back for part III, diving deeper into Executive Function. This series not only takes a look at the condition from the child’s point of view, but also the parents. Dr. Gaggino asks the questions that many have thought but few have asked. If you’re a parent of a child with ADHD, this is especially for you. Dr. Cullinan knows you. She hears you. And she gives a voice to those that have been on the sidelines. Pro Tip: listen to this with a pen and paper nearby. You’ll want to refer back to your notes often on this one.

[00:33 -12:42] Opening Segment
We’re introduced to Dr. Colleen Cullinan and continue with part 3 (of a 4 part) series
Picking up where we left off in episode 109 on “Executive Function”
How adults and children differ in terms of Executive Function
The definition of “Working Memory”
Driving a car in terms of Executive Functions
Data on ADHD and car accidents

[12:46- 19:54] Hindsight, Foresight and ADHD
Hindsight: working memory and time
Foresight: Anticipating potential outcomes in the future
Running through scenarios and consequences
Internal dialogue as a tool to insights and behavior

[19:55 -23:57] How to Find What’s Motivating For Kids
Communicating with the ADHD kid on their level, both developmentally and morally
Motivations are centered around “winning” or “losing”
Understanding right versus wrong
How to deal with temper tantrums in this stage

[23:58-46:13] Understanding the Stages of Developmental Empathy in Kids
Stage One – Lack of Empathy or Egocentrism
Stage Two – Beginning Stages of Understanding Others’ Perspectives
Stage Three – Moral Reasoning & Perspective Taking (capable of true empathy
Understanding that kids are capable of true empathy, they just need time and experience with it

[46:14 - 51:33] Closing segment Takeaways

You can reach Dr. Colleen C. Cullinan
Twitter: @ColleenCullinan

Links to resources mentioned on the show

Other episodes in the series:
Episode #88
ADHD: Strategies for Boosting Executive Function Pt I
https://302.buzz/88ADHD-Boosting Executive Function
Episode #109
ADHD: Executive Functions Pt II
https://302.buzz/109ADHDpt2

Key quotes for Twitter:
“Kids who meet criteria for ADHD tend to be about 2-3 years delayed compared to their same age peers. And I think this is particularly true with working memory and working memory is really a tricky executive function”.. Colleen Cullinan
“There is a lot of data that suggests that folks who meet criteria for ADHD are in more car accidents and have more moving violations and tickets… colleen Cullinan

THANK YOU FOR YOUR SUPPORT!
Pediatric Meltdown was listed as a Top 20 Pediatric...

118 ADHD: Assessment, Treatment and Pearls

Wed, 07 Dec 2022 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Lia Gaggino talks to Dr. Herschel Lessin on how physicians can juggle their ADHD patients, parents, practice.
Here are some facts on ADHD (Attention deficit hyperactivity disorder):
-There's more than one type of ADHD
-ADHD is genetic.
-There is no cure for ADHD, but medication and therapy can control symptoms
-ADHD often persists into adulthood
-People with ADHD may be protected by the Americans with Disabilities Act

“ADHD is a chronic condition of the brain that makes it difficult for children to control their behavior.
According to national data, AKHD affects about 9.4% of U.S. children ages 2-17 including 2.4% of children ages 2-5 and 4%-12% of school-aged children…” American Academy of Pediatrics ADHD | All AAP | AAP

[00:33 -8:20] Opening Segment
Dr. Gaggino introduces us to Dr. Herschel Lessin
What drives Dr. Lessin’s passion to be a pediatrician?
How his personal experience inspired him to learn more about ADHD
If managed properly, ADHD has to potential of being a “Superpower”

[8:21- 16:21] Current Pharmaceutical Development for ADHD Treatment
Issues with current drug availability
Potential solutions moving forward
Problem Regarding Pediatricians Comfort with Treating ADHD
Barriers to Treating ADHD

[16:22 -32:47] The economics behind drug pricing and formulary change
How this affects health care providers and patients
Challenges posed by mid-year formulary changes
Disruption to patient treatment plans
Difficulty in switching between medications
National Shortages of Short Acting Medication

[32:48 -59:32] Making a List from the ADHD Toolkit
Learning How to Code for all Service
Documenting Your Thinking
How to Set Up a Practice for ADHD Kid
The importance of documentation and avoiding being audited

[59:33 - 1:07:23] Closing segment Takeaway

Links to resources mentioned on the show
AAP
ADHD toolkit -
https://302.buzz/AAP-ADHDToolKit

ADHD Clinical Practice Guideline -
https://302.buzz/ClinicalPracticeGuideline

AAP publication “Congrats You’re Having a Teen!”
https://shop.aap.org/congrats-youre-having-a-teen-paperback/

REACH Institute -
https://thereachinstitute.org/Ma

Massachusetts General Child and Adolescent Psychopharmacology 2023 course -
https://302.buzz/mgcaPsycPharma

AACAP - ADHD Facts for Families -
https://302.buzz/AACAP-ADHD

NEI Global -

117 Tobacco and Nicotine Use in Teens: Screening and Intervention

Wed, 30 Nov 2022 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Susan Walley was born to work with kids. She was hooked from the beginning. Recognizing that repertory issues are the #1 cause of hospitalization and realizing that parents don’t realize the impact on their own kids, gave her the inspiration to dive into the work of tobacco/nicotine/vaping addiction. Dr. Lia Gaggino asks the questions that you’ve been wondering about. But first, let’s look at some stats:
Results from the Annual National Youth Tobacco Survey (22 findings)
Almost 1 Million Youths use 2 or more tobacco products
E-Cigarettes are the most commonly used tobacco products
About 1 Million youths use any combustible tobacco products
11.3% (3.08 million) middle & high school students reported current use (past 30 days) of any tobacco product
Approximately 3.7% (1.00 million) of all students reported currently smoking any combustible tobacco product
3.5% (960,000) reported current use of multiple (≥2) tobacco products

[00:32 -14:38] Opening Segment
Dr. Gaggino introduces us to Dr. Susan Chu Walley
Dr. Walley was born to take care of kids
Just how dangerous is second-hand smoke?
Vaping is a Youth epidemic
The tobacco companies are taking advantage of a loop hole in the law in order to market to kids

[14:39 - 27:07] The Teen brain is more sensitive to nicotine
Tobacco/Nicotine can cause irreversible brain cell damage and long term behavioral damage.
Usually, the gateway to future drug use
Data is still developing regarding vaping because it’s only been around for a fairly short time
There are currently around 15,000 vape flavorings

[27:08 -50:54] Messaging: What Works?
It’s difficult for clinicians to give their recommendations without sounding judgmental
Motivational interviewing and offering help in quitting is shown to be accepted
The money is being spent in advertising vs education of the dangers of tobacco/nicotine/E-cigarettes

[50:55 - 58:11] Closing segment Takeaway

You can reach Dr. Susan Walley
Linkedin: Susan Walley, MD, MHCM, NCTTP, FAAP | LinkedIn

Resources:

Other episodes you may like:
Episode #20 Talking to Teens about Sex, Drugs & Rock n Roll
https://302.buzz/E20-Teen

Episode #5 Substance Use Disorders and Childhood Exposures
https://302.buzz/E05-SubstanceUseDisorders

Mentioned in the Episode
EVALI stands for E-cigarette or Vaping use-Associated Lung Injury
ACT stands for Ask / Council / Treat

Resources:
MMWR Tobacco Product Use in US Middle and High School Students 11.11.2022.

116 Physician Wellness Coaching: Proven Benefit!

Wed, 23 Nov 2022 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Who will heal the healers? Managing physician burnout is a tall order. And yet when both Dr. Tyra Fainstad and Dr. Adrienne Mann found themselves going through difficult life-chapters, they saw a need in the system that had not been addressed. Their program, Better Together, is for the medical community that may feel isolated or may feel like there’s no outlet. Even though there are definite differences between a Coach and a Physician, when listening to the doctors speak about their program, it seems so logical that the two would work hand in hand with one another. If you’re dealing with burnout or know someone who is, you’ll want to take a listen.

[00:30 -23:04] Opening Segment
Dr. Gaggino introduces us to Dr.Tyra Fainstad and Dr. Adrienne Mann
We learn about their journey into medicine and being a life coach.
They found that burnout was their common thread.
The difference between Coaching and Therapy

[23:05 - 30:54] How a “Cute Little Study” grew into the “Better Together” program?
Web based program with 3 ways of participation; (Zoom, write in on the website and weekly modules)
When they first started, 100 people signed up and that told them how much it was needed.
Although many didn’t do the work, they actually listened and benefited from the recorded Zooms

[30:55 -56:28] The 3 “Better Together” factors
Emotional Exhaustion, Depersonalization, Personal Ethikasy (Accomplishment)
Burnout is 2-10 times higher in women vs men
Should a program like this be required for interns?

[56:29 59:35] What would you tell your “Intern-self”
If you knew then what you know now… would you have even been ready to hear it?
Are you grateful for your anxiety?
“There’s No Right Way”

[59:36 - 1:04:08] Closing segment Takeaway

You can reach Dr. Tyra Fainstad
Facebook: Tyra Fainstad | Facebook
Instagram: @tyraindenver
Twitter: @TyraFainstadMD

You can reach Dr. Adrienne Mann
Instagram: @amw1983
Twitter: @AMannimalMD

Resources:
Better Together website
www.bettertogetherphysiciancoaching.com

Life Coach School
https://www.lifecoachschool.com

Book mentioned:
“Lessons in Chemistry” by Betty Garmus
Amazon.com : lessons in chemistry

Other episodes you may like:
Episode #108 Physician Moral Injury; Healing the Healer

115 Chronic Pain Syndromes: Assessment and Management

Wed, 16 Nov 2022 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Eating the right foods, getting enough rest, participating in some activity... We’ve all heard that so many times, we can’t even count. However, when Dr. Lenz says it… he backs it up with evidence. Listen in while Dr. Michael Lenz makes the connection of what’s really going on in a patient that is suffering from chronic pain. It all sounds so logical when Dr. Lenz talks about the Food-Mind-Body connection. Dr. Gaggino and Dr. Lenz talk about how the brain processes pain and offer some answers that you may not have thought about. If you suffer from chronic pain, fibromyalgia, etc., you’ll want to listen with a pen and pad nearby.
[00:33 -16:29] Opening Segment
We hear about Dr. Lenz journey into the medical profession
How his love of sports relates to his chronic pain practice
When all those around them are in disbelief, just validating a patient's pain is half the battle
Are “Growing Pains” real??? Maybe it’s something else… Dr. Lenz digs deeper to find the actual answer

[16:30- 29:20] The Pain Continuum
How the brain processes pain
Some physicians are not connecting the symptoms; don’t ask the right questions
40% of children that have Crohn's disease also have IBS
The importance of Food-Mind-Body relationship

[29:21 -39:32] Connecting the dots
Offering validation, hope, and trust….however, maybe medication is not your first “go-to”
The hypervigilant brain
Dr. Lenz’s evidence based approach
People who are on the Central Pain Spectrum need regularity more than originally thought

[39:33 -27:05] But what about Medication?
Opioids may make chronic pain worse
Having patients keep track with a Diary, record the schedule and history,
You can have an impact early on in a patient’s life so they don’t end up “just like grandma”

[57:06 - 1:02:26] Closing segment Takeaway

Links to resources mentioned on the show

The Podcast: Conquering Your Fibromyalgia
     Apple: Conquering Your Fibromyalgia Podcast on Apple Podcasts
     Spotify: https://cutt.ly/ConqueringFibromyalgia

Dr. Lenz's Book
https://cutt.ly/ConqueringYourFibromyalgia
Key quotes for Twitter:
“I got kicked off of Facebook. I said boy, a lot of people here. It seems like they're talking about this like it's a stage four metastatic cancer and we're just doing palliative care. Like nobody's ever going to get better. And I said, my patients get better” ...Dr. Michael Lenz

"Right now, there is no specialist that's really the expert. There may be people in a GI dept and one of them has an interest in this area, but they are not psychiatrists. There might be a psychiatrist who's interested in things, but they're not the neurologist and vice versa".. Dr. Michael Lenz

THANK YOU FOR YOUR SUPPORT!
Pediatric Meltdown was listed...

114 Palliative and Hospice Care: A Conversation on Grief and Joy

Wed, 09 Nov 2022 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
You should know that we’re talking about very hard things today. However, death is part of life, and (just like adults), children are not excluded. But logic doesn’t ease the blow when a child passes. Keith was only 6 months old. He left behind 2 loving parents who have now dedicated their lives to creating special programs, support groups and educating medical professionals on best practices when faced with a family going through this kind of a life altering chapter. Dr. Gaggino talks with Rachel and Aaron Lewis about their journey with their son Keith. They’re also joined by Dr. Lisa Humphrey, Director of the Division of Hospice and Palliative Medicine at Nationwide Children’s Hospital. Together, they’ll tell you about the effect that Keith’s life and death have had on the practice of children in palliative and end of life care. Oh, by the way……Grab your tissues, this will be a tough one.

[00:33 -20:16] Opening Segment
We’re introduced to Dr. Lisa Humphrey and we hear about how her passion for palliative care was born
We meet Rachel and Aaron Lewis who talk about their son Keith’s journey
The myths about palliative care
The difference between Palliative Care and Hospice
Being Decisionally Agnostic is a key factor in Palliative Care

[20:17- 35:48] Hope for the Best, Prepare for the Worst
The importance of respecting the decisions of the family
There is active communication between team members to “keep themselves in check”
Is it okay to talk about death with the parents and how do we do that in a helpful way?
Reading the room is a valuable skill set

[35:49 -48:43] Preconceived Notion
Important to have the families in the room (if they want to be there)
Parents actually watching the team work to save their child with dignity, intellect and intent can be helpful for the bereavement process
The magic of the first breath and the last breath

[48:44 1:05:05] Get out of your comfort zone
Biggest fear is that the child’s name will be forgotten
Encourage the family sitting out in the waiting room to be a part of the care
For team members: show your validation of the child by showing up, being there saying the child's name, push your humanity forth.

[1:06:06 - 1:11:25] Closing segment Takeaway
You can reach Rachel Lewis
Facebook: Rachel Houser Lewis | Facebook
Instagram: @rachel_lewis21.12

You can reach Aaron Lewis
Facebook: Aaron Lewis | Facebook

Links to resources mentioned on the show
You can learn more about Keith’s story at

113 Advocate for Kids!: #PutKids1st

Wed, 02 Nov 2022 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Advocacy can take many forms, from speaking out publicly to organizing groups to writing letters to elected officials. Whatever the form, advocacy is an important way to bring attention to issues and make change. And although anyone can be an advocate, there’s definitely an art to being an “Effective Advocate”. Today, Dr. Gaggino talks with Dr. Pam Shaw who has perfected the art of advocacy. Among the many hats that Dr. Pam Shaw wears, (i.e., Professor of Pediatrics, Assistant Dean for Clinical Sciences, Associate Vice Chancellor for Student Services, President of the Kansas Chapter of the AAP– just to name a few), her passion to make things better for all children has no boundaries. Listen in to not only Dr. Shaw’s personal journey, but also about her work in Washington, D.C. on behalf of all children everywhere.

[00:33 -12:46] Opening Segment
Dr. Gaggino introduces us to Dr. Pam Shaw
What drives Dr. Shaw’s passion to be an AAP Advocate on the national level?
What does an AAP Advocate actually do?
For children's issues, you need lots of organizations working together

[12:47- 25:03] Bipartisan Concerns
Good opportunity to start with AAP
Politics are affecting the doctor/patient relationship
Learning opportunities are created when local chapters share successes as well failures with each other
In order to make an impact, VOTE!!

[25:04 -41:20] Emphasis On Pediatrician’s Needs
Safety
Training
Vaccine Funding
Mental Health parity
Payment for Services
Coding review

[41:21 -45:13] How Can Pediatricians Up Their Game?
Join your local chapter of AAP
Sign up to be a key contact for AAP
VOTE! (And encourage family and friends to vote as well)

[45:14 - 50:40] Closing segment Takeaway

You can reach Dr. Pam Shaw
Facebook: Pam Shaw | Facebook
Instagram: @pkshaw
Twitter: @Pkshaw1
Links to resources mentioned on the show

HRSA (Health Resources and Services Administration)
Apply for a Grant | HRSA

COSGA (Committee for State Government Affairs)
Committee on State Government Affairs (COSGA) (aap.org)

American Association of Pediatrics
https://www.aap.org/
“67,000 pediatricians committed to the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults”

Get a non-partisan Vote-ER badge and sign-up families to vote -

112 Schizophrenia: Recognizing the Early Symptoms

Wed, 26 Oct 2022 09:00:00 +0000

TRIGGER WARNING: Please note that this episode contains a discussion of suicide, self-injurious behavior, depression and/or reference of other mental health disorders that may act as triggers.
https://302.buzz/PM-WhatAreYourThoughts
No one expected it. How could you? I mean, he was doing so well. Taking the meds, socially engaged. Everything seemed fine….. But one day in February something went wrong. Dr. Colleen Kraft makes a second appearance on the podcast, but this time, she walks us through her very personal journey of how schizophrenia has affected her family as well as her, as a mother. It’s difficult to hear, but it’s something that will stay with you for a very long time. Dr. Elise Falluco, one of the foremost leading pediatric psychiatrists, helps shed light on this mental illness that 24 million people deal with every day. Our host, Dr. Lia Gaggino gets the hard truth to some hard questions. Listen in as 3 of the most accomplished medical professionals in the United States discuss this often-stigmatized mental illness, schizophrenia.

Schizophrenia:
Noun PSYCHIATRY
a long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.

(in general use) a mentality or approach characterized by inconsistent or contradictory elements.
"Gibraltar's schizophrenia continues to be fed by colonial pride"

[00:30 -15:37] Opening Segment
The back story on Dr. Falluco and Dr Kraft and what led them to wanting to work with children
Dr. Falluco talks about (her son), Tim’s schizophrenia diagnosis
33% diagnosed schizophrenics are treatment resistant
If 33% of cancer patients were treatment resistant, we would be demanding new and better treatment

[15:38 - 24:46] What are the early signs to look out for?
No longer cares about appearance, gets tired, sleep disrupted, apathy, stops bathing, etc.
Psychosis sometimes masquerades as depression
The difference between the child who has an “imaginary friend” and a child that is not developmentally typical
Most common scenario: parents bring their child to the doctor because the child was found talking to themselves.

[24:47 - 34:16] How to Ask the hard questions
The question that will determine “True Psychosis” vs “Psychotic Like Experiences”
Why headphones might be a red flag?
How to get past the stigma

[34:17 - 59:13] What causes Schizophrenia?
Medications and treatments currently being researched
How much do genetics factor into diagnosing schizophrenia
Making the distinction between bipolar and psychosis
We need to change the language that is associated with schizophrenia (i.e. “Psychotic Killer”, Schizophrenic Criminal”)

[59:14 - 1:08:56] Closing segment Takeaway

You can reach Dr. Colleen Kraft
Instagram: @docmom3460
Linkedin: Colleen Kraft | LinkedIn

You can reach Dr. Elise Falluco
Linkedin:

111 Health is a Human Right: Why Are We Falling Behind?

Wed, 19 Oct 2022 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Why is the U.S. falling behind in healthcare and what can we do to change the narrative? In this episode, Dr. Gaggino talks to the author of “Who Shall We Let Die”, Dr. Koye Oyerinde. As a Public Health/Global Health Expert, Dr. Oyerinde has had a major role in strengthening health systems for the delivery of Reproductive, Maternal, Newborn, Child and Adolescent Health services in low and middle-income countries. Listen in as Dr. Gaggino and Dr. Oyerinde have a frank discussion about the current state of healthcare in the U.S.
According to the World Health Statistics 2022:
"The Billion target will not be reached by 2023, and progress is less than 1/4 of that required to reach the Sustainable Development Goals by 2030"
[00:33 -10:42] Opening Segment
Dr. Gaggino introduces us to Dr. Koye Oyerinde
It was inevitable that Dr. Oyerinde would become a doctor since he spent so much time in hospitals when he was a child.
What is a “Go Fund Me Health System”?

[10:43- 25:29] Human Rights Abuse
Top Executive compensations are in competition with our healthcare..
Too many programs without coordination between any of them
Do the American Indians, the UK and Canada have a healthcare system that the US should duplicate?
The mindset of today’s healthcare stems from a long held tradition

[25:30 -30:53] Global Health section of the AAP
AAP is able to influence other countries by sending US based experts to initiate better practices
The US can be proud of the work we do well, but we need to be humble about the work we don’t do well.
If members of the AAP are interested in Global Health, there are opportunities to join the Global Health section

[30:54 - 36:20] Closing segment Takeaway

You can reach Dr. Koye Oyerinde
Website: www.drkoyeoyerinde.com
Twitter: @DrKoyeOyerinde
Linkedin: linkedin.com/in/koyeoyerinde

Dr. Oyerinde’s Book
“Who Shall We Let Die”
Amazon: https://cutt.ly/WhoShallWeLetDie

Discounted copies are also available upon request at www.drkoyeoyerinde.com (contact tab)

American Association of Pediatrics
https://www.aap.org/
“67,000 pediatricians committed to the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults”

For current Data and Stats
Check out the World Health Organization
World Health Organization (WHO)

Other episodes you may like:
Episode #46
Moral Dilemmas: Where Medicine and Ethics Meet

110 LGBTQ+ Youth Sexuality: Inclusive Parent-Child Conversations

Wed, 12 Oct 2022 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Dennis Flores’ first study looked into the circumstances that contributed to the recent HIV infection of young gay men in Atlanta. This was done with an awareness of the personal and contextual factors that increase sexual and gender diverse individuals' vulnerability for HIV/STI infection and poor care-related outcomes. His subsequent HIV/STI prevention work, which includes community education in both urban and rural areas, serving as the national spokesperson for HIV testing campaigns, and workforce development with about 1400 nurses across three continents, has been inspired by that study. Serving in numerous leadership positions for the Association of Nurses in AIDS Care is only one example of the man's career-long dedication to nursing leadership and HIV/AIDS care. Dr Gaggino and Dr. Flores talk about his work over the years in the community and the Social Stigma of LGBTQ+ and its Effects.
Heteronormative: * adjective
            denoting or relating to a world view that promotes heterosexuality as the normal or
preferred sexual orientation.
"This is believed to stem from heteronormative and patriarchal setups of
traditional heterosexual relationships"
Cisgender * adjective
             denoting or relating to a person whose sense of personal identity and gender
corresponds with their birth sex.
"If you were born a male and you identify yourself as a male, you are considered
cisgender."

[00:30 -12:36] Opening Segment
Dr. Gaggino introduces us to Dennis Flores, PhD, ACRN
Dennis’ passion is facilitating conversations between the LGBTQ+ child and the parent
The US has a different way of looking at sexuality vs the rest of the world.
Removing stigma around sexuality is the first step
Don’t let fear of the myth that just talking about sex with your child will make them want to have sex

[12:37 - 24:58] Is Gatekeeping an American trait?
Insecurity is magnified even more when they don’t see representation in the media.
A parent that provides a supportive , accepting and inclusive context is the most that you can do
Media is finally coming around regarding depictions of LGBTQ+ in commercials, movies, TV shows
Dennis’ talk about his in depth research on LGBTQ+ youth and the relationship they have with their parents
Establish open lines of communication during those elementary years.

[24:59 -32:26] Resources that clinicians can offer parents
Construct these conversations over a period of several years; personal space, permission, consent, etc.
Clinicians can facilitate these conversations
Be open to perhaps the parent isn’t ALWAYS the expert

[32:27 -44:53] Normalize the LGBTQ+ conversations
A TV show can initiate “difficult” conversations.
Watching shows together lightens the mood and makes it so much easier to talk
Capitalize on teachable moments
Advice for clinicians: language / visual cues to establish a welcoming atmosphere (a “safe place”)

44:54 - 49:22] Closing segment Takeaway

You can...

109 ADHD Symptoms: Executive Functions Part II

Wed, 05 Oct 2022 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
The eight key executive functions are Impulse control, Emotional Control, Flexible Thinking, Working Memory, Self-Monitoring, Planning and Prioritizing, Task Initiation, and Organization. Early identification and intervention is important for helping individuals with ADHD to reach their full potential. Dr. Colleen Cullinan is back for part 2 in Dr. Gaggino’s series on ADHD. They pick up where they left off on Episode #88 (the link to the episode is below). You’ll hear a deeper dive into the strategies and specific techniques of caring for the ADHD child. According to a 2016 CDC report, about 3 in 4 US children with current ADHD receive treatment. Let’s take a closer look at some of the other stats on that report.

62% were taking ADHD medication
Ages 2–5: 18%
Ages 6–11: 69%
Ages 12–17: 62%
47% received behavior treatment
Ages 2–5: 60%
Ages 6–11: 51%
Ages 12–17: 42%
Altogether, 77% were receiving treatment. Of these children:
About 30% were treated with medication alone.
About 15% received behavior treatment alone.
About 32% children with ADHD received both medication treatment and behavior treatment.
About 23% children with ADHD were receiving neither medication treatment nor behavior treatment.

[00:30 - 08:17] Opening Segment
Dr. Gaggino introduces us to Dr. Colleen Cullinan
Dr. Gaggino and Dr. Cullinan pick up where they left off from Ep 88

[8:18 - 10:37] The diagnosis should be a “strength based model”
The Hyper focus of an ADHD child will activate that chemical excitement in their brain.
“Attention Deficit” is a misnomer
What is the true definition of ADHD?

[10:38 - 24:00] How do we adjust to meet where kids are?
Redirect the attention that they DO have
Tolerating the experience of “Chemical Boredom”?
The ADHD child can strengthen their weaknesses in a planful, stepwise, gradual way
The executive function of INTERNAL SPEECH


[24:01 -54:26] The Golden Ratio for ADHD
This is not to be used as a reward
14 positive interactions to neutralize 1 negative interaction
It only takes 5 minutes a day
The parent’s job is to listen, reflect and praise

[54:27 - 1:01:48] Closing segment Takeaways
You can reach Dr. Colleen C. Cullinan
Email: colleen.cullinan@nemours.org
Twitter: @ColleenCullinan
Resources:
Episode #88
https://cutt.ly/ADHD-Ep88

Parent Child Interaction Therapy (PCIT)
pcit.org

Book Mentioned in the Episode
https://cutt.ly/RaisingAnEmotionallyIntelligentChild

Key quotes for Twitter:
“When we think about a 7 y/o, who, when it comes to internal speeches, actually looks more like a 5 or 4 y/o, we really do need to think about how we can start to teach this skill of pause, reflect, look around, use your...

108 Physician Moral Injury: Healing the Healer

Wed, 28 Sep 2022 09:00:00 +0000

TRIGGER WARNING: Please note that this episode contains a discussion of suicide, self-injurious behavior, depression and/or reference of other mental health disorders that may act as triggers.
https://302.buzz/PM-WhatAreYourThoughts
When Dr. Kemia Sarraf's 13-year-old son was diagnosed with leukemia in 2014, her world — at least for the next three years — came to a full stop. And as he regained his health—which, by the way, he's great now—it led her down a path that would ultimately become her life's work. In this episode, she discusses with Dr. Gaggino, the trauma she experienced that inspired her to develop a special trauma-responsive coaching paradigm that is especially well-suited for frontline workers who are exposed to chronic toxic stress and who are therefore directly affected by the numerous ways that vicarious and secondary trauma "show up" in everyday life. Dr. K established Lodestar in 2016 with a focus on coaching techniques that are trauma-responsive for medical colleagues who are suffering from severe burnout, vicarious trauma, and moral injury.

[00:30 - 11:15] Opening Segment
Dr. Gaggino introduces us to Dr. Kemia Sarraf
How her son’s illness started her on the path of helping other medical professionals
The discovery of the common thread: Trauma among medical professionals

[11:16 - 16:00] Being mindful about building a “Trauma Informed” practice
People who are in intense pain and want to be coached toward something
The client holds the outcome
The concept: we all carry wounds
Unbearable “Stuckitude”

[16:01 - 38:28] The impact of chronic, toxic stress
Both Dr. K and Dr. Gaggino talk about what they experienced during the early days of the pandemic
How children of different ages handle stress
An underutilized tool: curiosity
The shift from “how do we take care of our patience” to “how do we take care of ourselves”
“We are hemorrhaging colleagues”

[38:30 -41:44] The factors that move us toward Trauma
The unrelenting nature of trauma itself
Lack of rest and recreation
Real or perceived loss of control
Lack of resources (emotionally as well as physically)
Loneliness (disconnection)
The toxic story of “I’m the only one”

[41:45 -52:45] So…. What’s the way out?
Actively connect with others
There’s power in naming and sharing
The asking is therapeutic
Self-Compassion
It’s ok to ask… “are you having thoughts of hurting yourself”

[52:46 - 58:15] Closing segment and Takeaways

**For More episodes on Suicide Awareness**
Listen as Dr. Gaggino interviews her own sister (Ep105)
https://cutt.ly/show105

Website
https://www.lodestarpc.com

social media links
Facebook: Kemia Sarraf | Facebook
Twitter: @DrKemia
Linkedin: Dr. Kemia Sarraf...

107 Suicide Prevention That Works: The Zero Suicide Framework

Wed, 21 Sep 2022 09:00:00 +0000

TRIGGER WARNING: Please note that this episode contains a discussion of suicide, self-injurious behavior, depression and/or reference of other mental health disorders that may act as triggers.
https://302.buzz/PM-WhatAreYourThoughts
A national project called Zero Suicide aims to address the issue of suicide in the medical and mental health systems. The effort is founded on the idea that suicide can be stopped and that systems of medical and mental health care can do more to do so. Seven elements make up the entire Zero Suicide prevention strategy: LEAD, TRAIN, IDENTIFY, ENGAGE, TREAT, TRANSITION and IMPROVE. These elements insure a practical comprehensive approach to suicide care. In this episode, Dr. Gaggino interviews Dr. Julie Goldstein Grumet. Dr. Grumet is a clinical psychologist and public health expert. Dr. Grumet is the director of the Zero Suicide Institute at EDC, Inc. and she developed the Zero Suicide Toolkit to assist health and behavioral care leaders and leadership teams in implementing the seven elements (mentioned above) of the initiative. Her goal has been to develop the framework, tools, and work schedules required for the Zero Suicide effort to be implemented effectively.

[00:30 - 06:29] Opening Segment
Dr. Gaggino introduces us to Dr. Julie Goldstein Grumet
Dr. Grumet tells us about her background and how she came into the field
Julie recognized that the healthcare system had been left out of the first national strategy for Suicide Prevention.

[6:30 - 9:41] How Dr. Grumet came to develop the Toolkit
First launched in 2014
Taking the guesswork out of implementing the recommendations
An organized, concise blueprint that outlines the seven elements

[09:42 - 22:07] What makes this program so different?
Evidence based Fidelity
The Core Clinical Components: Screen, Risk Assessment followed up with a safety plan
The seven elements: LEAD, TRAIN, IDENTIFY, ENGAGE, TREAT, TRANSITION and IMPROVE
The clinical data and being completely “evidence based” is what makes this program work as well as it does.
How Zero Suicide is about a culture shift
These components bundled with the seven elements will not only keep the patient safe but will also keep the staff safe as well.

[22:08 -48:39] Get comfortable having that conversation
Removing lethal means
There are online courses you should take (see link below)
“I GOT THIS” ....

[48:40 - 54:26] Closing segment - Takeaways
Thank you to Julie for her time today and to the entire ZS team at EDC for offering guidance and support for system change and ZS implementation.
Zero Suicide is an aspirational goal and a methodology for suicide prevention. In 2012, The Action Alliance included ZS as part of the National Strategy to transform healthcare systems.
ZS is a bundle of strategies that include both clinical components and implementation components. Strap on your seat belt, this is your roadmap to better care.
LEAD, TRAIN, IDENTIFY, ENGAGE, TREAT, TRANSITION, IMPROVE. You can start at any spot though would HIGHLY recommend LEAD then TRAIN!!!
Many of you are already doing IDENTIFY with PHQ screening as we were. With the new BF guidelines to add suicide screening this is a perfect opportunity to use TRAIN to implement ASQ or CSSR-S screening.
Clinical components include screening, risk assessment, safety planning, lethal means...

106 Youth Suicide Prevention: Building Community Coalitions

Wed, 14 Sep 2022 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
TRIGGER WARNING: Please note that this episode contains a discussion of suicide, self-injurious behavior, depression and/or reference of other mental health disorders that may act as triggers.
https://galas.fm/episode/08d6fc7c-09cb-59bb-a0d4-865ece3e4580
In the United States, suicide is the second leading cause of death for children and adolescents between the ages of 10 and 24. Suicide rates have been increasing in recent years, with the rate for girls aged 15-19 doubling between 2007 and 2015. While boys are more likely to die by suicide, girls are more likely to attempt it. There are many factors that contribute to pediatric suicide, including mental health disorders, bullying, social media, and family stressors. Teenage girls are particularly at risk for depression, which is the most common mental health disorder among adolescents. Depression can be a precursor to suicide and lead to self-harming behaviors, such as cutting. Here are some hard core facts:
There are more suicide deaths than motor vehicle accidents
There are more suicide deaths than homicides

In this episode, Dr. Gaggino speaks with Sarah Mead and Erica Espinoza, from Gryphon Place (the local crisis center in Kalamazoo Michigan). They give us their unique perspective on working with people in crisis.
[00:30 - 10:16] Opening Segment
Dr. Gaggino introduces us to Sarah and Erica
Erica tells us what it takes to be a crisis volunteer
There’s been over 20 million calls since the hotline started in 2005.
Erica tells us the different ways to de-escalate a situation

[10:17 - 12:54] 988 is not a new program…. They just gave us an easier way to get to the hotline
Myth: 988 goes directly to the police… Fact: 988 is actually made to reduce the amount of emergency involvement
988 is there to de-escalate the situation and not involve the police
There was a 45% increase in volume the week that 988 was implemented compared to the week before (that’s a 66% increase from the same week last year)

[12:55 - 15:10] Some Things To Look Out For
Risk Factors: Depression or substance use disorder, traumatic brain injury, chronic pain, any serious health conditions
Risk Factors: bullying, unemployment, any sudden drastic change in a person's life. (i.e. divorce, a death of a loved one, a suicide), a history of childhood trauma or a family history of suicide
Warning signs: They might talk openly about killing themselves or use language like I'm feeling hopeless. I feel overwhelmed. I just don't know what to do. I don't see another way out. Nobody can understand the situation that I'm in and they may talk about the unbearable pain that they feel.
Warning signs: increased use in alcohol or drugs, if they're buying a gun or stockpiling pills, if they start saying goodbye or giving away priceless possessions.

[15:11 -29:30] Asking someone if they’re having thoughts of suicide will not encourage them to kill themselves
Why we should not use the phrase, “Committed Suicide”
Why we should not refer to it as a “failed” or “unsuccessful attempt”,
One of the goals of SPAN is to educate the gun retailers on how to pick up on the warning signs of someone who may have thoughts of suicide.

[29:31 - 34:04] Closing segment
Takeaways

Resources:
Gryphon.org and for Kalamazoo

105 Suicide Prevention - Hope and Resilience: My Sister’s Story

Wed, 07 Sep 2022 11:00:00 +0000

TRIGGER WARNING: Please note that this episode contains a discussion of suicide, self-injurious behavior, depression and/or reference of other mental health disorders that may act as triggers.
https://302.buzz/PM-WhatAreYourThoughts
In this very personal episode of Pediatric Meltdown, Dr Gaggino talks with her sister, Alyssa, who attempted to take her own life 19 years ago. As with many who attempt suicide, there were many factors that may have contributed. Risk factors include a history of trauma, mental health disorders, relationship difficulties that can all add up until the individual is overwhelmed and feels hopeless. Dr. Gaggino and her sister talk about the dark times, but also talk about Alyssa’s recovery and incredible resilience. But first, some facts and figures
Suicide is defined as death caused by self-directed injurious behavior with intent to die as a result of the behavior.
A suicide attempt is a non-fatal, self-directed, potentially injurious behavior with intent to die as a result of the behavior. A suicide attempt might not result in injury.
Suicidal ideation refers to thinking about, considering, or planning suicide
Suicide was the second leading cause of death among individuals between the ages of 10-14 and 25-34 , the third leading cause of death among individuals between the ages of 15-24, and the fourth leading cause of death among individuals between the ages of 35 and 44.
There were nearly two times as many suicides (45,979) in the United States as there were homicides (24,576)

[00:-5:26] Opening Segment
Lia introduces us to Alyssia
Together, they talk about the trauma they went through growing up
How trauma manifests itself.

[5:27-15:22] How Alyssa started her journey “into the system”
Finding the right regiment
The one clinician that made the difference
After bottoming out, how Allyssa recovered

[15:07-26:03] Closing Segment
The “Rewired version” of Alyssa
Signs to look out for
Alyssa brings us up to date on her life

[26:04-30:15] Dr. Gaggino’s Takeaways
9 takeaways to think about
Closing Goodbyes

Tweetable Quotes:
“I got to a point where….. I just couldn’t try anymore…" - Alyssa Gaggino, LMSW (on her suicide attempt)
“I think people worry sometimes that they’re going to make someone suicidal by asking the question There’s lots of evidence that that isn’t the case….” Dr. Lia Gaggino

Resources mentioned in the episode:
-Child Psychiatry Access Network Program locator map: www.Nncpap.org
-Suicide warning signs and risk factors: https://afsp.org/risk-factors-protective-factors-and-warning-signs

Numbers to reach out to for help
1-800-273-TALK (8255) National Suicide Prevention Lifeline
Talk: 988 Suicide & Crisis Lifeline
Crisis Text: Dial 741-741 and Text the word “HOME”

For Veterans (wasn’t mentioned, but still good to know)
Talk: 988 then press 1 (Veterans Crisis)
Text: Dial 838-255 (For Veterans)

MC3 (Michigan Medicine)

104 Youth Mental Health: Crisis Intervention and System Change Innovation with Travis Atkinson

Wed, 31 Aug 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Welcome to Pediatric Meltdown! In Today’s episode, our guest is Travis Atkinson.
Travis has worked in the crisis intervention field for over 20 years and describes how our mental health system of care was created with a medical model that does not meet the needs of our patients. Our offices and emergency departments are facing enormous numbers of kids who are struggling, and it is up to us to create a patient-centered system that works based on choice, agency, and freedom. Many models work: mobile crisis response and stabilization teams, peer support and recovery coaches, and integrated behavioral health in outpatient clinics. When treating mental health historically we have been wrong so many times. We must do better now. Travis closes with advice for change - lead with a servant's heart and consider the serenity prayer - grant me the serenity to accept the things I cannot change; the courage to change the things that can be changed, and the wisdom to know the difference.
[00:30 - 09:02] Opening Segment
Travis Atkinson is a skilled clinician and musician who has worked in behavioral health services for 20 years.
He is the president of the Crisis Residential Association and former Crisis Services Committee chair for the American Association of Suicidology.
He received his BA from the University of Michigan and his master's degree from National Lewis University.
Travis lives in Grand Rapids, Michigan with his wife and three daughters.

[09:02 - 17:04] Community Responds to Behavioral Health Emergencies with Dedicated Mental Health Crisis Lines and Mobile Crisis Teams
There are dedicated mental health crisis lines available that can help divert people from psychiatric hospitals or emergency departments.
Mobile crisis teams are a type of intervention that can be used to meet people in the community who are experiencing a mental health crisis.
These teams are available in most communities and can provide support for up to 90 days.

[17:04 - 25:25] TD Solutions: How to save $5,000 a day by using mobile crisis teams
The community mental health services are often responsible for the operation of mobile crisis teams.
One type of team that we haven't talked about yet is the co-sponsor model, in which a clinician and a police officer or law enforcement work together.
Reaching out to your community mental health center or your local law enforcement to find out if these teams are available and who they are available for is important.
People with mental illness are more likely to be a victim of crime than they are to be a perpetrator of the crime.

[25:26 - 33:14] Mental health services should be available to everyone
There is a need for psychiatric hospitals to provide high-quality treatment that meets the goals of the individual, not just keeping them safe.
The goal of psychiatric hospitals should be to help patients develop meaningful life skills that will carry on beyond their stay.
There is a trend toward treating patients as individuals and leveling the hierarchy between doctors and other professionals.

[33:14 - 41:22] Intervening Found Strategies to Help You
Intervening found that other strategies...

103 Talking to Teens and Parents: A Re-Frame with Dr. Ken Ginsburg

Wed, 24 Aug 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Welcome to Pediatric Meltdown! In Today’s episode, our guest is Ken Ginsburg, MD, MSEd. Dr. Ginsburg re-frames adolescence - not peril and drama, but instead, a time marked by exploration, curiosity, and joy. Parents often believe that they won't matter anymore, but in reality, they matter more than ever. While teens are embarking on their journey to independence, the adults in their lives, us too, serve as guides and teachers. We are the emotional containers for big feelings and "lend our calm". Teens are "super learners" and the world is their oyster if we paint the journey with hope and excitement. Pediatric clinicians offer a safe space to share all the ups and downs. For teens and parents, knowing that we have their back is golden!

Dr. Ginsburg is the Founder & Program Director, of the Center for Parent and Teen Communication He is a physician, adolescent medicine specialist, and Professor of Pediatrics at Children’s Hospital of Philadelphia. He is committed to preparing adults to be the kind of people that adolescents deserve in their lives. He supports local, regional, and national organizations in developing programs and policies that strengthen families and see young people through a strength-based lens. He speaks to parent, professional, and youth audiences nationally and internationally and is the author of 5 award-winning parenting books as well as a toolkit for youth-serving professionals. CPTC is rooted in his strength-based philosophy and resilience-building model.
[00:30 - 08:59] Pediatric Meltdown: Dr. Ken Ginsburg on the Importance of Adolescence
Dr. Ken Ginsburg is the founder and program director of the center for parent and teen communication.
He is a physician adolescent medicine specialist and professor of pediatrics at the children's hospital of Philadelphia.
He supports local, regional, and national organizations in developing programs and policies that strengthen families and see young people through a strength-based lens.
He speaks to parent-professional and youth audiences nationally and internationally, and is the author of five award-winning parenting books as well as a toolkit for youth-serving professionals.
CPTC is rooted in his strength-based philosophy and resilience-building model.

[08:59 - 17:37] How to Raise a Resilient Child
At some point, parents need to learn how to do things independently, and adolescence is a crucial time for this.
Parenting during this time can be difficult because parents are anxious and want to protect their children from harm.
To help parents navigate this stage successfully, they need to remember that their children are growing and developing and that mistakes are part of the process.
Parents should also share their strengths with their children and help them develop coping mechanisms for when stress is unavoidable.

[17:37 - 26:38] The Truth About Adolescences
Adolescents are emotional and rational beings, with brilliant emotional brains.
The emotional brain takes over during adolescence, and this can be challenging for adults to manage.

102 School Avoidance? Phobias?: A New Virtual Reality Therapy with Dr. Abbie Vanderwege

Wed, 17 Aug 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
School Avoidance, social anxiety, and phobias are all common in childhood affecting 5% to 12% of kids. This is a lot of patients showing up in pediatric practices. The gold standard for treatment is exposure therapy, but that model has its limitations. How do you get a kid on an airplane multiple times to help with fear of flying? A new virtual reality (VR) therapy model is an exciting option. Trained psychologists use VR goggles and with sophisticated software create a patient avatar and experiences where patients can gradually face their fears. Research shows in small studies that the experience feels real and that fears diminish. Larger RCT are needed to push this therapy into the mainstream. Dr. Abbie Vanderwege shares her successes with this therapy and walks us through the patient experience. This is an exciting option for children and adolescents who are struggling.
Dr. Vanderwege with a major in Psychology from Kalamazoo College in 2004, quickly transitioned into the master's degree program in Counseling Psychology at Western Michigan University, which she completed in 2006. While working toward that degree, she developed an interest in holistic health and pursued a graduate certificate in Holistic Health Care, which she also received in 2006. Dr. Vanderwege then accepted a position as a family therapist for the Family Reunification Program at Bethany Christian Services. Feeling at home in Kalamazoo, she entered the APA-accredited Ph.D. program at Western Michigan University in Counseling Psychology in 2007 and completed a full-time APA-accredited predoctoral internship at the Battle Creek VA Medical Center where she pursued rotations in outpatient and residential PTSD, outpatient mental health, inpatient mental health, and substance abuse treatment. After completing her Ph.D. in 2011, she joined Child & Family Psychological Services 2011, and then directed the Portage office from 2014 to 2020. In 2020 she joined Teletherapy Group where Dr. Vanderwege sees children and adult clients virtually and face-to-face. Dr. Vanderwege has completed advanced training in psychological evaluation, anxiety and PTSD therapies, and mindfulness
[00:30 - 08:58] Pediatric Meltdown: Dr. Abbie Vanderwege Talks About Social Anxiety, School Refusal
Dr. Abbie Vanderwege is a pediatric psychologist who has a Ph.D. in counseling psychology from Western Michigan University.
She has worked as a family therapist for the family reunification program at Bethany Christian services and entered the APA accredited Ph.D. program in counseling psychology at Western Michigan University in 2007.
After completing her Ph.D., she joined child and family psychological services and then directed the Portage office until 2020.
In 2020, she joined a teletherapy group where Dr. Vander Wigg sees children and adult clients virtually and face to face.

[08:59 - 17:05] Nurture vs Nature?, School Avoidance: How to help kids
Specific phobias occur in about 5% of children and can be grouped into a few different areas such as animals, medical procedures, loud noises, storms, and clowns.
Some changes that may indicate a child is experiencing anxiety include dropping out of school, not wanting to practice driving, sleeping less than the recommended amount, and having little free time.
If parents notice any changes in their child's behavior that seem out of the ordinary or interfere with their ability to function normally, they should consult a therapist.

[17:05 - 26:01] Exposure Therapy...

101 Early Child Development: Pandemic Impact and Reasons for Hope with Dr. Colleen Kraft

Wed, 10 Aug 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Welcome back to Pediatric Meltdown today we are joined by Dr. Colleen Kraft. Dr. Colleen, the past president of the AAP 2018 and offers an overview of the impact the pandemic has had on child development including safety and security, nutrition, physical health, educational opportunities, and responsive caregiving. These are the pillars that make up the WHO Nurturing Care Framework. Dr. Kraft takes us beyond assessing the damage and instead focuses on the strengths that still stand. She makes the analogy of a house on fire. The house is burnt to the ground, but the foundations remain. Let's build from that. Rooms were damaged, but the house still stands nearly whole. Let's repair and rebuild. The home was filled with smoke, but the fire was extinguished. Let's clean away the soot and repaint. This analogy reminds us of the power of hope and action. As clinicians, we can help families see the possibilities and we can connect them to resources. We can also advocate for an educational reframe that supports college and academics and vocational paths. We need a society that embraces all skills and opportunities. In closing, Dr. Kraft reminds us that we are the child experts and that our voices matter.

Colleen A. Kraft, MD, MBA, FAAP is the Senior Medical Director for Clinical Adoption at Cognoa, a digital medical device company designing products to address the unmet developmental and behavioral health needs of children. Dr. Kraft served as the 2018 President of the American Academy of Pediatrics. Her background includes work in primary care pediatrics, pediatric education, and health care financing. Dr. Kraft received her undergraduate degree at Virginia Tech and her M.D. from Virginia Commonwealth University, and her MBA from the University of Cincinnati. She completed her residency in Pediatrics at Virginia Commonwealth University.

[00:29 - 08:47] Pediatrician Colleen Craft Shares Her Vision for the Future of Pediatrics
Dr. Colleen Kraft is a pediatrician and the senior medical director for clinical adoption at Cognoa.
She has been a pediatrician for 34 years and served as the 2018 president of the American academy of pediatrics.
Her journey into pediatrics drew her to work with families and children, promoting their optimal physical, developmental, and psychosocial health.
She is also an advocate for pediatricians and all the work that we can do on behalf of kids.

[08:47 - 16:51] Virtual Reality Therapy for Phobias
The world health organization promotes the nurturing care framework, which focuses on five pillars of early childhood development: adequate nutrition, safety and security, opportunities for early learning, and healthy relationships.
During the pandemic, safety and security for children were disrupted by the death of adults and the displacement of secure bonds with parents.
Housing insecurity was a major problem during the pandemic.

[16:51 - 24:36] Children Suffered from Cognitive and Motor Developmental Deficits during the Pandemic
There is a disruption in various aspects of children's lives during the pandemic, including their...

100 The Art of Medicine: The Gift We Have To Offer with Dr. Robert Saul

Wed, 03 Aug 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Welcome back to Pediatric Meltdown Today we are on our 100th Episode, once again we have Dr. Robert Saul, Dr. Saul is a pediatrician and medical geneticist, and has been guiding parents and their children’s physical, and behavioral, and mental care for over 40 years. He is a Professor of Pediatrics (Emeritus). Dr. Bob Saul developed the Parental Awareness Threshold, a simple framework that guides parents and guardians to actively parent with self-awareness, empathy, and compassion. Parents who use this framework create a healthy environment where children learn to build safe, stable, and nurturing relationships as well as exhibit love and respect for others in their community.

In the medical world of high-tech imaging and laboratory testing, the true practice of taking a comprehensive medical history and the laying on of hands gets forgotten or brushed aside relegating physicians and advanced practitioners to the role of technicians. We must never underestimate the skills of listening and the power of shared humanity. After four decades of pediatric practice, Dr. Robert Saul shares his wisdom and his insights about practicing the art of medicine.

[02:00 - 10:29] The Art of Medicine: Dr. Saul on the Relationship between Science and Art

Dr. Saul is a pediatrician and medical geneticist who has been guiding parents and their children's physical behavioral and mental healthcare for over 40 years.
He is a professor at the Medical University of South Carolina and has authored four books.
Dr. Saul is also a very prolific writer and has blogged about leaving the Columbine world and how to be the best parent you can be.

[10:30 - 18:22] How to Connect with Patients

Medical things that need to be done may not be able to be done because of socioeconomic status or what is happening in a person's life at the time.
The art of medicine is to ask routine medical questions and then let the patient know how much they matter to the physician.
It takes years of training and experience to become a good physician.
It is important to remember the patients' names and what is important to them, in order to connect with them.

[18:22 - 26:08] Doctor Shares What brings Him, Joy, When He thinks About His Career

The importance of a physical exam and how it can be used to diagnose medical conditions.
Talks about the importance of establishing trust with patients and how this can be done through listening and providing reassurance.
The joys that come with practicing medicine say that it is especially rewarding to see the positive responses from patients years after their encounter.

[26:09 - 33:42] Lessons from a Career in Medicine

Seeing patients and helping families down the line. Remembering him as their doctor before.
He finds being in...

99 The Imposter Syndrome: Yep Me Too!

Wed, 27 Jul 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Year 2 of the podcast is coming to a close and just sharing a few thoughts about yours truly and inviting you to join the mailing list for upcoming opportunities... stay tuned! The imposter syndrome is a thing, and yep, I experience all those self-doubts and thoughts "who am I to..." fill in the blank. So, here's a little pep talk for you and for me too!
[00:01 - 01:46] Stepping Away from Clinical Care in 2022
Who am I if I’m no longer seeing kids Am I still a pediatrician?
After 33 years as a practicing pediatrician, not including the time spent in residency, it’s a huge shift.
Yes, I am, and It’s called reinvention.
I consider this a new chapter and a new adventure.
Having no idea how to do a podcast, I jumped in and had some help and encouragement
And Pediatric Meltdown was born.
This gives me an opportunity to meet and talk to amazing pediatricians, therapists,
Parents and educators and even some grown-up patients.

[00:01 - 01:46] Many of us suffer from imposter syndrome.
Asking yourself a question such as “Am I smart enough? Do I have the right stuff?.”
Pep Talk for you and for me
You are smart enough
Your work
And you are helpful
You speak from experience
You have given up enough and it's okay to take a break, and change course

[00:01 - 01:46] Closing Segment
My goal in year 3 is to build listenership
I believe that the information from our guests is valuable and can bring help to everyone.
Kindly share our podcast and help me reach the goal:
See links below.

THANK YOU FOR YOUR SUPPORT!
Pediatric Meltdown was listed as a Top 20 Pediatric Podcast on FeedSpot.
If you’d like to connect with me, you can find me on LinkedIn, Facebook, Instagram, and Twitter, or email me at gagginol@medicalbhs.com or gagginol@yahoo.com. To learn more about me visit https://www.medicalbhs.com/
LOVE WHAT YOU HEARD? Leave us a 5-star review so we can continue to provide you with great content. Share this episode and help people know more about children’s health and well-being.

98 Anxiety? Inattention? Depression?: Prescribe Nature! with Dr. Stacy Beller Stryer

Wed, 20 Jul 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Stacy Beller Stryer walks us through all the reasons why we all need to put down our phones, tablets and computers and get outside! Being in nature provides a myriad of benefits for our emotional and physical well-being with reductions in stress, improved attention and lowered blood pressure and cortisol. It's a free and safe remedy that can be prescribed online right in your practice! Using Nature Prescribed, clinicians, patients and families, create a prescription for a nature experience that includes dose, frequency and instructions with a built in text reminder!

Key Highlights:

[00:30 - 08:38] Pediatric Meltdown: How Nature Can Help
Pediatrician and associate medical director for nature prescribed, Stacy Beller Stryer, joins the show to discuss the benefits of nature for children and how to prescribe nature prescriptions to improve their health.
Stacy emphasizes the importance of nature for social development, mental health, and physical health, and notes that it is important for children of all ages.
Studies have found that children who spend more time outside have better mental health outcomes, including decreased anxiety and depression.
Stacey encourages adults to spend more time outside to benefit their mental health as well.

[08:39 - 16:24] How to Prescribe Nature to Improve Mental Health
The benefits of nature include physical and mental health improvements.
Forest bathing is a form of therapy from Japan that focuses on green space and taking in the environment.
There are studies that show people who are prescribed nature are less stressed and have better immune systems.
Providers can prescribe nature by filling out a prescription on Nature Prescribed's website.
The prescription is sent to the patient's cell phone or computer, and they can decide how often to receive reminders.

[16:24 - 24:11] Prescribing Prescription Drugs to Kids
There are many ways to prescribe nature for mental health, including writing a prescription and having a doctor enter it into the electronic medical record (EMR).
There are many resources available online, including posters and swag, to help people get started.
One way to make nature more accessible for people is to work with local parks or green spaces.

[24:11 - 32:16] Teachers Encouraged to Take Kids Outside for Therapy
Teachers should take kids to therapy or sessions, bring them outside, and do the session outside to improve outcomes.
There are now more and more therapists who are doing their sessions outside or walking and talking.
Nature has many benefits, including decreased anxiety and depression, increased physical activity, and better academic outcomes.

Closing segment
Final Words

Thank you to Dr. Stacy...

97 Helping Kids Thrive: A Parent's Story

Wed, 13 Jul 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Welcome to another episode of Pediatric Meltdown. Parenting children requires patience, hope, limitless love, and joy, however, it is the hardest job ever. As pediatric clinicians, we partner with parents to ride the sometimes bumpy ride of parenthood. We all want happy, successful children, but for many children, the journey is difficult and for children with mental health concerns, finding help is often difficult.
Parent Natasha Robinson is a fierce advocate for her son Isaiah. From an early age, Natasha knew that her son needed help and resources. She began an exhausting journey of finding the right autism diagnosis and the services and programs to meet his needs. Sometimes we, the pediatricians, psychiatrists, teachers, and therapists helped immensely, and sometimes we got it wrong and got in the way. She persisted and continues to be a voice for him, and now, having sought additional training is a strong parent advocate for all children who need more.
Key Highlights:
[00:30 - 09:29] Opening Segment
Natasha Robinson is a 35-year-old single mother from Kalamazoo who spends her days hanging with her 11-year-old son.
She currently runs her own communications business and works part-time as a secretary.
Her favorite job, however, is being a mom to Isaiah.
Natasha has worked as a news reporter, substitute teacher, community health worker, and social worker in Michigan and North Carolina.
She has a BA in journalism from Wayne state university and an MS In psychology from the University of Phoenix.

[09:30 - 18:51] Having A 7-year-old son with ADHD and Dysregulated Emotional State.
Natasha shares her struggles of parenting an autistic son, specifically the challenges of managing his ADHD and emotional dysregulation.
She describes a journey to find medications and therapies that work best for her son. This process has been difficult and ongoing, with many side effects.
Her main concern has been the potential for harmful side effects from medication, which can be difficult to research and navigate.

[18:52 - 27:29] Navigating Through The Pandemic

Isaiah has a lot of challenges due to his disabilities, Despite this, he is also very funny and loves to make people laugh.
Due to the pandemic, Isaiah's school year was disrupted and he was unable to access many services he was used to. This was very difficult for him.
Since the pandemic, Isaiah has been able to resume some of his old activities, but his mood can vary greatly and he can be difficult to deal with when he is in a bad mood.

[27:29 - 36:06] The Advocacy for Change

Natasha has dedicated her life to advocating for her son with autism and would like to do more in the future to help other families with similar situations.
One of the ways she plans to do this is by creating a focus group of parents who have children with various disabilities.
She believes that having parent voices in places where decisions are made will help improve the quality of care for children with autism."
Closing segment
Final Words

Huge Thanks to Natasha for honest and raw conversations about parenting who struggles to meet social...

96 AAP Blueprint for Youth Suicide Prevention: A Roadmap

Wed, 06 Jul 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
In February of 2021, the AAP, NIMH, and the AFSP convened, along with over 100 clinicians, a workgroup with a shared goal and dream of compiling a roadmap for youth suicide prevention, and in March of 2022, the AAP Blueprint for Youth Suicide was released. This comprehensive body of work provides clinical pathways, initiatives for community partner collaborations, resources, and advocacy materials. Additionally, there is an extensive section on the epidemiology of youth suicide informed by a health equity lens. The panelists share the story of the creation of the Blueprint along with practical information on the navigation of the site.

Today we are joined by Dr. Lisa Horowitz, Dr. Christine Moutier, and Dr. May Lau

Dr. Lisa Horowitz is a Staff Scientist / Pediatric Psychologist in the National Institute of Mental Health Intramural Research Program at the National Institutes of Health. The major focus of Dr. Horowitz’s research has been the detection of suicide risk in the medical setting. She is the lead PI on six NIMH suicide prevention protocols that involve validating and implementing the Ask Suicide-Screening Questions (ASQ) in the ED, inpatient medical/surgical, and outpatient primary care settings. Dr. Horowitz is collaborating with hospitals, outpatient pediatric clinics, and school settings around the country, assisting with the implementation of suicide risk screening and management of patients who screen positive using the ASQ Toolkit and Youth Suicide Risk Screening Clinical Pathways

Dr. Christine Yu Moutier, Chief Medical Officer of the American Foundation for Suicide Prevention, knows the impact of suicide firsthand. After losing colleagues to suicide, she dedicated herself to fighting this leading cause of death. Dr. Moutier has served as UCSD professor of psychiatry, dean in the medical school, medical director of the VA Psychiatric Unit, and has been clinically active with diverse patient populations, such as veterans, Asian refugee populations, as well as physicians and academic leaders with mental health conditions. She has presented at the White House, testified before the U.S. Congress, and has appeared as an expert in The New York Times, The Washington Post, Time magazine, The Economist, The Atlantic, the BBC, and CNN.

May Lau, MD, MPH, is an Associate Professor in the Department of Pediatrics at the University of Texas Southwestern Medical Center and the medical director of the Adolescent and Young Adult Program at Children’s Medical Center Dallas, where she provides care for adolescent females and males, including sexual and gender minority youth. Dr. Lau co-chairs the American Academy of Pediatrics (AAP) Texas Pediatric Society (TPS) Committee on Adolescent and Sports Medicine, has been elected to the AAP Section on Adolescent Health Executive Committee and is a fellow of the Society of Adolescent Health and Medicine. She educates fellows, residents, and medical students on the specialized care of adolescents. Her research focuses on a variety of areas including adolescent mental health and gender-affirming care. Dr. Lau has spoken at national meetings on a variety of adolescent medicine topics including mental and sexual and reproductive health.

Key Highlights:

95 A Child Psychiatrist's Perspective for PCP's: Leave the "Fix It" Mindset at the Exam Door

Wed, 29 Jun 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Welcome to Pediatric Meltdown, the podcast for busy pediatricians who want to better understand children's emotional health and behaviors and gain the skills and knowledge to help them thrive. I am your host, Lia Gaggino, Today we are joined by Dr. Sarah Mohiuddin.

Dr. Mohiuddin is the Director of the Multidisciplinary Autism Program at the University of Michigan. She also is the fellowship training director of the Child Psychiatry Fellowship Program at Michigan Medicine and co-director of behavioral science sequence at the University of Michigan Medical School. She is passionate about educating medical students, residents, fellows and other physicians about childhood mental health and care of individuals with ASD and developmental disabilities across the lifespan.

In a surprising, at least to me, conversation, child psychiatrist Dr. Mohiuddin shares a new mental healthcare perspective for PCP's - abandon the "fix it" mindset and instead consider a chronic illness model that focuses on partnership with the patient and family to identify their most important concerns. Her insights suggest that using our longitudinal relationship with families, we can make enormous impact. For those of us who are overwhelmed by the notion of mental health care is primary care, Dr. Mohiuddin suggests reframing our negative self-talk and setting positive intentions for the day - "You've Got This!" comes to mind for me. Deep breath, you know more than you think you do!

Key Highlights:

[00:30 - 09:04] Dr. Sarah Mohiuddin on How to Address Overwhelming Mental Health Needs in Pediatric Patients
Welcoming back, Dr. Sarah Mohiuddin is a child psychiatrist and director of the multidisciplinary autism program at the University of Michigan.
She also is the fellowship training director of the child psychiatry fellowship program at Michigan Medicine and co-director of behavioral science sequence at the University of Michigan Medical School.
She is passionate about educating medical students, residents, fellows, and other physicians about childhood mental health and care of individuals with autism spectrum disorders and developmental disabilities across the lifespan.
During the course of becoming a physician, she believes that breaking down patients and building them up is important, but can lose pieces

[09:05 - 25:56] How to Address the System of What's Going On at School, but Not Everything Has to Be Achieved in a Visit
Pediatric clinicians need to reframe their job as a partnership with patients and families, rather than “Fixing” things
Mental health is similar to medical issues in that there are acute exacerbations and chronic stressors that cannot always be fixed\
It is important for pediatric clinicians to listen to patients and understand their values in order to help them make change
Mental Health Conditions: It's Not Just About Fixing Them

94 Taking My Own Mental Health Break: Bali Breather

Wed, 22 Jun 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Welcome to Pediatric Meltdown, the podcast for busy pediatricians who want to better understand children's emotional health and behaviors and gain the skills and knowledge to help them thrive. I am your host, Lia Gaggino. Summer is here and it's time to take a breath, enjoy the sunshine and take a little downtime. Heading to Bali, yes Bali!, with my sister and daughter for a tropical adventure - My Bali Breather. Hope you will make time for yourself too!

Key Highlights:

[00:30 - 02:30] Taking a Mental Health Break:
Taking a mental health break and going to Bali
some thoughts on the world and how it feels right now
War in Ukriane
Covid is still here.
Shootings
But despite of all of these, In the words of Dr. Heather Forkey “We can Affiliate with others”

[02:30 - 02:30] Sharing Some Things That Brings Me Joy
Resources Mentioned:
I love listening to podcast
Hidden Brain by Shankar Vedantan
Happier with Gretchen Rubin and her sister Liz
I’m a worrior and getting lost in reading a book, makes me forget about my worries.
Such a lovely book: This is How it Always Is by Laura Frankel
A Movie that I would recommend!
Hands down best movie ever: Lars and The Real Girl - you have to watch this one!!

[03:04 - 05:28] Summer Escape: Find some escape in things that aren't deep
It’s okay to do nothing. Take your time and relax.
Eat something that are delicious food like
Watermelon
Juicy peaches
Ice cream!
Closing segment
Final Words

Key quotes:
“I think that we have to really look at the world as being open to possibilities and that good pervades, all of the awful stuff.” Dr - Lia Gaggino
THANK YOU FOR YOUR SUPPORT!
Pediatric Meltdown was listed as a Top 20 Pediatric Podcast on FeedSpot.
If you’d like to connect with me, you can find me on LinkedIn, Facebook, Instagram, and Twitter, or email me at gagginol@medicalbhs.com or gagginol@yahoo.com. To learn more about me visit https://www.medicalbhs.com/
LOVE WHAT YOU HEARD? Leave us a 5-star review so we can continue to provide you with great content. Share this episode and help people know more about children’s health and well-being.

93 Trauma and Resilience: Affiliate!

Wed, 15 Jun 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Welcome to Pediatric Meltdown, the podcast for busy pediatricians who want to better understand children's emotional health and behaviors and gain the skills and knowledge to help them thrive. I am your host, Lia Gaggino. In this episode, we are joined by Dr. Heather C. Forkeyl, MD
Heather C. Forkey, MD, is a Professor of Pediatrics at the University of Massachusetts Chan Medical School, and Division Director for the Child Protection Program and Foster Children Evaluation Service (FaCES) of the UMass Memorial Children’s Medical Center. She also serves as the Medical Director of Lifeline4Kids at the University of Massachusetts Medical School. She received her undergraduate degree from Cornell University and medical degree from the State University of New York at Buffalo School of Medicine and Biomedical Sciences. She completed her pediatric residency and chief residency at the Children’s Hospital of Philadelphia. In addition to her clinical work, Dr. Forkey has been the recipient of local and federal grants to address issues of children in foster care and to translate promising practices to address the physical and mental health needs of children who have been traumatized. She has published and presented nationally and internationally on the topics and serves in leadership roles for the National Child Traumatic Stress Network and the American Academy of Pediatrics on issues related to foster care and child trauma. She recently co-authored the book Childhood Trauma and Resilience: A Practical Guide, now available from AAP Press.

We commonly think of the human response to trauma, stress, and threat as "fight, flight or freeze", but there is one more, "affiliate". We are designed to be with others and resilience lies in our ability to find safe, stable, and nurturing relationships. Our past is not our future and surrounding ourselves with those who truly care for us is the key to thriving.

Key Highlights:

[00:01 - 18:47] Affiliate Response: Recognition of Young Adults from Foster Care having Similar Outcomes Yet Genetically Unrelated.

Various aspects how toxic stress impact kids
Kids that experience trauma has impacts on immune system, neural pathways and that are rapidly endocrine system especially epigenetic areas.
Ex. why traumatized kids might have constipation.
Fight-Flight and Freeze has a limited Benefits
Affliation: How one can be able to ask for help managing stress
How humans has evolved to have an ability recognizing what is safe and not safe
Pulling people to manage stress together.
Affiliate response
Safe, stape and nurturing.
Tiger Chameleon: Determining trauma through patterns.
Dr. Baylin coming up with animal analogies responding exposure to trauma
Tigers are kids associated with developmental delay that feels constantly threatened.
Chameleons are kids that can look like manipulators but infact they are just good at using clues and can manage situations.

[18:48 - 43:47] How Behaviors should not be placed out of the blue.
Cognitive triangle: Thought leads to feeling that leads to a behavior
Changing negative message can help kids change their cognitive triangle processing into a positive one.
Interactions from caregivers, is shaping your map and the map of your world.
How parents and kids has the opportunity to rewrite the map
Three R’s: Reassure, Routine, Regulate
Stress kids has a difficulty of Learning the skills of play
Letting the child lead by using Praise Paraphrase...

92 Children With Disabilities: Don't Forget Their Emotional Well-being!

Wed, 08 Jun 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Welcome to Pediatric Meltdown, the podcast for busy pediatricians who want to better understand children's emotional health and behaviors and gain the skills and knowledge to help them thrive. I am your host, Lia Gaggino. In this episode, we are joined by Katherine Steingass, MD.
Dr. Steingass is a Developmental-Behavioral Pediatrician at Nationwide Children's Hospital and an assistant professor of Pediatrics at the Ohio State University College of Medicine. She is a member of the complex health care team and the medical director for the Spinal Bifida Program, as well as the Program Director for the Developmental-Behavioral Pediatrics Fellowship; her primary clinical interests include evaluation and care of children with developmental delays and disabilities, including cerebral palsy, myelomeningocele genetic conditions, autism and the sequelae of prematurity.

She is a co-chair for the early childhood Special interest group in the Society for Developmental-Behavioral Pediatrics and is involved in the AAPS Council on Children with Disabilities. Dr. Steingass received her medical degree from the Medical College of Ohio at Toledo and completed her Residency at Nationwide Children's Hospital, followed by a Fellowship in Developmental-Behavioral Pediatrics at Rainbow Babies and Children's Hospital in Cleveland, Ohio.
Join us today as we talk about Children with Disabilities: Don't Forget Their Emotional Well-being!
Key Highlights:
[00:01 - 22:13] Kids with Disabilities Often Miss Out on Mental Health Screening
There is a significant body of literature suggesting that children with disabilities experience higher rates of mental health symptoms, including ADHD, anxiety, and depression.
Developmental screening is essential for identifying kids who may be at risk for these conditions.
Qualitative questioning can provide valuable information about a child's overall well-being
It is essential to balance the need to assess a child's medical conditions with the need to determine their behavioral health.
Should we be rethinking our perspective on medications for kids with autism?
Behavioral interventions should be tailored to the child’s individual needs with autism.
Physical symptoms and medical causes should be investigated to determine the cause of aggression in children with autism.
Constipation is a common culprit in the development of aggressive behaviors in children with autism.
There are identifiable triggers for a head banging, and it can be helpful to look at the behavior in terms of its function.
It is vital to consider the child's symptoms and history and their environment.
It is common for children with autism to have comorbid mental health disorders.
Medication options for aggression can vary depending on the child's symptoms.

[22:14 - 37:41] We Have to be Mindful of the Families, the Parents, and Siblings When Approaching Care for Kids with Chronic Medical Conditions
There is a lot of investigative work that needs to be done before starting a medication like this, as it has potential side effects.
One way to help families during this difficult time is to normalize the experience and ask open-ended questions about their well-being.
When talking with families of kids with chronic medical conditions, it is crucial to also focus on their function and quality of...

91 Getting Paid for the Work You Do: Financing Mental Health Care with Dr. Jon Price and Dr. Jenna Vallejo

Wed, 01 Jun 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Welcome to Pediatric Meltdown, the podcast for busy pediatricians who want to better understand children's emotional health, behaviors, and gain the skills and knowledge to help them thrive. I am your host, Lia Gaggino. In this episode, we are joined by Dr. Jon Price and Dr. Jenna Vallejo.
Jon Price, MD FAAP, is a Dublin, OH general pediatrician who has been in primary care and pediatric urgent care. He is co-chair of the Ohio Pediatric Council, a dialog group linking pediatricians and insurance plans looking for win/win solutions to improve health care access and coverage for children and attain the financial means for pediatric practices to provide excellent care. He is a member of AAP committees dedicated to child health financing policies and advocacy with public and private health insurance payers. (COCHF,PAAC)
Jenna is the Chief Operating Officer of Potomac Pediatrics in Rockville, MD. She is a healthcare executive that utilizes innovative ideas to revolutionize the patient experience. For the past few years, she has focused on building an integrative mental health model in primary care pediatrics that is accessible & affordable for patients and financially viable for the practice. Jenna is passionate about striving to offer more expansive pediatric services that can be tailored to the patient to optimize patient outcomes while reducing overall medical expenses for families and the healthcare system. Jenna previously served in the United States Navy as a Hospital Corpsman, as well as worked in family practice and urgent care nursing roles. Her clinical experience combined with her healthcare leadership expertise allows her to approach challenges from the patient experience viewpoint and the practices need to achieve financial success.
Join us today as we talk about the importance of insurance credentialing and how physicians should be paid for the extra work that we do.

Key Highlights:
[00:01 - 15:41] The Struggles of Child Poverty in America
Eligibility of Medicaid and Chip for children in the United States.
The states have agreed to not disenroll any patients until the government declares that the public health emergency from Covid19 is over.
· Jon talks about how employers can provide health insurance for their employees
They discuss how Medicaid and Chip differ, how the program works, and how it might change in the future.
There is a lot of confusion about how to code for mental health services, and payers are looking at those who are using more upper-level codes
Pediatricians need to get creative to cover mental health costs

[15:41- 32:14] Mental Health Staff Urge Insurance Companies to Do Better
How insurance companies could be doing better in terms of reimbursing mental health professionals, and stresses the importance of insurance credentialing
How care plans for children with mental health issues can be complicated to manage
After a child leaves the doctor's office, they are still often linked to the child's care and may be called upon to assist in the future.
How to get paid for your phone calls and portal...

90 Why Kid's Mental Health Means So Much to Me: Moving Mountains

Tue, 24 May 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
"You have been assigned this mountain so you can show others how it can be moved" Mel Robbins. In this podcast, Dr. Lia Gaggino discusses her experience with children's mental health and emotional wellbeing. She shares the reason why she has been so interested in this field, and that childhood experiences can shape who you become as an adult. She also discusses the importance of seeking help and how therapy can be a gift. Dr. Lia explains why there should be no shame in seeking medication if it is necessary to help improve a child's mental health. Pay close attention since she will be sharing interesting ways to cultivate self-help. Listen and enjoy!
Key Highlights:
[00:01 - 03:34] Opening Segment
Why Lia became interested in the children's mental health field
The importance of children's mental health and emotional wellbeing
The benefits of therapy and medication for those who need it.
[03:35 - 09:23] Why Kid's Mental Health Means So Much to Me
How medication can be a game changer for those with mental health issues
Ways to connect with others and cultivate self-help
Lia recommends books, podcasts, movies and music
Seven things Bessel van der Kolk shares in The Body Keeps The Score
[09:24 - 13:06] Closing Segment
How to best take care of yourself
Resources Mentioned:
Podcast: Happier by Gretchen Rubin, Unlocking Us by Brene Brown
Books: Theophilus North by Thornton Wilder, The Language of Flowers by Vanessa Diffenbaugh. Anything by Alice Hoffman and Brene Brown.
Film: Lars and The Real Girl - WATCH THIS ONE
Music: Fleetwood Mac Rumors, Moonlight Sonata, pop music, Maroon 5, Pachabel's Canon
Key Quotes:
"Childhood shapes you and you rise above or you struggle." - Lia Gaggino
"Mental illness does not limit you, but it is important to seek help." - Lia Gaggino
"We're really good at meeting other people's expectations, but not always our own." - Lia Gaggino
THANK YOU FOR YOUR SUPPORT!
Pediatric Meltdown was listed as a Top 20 Pediatric Podcast on FeedSpot.
If you’d like to connect with me, you can find me on LinkedIn, Facebook, Instagram, and Twitter or email me at gagginol@medicalbhs.com or gagginol@yahoo.com. To learn more about me visit https://www.medicalbhs.com/
LOVE WHAT YOU...

89 Youth Mental Health Crisis: An Opportunity for Innovation

Tue, 17 May 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Even though the situation that we are facing with the youth mental health crisis right now is daunting, there is such an opportunity for creativity and innovation and with the kind of clinicians that we interview today, there is such an opportunity to really write a new plan. Dr. Lois Lee and Dr. Ben Biermann discuss how primary care settings are seeing an increase in children coming in with suicidal thoughts or attempts. They emphasize the importance of partnerships between providers and discuss ways to advocate for funding for expanded mental health care. They also talk about early intervention services, community-based mental health programs, and school-based mental health services.
Dr. Lois Lee’s work focuses on pediatric emergency medicine, health disparities, injuries, and health policy. This is grounded in her clinical work as a pediatric emergency medicine physician at Boston Children’s Hospital and Associate Professor of Pediatrics and Emergency Medicine at Harvard Medical School. At Boston Children’s Hospital, she is the Associate Program Director for Public Policy at the new Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion.
Dr. Biermann is a child and adolescent psychiatrist on faculty at the University of Michigan Medical School. His clinical work focuses mainly on hospital-based care: psychiatric emergency services, psychiatric inpatient, consultation/liaison, and ECT treatments. Dr. Biermann’s clinical and scholarly focus has been on adolescents with mood disorders and disruptive behaviors, treatment-resistant depression, and youth in crisis. He also has an interest in substance use disorders and dual diagnosis.
Key Highlights:
[00:01 - 08:41] Open Segment
Dr. Lois and Dr. Ben share their background and work
The increase in the boarding of mental health patients
Mental health crises are not a COVID induced problem
[08:41 - 18:22] Risk Assessments And Safety Planning With The Child First
Pediatrician's perspective on the current state of emergency rooms and children who are seeking care
How child psychiatry can be helpful to know if a child should be admitted or not to the hospital
Social work helps to ensure that mental health is a part of the patient's care
[18:23 - 28:24] How We Can Better Serve Our Kids
Why emergency room doctors should assess a child's risk for suicide
Doctors should consider if kids need to be medically cleared before admitting them
How to provide more equitable care for all children
[28:25 - 38:02] Ensure Patients Receive The Best Possible Care
The potential of telehealth in psychiatry
The importance of investing in psychiatry workforce development
There is a need for more mental health professionals due to the increasing population
Engaging patients in a standardized way can help connect them to treatment
[38:03 - 51:50] Mental Health Is A National Crisis
Why the integrated behavioral health care can be helpful
More collaboration and coordination are needed to address the youth mental health crisis
What can help improve access to care and funding for mental health initiatives
[51:51 - 1:00:24] Final Takeaways
Our kids are not doing well emotionally
Access to mental health care is in short supply
Suicide remains the second leading cause of death in youth
The emergency rooms are overrun with kids waiting, boarding for help
The pandemic magnified the mental health crisis
For underserved minoritized and poor youth, the access to services is even more...

88 ADHD: Strategies for Boosting Executive Function

Wed, 11 May 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
ADHD is a label, it's a name of a category of behaviors that we want to look at and potentially see how can we change the environment to make a kid the most successful as possible. In today’s episode, our guest is Colleen Cullinan, Ph.D., a pediatric psychologist at Nemours/Alfred I. DuPont Hospital for Children in Wilmington Delaware. She specializes in integrated primary care within the Division of Behavioral Health. Dr. Cullinan completed her Ph.D. in Clinical Psychology at Western Michigan University in 2015. Dr. Cullinan supervises psychology externs and interns, and she directs medical education efforts for Nemours’ residency training programs. Her presentation and publication records center around integrated care, family-based interventions, and experiential cultural humility training.
If you want to gain a deeper understanding of the strategies for boosting executive function, this episode is for you!
Key Highlights:
[00:01 - 11:13] Open Segment
An overview of ADHA management
Having conversations with families about the types of ADHA
The executive functioning in kids and adults
Why setting families expectations is a critical part of ADHD management
[11:14 - 22:42] The Journey of Starting to Manage A Chronic Neuro-Biological Condition
Dr. Colleen’s outlook on children having trouble at school
Why the Vanderbilt can be helpful
You need the time to do a good job to gather information
[22:43 - 33:47] Kids with ADHD Need a Lot of Practice
What happens when the medication therapies are not working
How executive function coaching looks like
Why internal speech is important and complex
Kids need more training in nonverbal cues
[33:48 - 45:49] Executive Functions That Are Underdeveloped
Incentive systems do work, but sometimes we are trying to incentivize the wrong thing
Talk about hindsight, foresight, and insight
How the sense of time is perceived by kids vs adults
[45:50 - 57:07] Working Memory vs Multitasking
The executive function of working memory
Dr. Colleen's insights about multitasking being a fantasy
Always think about the kid and their family
[57:08 - 1:11:44] Final Takeaways
Start with conceptualizing the diagnosis when talking to parents
Take a good history, a really good history
Throw away the label and really look at the executive function
Start with psycho-education for families and patients
Lay out the deficits of ADHD
For kids with ADHD, the impact of those executive functional skills deficits may set them back two to three years
Lay out building the parent's skills of expectation, setting realistic goals
Let's talk about some of the specific deficits
Internal speech
Hindsight, foresight, and insight
Cents of time
Working memory
Explain to families that ADHD is highly genetic and that there are often ADHD families
Future teaching and predicting setting expectations and what that can look like
Set the tone with the families
Lay out that intervention and management will be an experiment

Resources Mentioned:
Driven To Distraction - Ned Hallowell

87 Childhood Apraxia: When in Doubt, Check it Out!

Wed, 04 May 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Apraxia is a disorder that affects language development. It is most commonly seen in children between two and seven years old, but it can also occur at any point during development. In this episode, Dr. Sheryl Rosin, Ph.D. discloses the symptoms of apraxia speech and the importance of visiting a specialist for an evaluation if you believe that your child may have it. During the evaluation, your child's receptive and expressive language skills will be assessed to determine if there is a problem with that area of development. If there is a problem, therapies may be recommended to help your child improve their speech. Let’s dig into the childhood apraxia!
Dr. Sheryl Rosin is a speech-language pathologist, professor, and certified autism specialist with 25 years of experience in the field. She has presented around the world and has been published in research journals on best practices in assessment and intervention for individuals with ASD. She is the owner and director of Palm Beach Speech-Language Specialists in south Florida and the Founder and Consulting Director of The St. Kitts Spectrum Services Centre in St. Kitts, the first autism clinic in the Caribbean. Dr. Rosin was the recipient of the 2017 Louis M. DiCarlo Award for Clinical Achievement from the American Speech-Language-Hearing Association.
Key Highlights:
[00:01 - 09:27] Open Segment
An overview of apraxia speech
The difference between apraxia in adults and children
A referral to a professional for further evaluation is always beneficial in determining if apraxia is present
[09:28 - 22:46] Referring A Child For An Assessment
Have an honest and open conversation with parents when referring the child for an assessment
Things pediatricians might see when referring a child for an assessment of a speech or language disorder
Different ways apraxia can be diagnosed
[22:47 - 32:53] Therapy Involves Building Up Vocabulary and Fluency
Speech therapy for children with apraxia and dislocates
It is more typical for individuals to have typical disfluency than stuttering
Why singing can be a great way for disfluent individuals to improve their communication skills
[32:54 - 44:17] It's Always Okay to Check Out A Child's Development
The difference between stuttering and apraxia
When pediatricians should refer children for speech and language evaluation
Pediatricians shouldn’t wait too long to refer a child for evaluation to offer hope to parents
The importance of following up on any concerns or suspicions that may arise after a good visit
[44:18 - 50:53] Final Takeaways
When children are not meeting developmental milestones for receptive or expressive language, check it out.
Childhood apraxia is a speech disorder of motor coordination and planning
Apraxia may look like groping or searching to get sound out
Because this is a motor coordination and planning disorder, there may be associated fine motor and gross motor delays as well
The differential includes brain trauma and injury
Refer for an evaluation when you're concerned, there is no time to waste
It helps the speech therapist for us to set the state of what some of these possibilities might be
The evaluation with the therapist, especially with these young kids is to play really smart play
Therapy for apraxia looks like learning a sport and building motor memory
Moving on to stuttering and stutter like
Stuttering can be a lifelong disorder
Trust your expertise to know what feels like a typical development
When in doubt, check it...

86 Domestic Violence: How it Impacts Children

Wed, 27 Apr 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Domestic violence is a pattern of abusive behavior in which one partner repeatedly uses physical force or threats of violence against the other partner. It can take many forms, including physical, sexual, emotional, and economic abuse. Domestic violence affects everyone, no matter what age or size, and it is an important topic we should cover, however, it might be triggering for some people. If you're worried that someone you know may be experiencing domestic violence, it's important to talk to them about it. In today’s episode, our guest Dr. Claudia B. Fenderson, EdD shares with us relevant information about the resources available to help victims get out of abusive relationships and discloses why professionals like pediatricians can play an important role in identifying and providing resources to children and families affected by domestic violence.
Dr. Claudia B. Fenderson has served as the Director/Chair of the Doctor of Physical Therapy Program at Marist College until her retirement this past year. She has a BS in Physical Therapy from Columbia University; an MS in Physical Therapy from Long Island University and an EdD in Child and Youth Studies from Nova Southeastern University. Her career spans more than 45 years and the majority of her experience has been in the areas of education and neurologic rehabilitation, primarily in infants and preschoolers with developmental delays and disabilities.
Key Highlights:
[00:01 - 09:31] Open Segment
How Dr. Claudia got interested in domestic violence
Violence can be classified into four types: physical, sexual, psychological, and economic
Domestic violence can involve any type of abuse, from physical to emotional to financial, and can happen to anyone
[09:32 - 20:07] Have Conversations About Healthy Relationships with All of Your Patients
There are warning signs that should be observed in order to identify domestic violence
It is important for professionals to ask about domestic violence when they are concerned for a child's wellbeing
How to identify a controlling relationship, and offer resources to teens who are in a difficult relationship
[20:08 - 33:28] Provide Resources and Support to Victims
During Covid was difficult to identify people who were experiencing domestic violence
Health care professionals should be aware of risks and be prepared to help victims in difficult situations
Domestic violence is a problem that affects both men and women, but it is especially an issue for women
Healthcare providers should be aware of the signs and symptoms of domestic violence
[33:29 - 41:45] Help Patients Feel Less Alone
By asking questions, clinicians can help prevent harm to patients and children
Offering resources and help to adult victims of domestic violence is essential
Adults need to know that they are not alone and that they can come to talk to us if they need help
[41:46 - 44:38] Final Takeaways
All professionals who care for kids have an opportunity to ask about domestic violence and safety
Domestic violence and intimate partner violence is all about control
We often consider physical abuse, but we need to think about emotional abuse
Domestic violence is common with estimates that one-third of men and women have been in a domestic violence situation and that 15% of children may have witnessed domestic violence
Domestic violence is a public health concern
Teens who have witnessed domestic violence may believe that violence is an acceptable way to deal with conflict
Ask universally about domestic violence and intimate...

85 Neighborhood Transformation: Changing the Zipcode Impact

Wed, 20 Apr 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
We know that change is hard and it takes a lot of hard work, but we want to remind you that it's okay to take small steps in the right direction. If you're feeling stuck or frustrated with your current path, remember that it's okay to be patient and to start small! In this episode, Dr. Jutte shares his journey as a pediatrician, and why he has focused on community-based interventions to address social determinants of health. He also discusses the importance of poverty and how it impacts health disparities in our population. Pay close attention since we have a deep conversation on how pediatricians can raise awareness and connect with their patients to make a difference. His mission is to increase thoughtful investments into low-income communities in order to revitalize them and support the well-being and health of these neighborhoods. We need your help. We need your voice. We need you to get involved. Let’s dig into Neighborhood Transformation: Changing the Zipcode Impact!
Douglas Jutte, MD, MPH is Executive Director of the Build Healthy Places Network, a national organization with the mission to transform the way organizations work together across the health, community development, and finance sectors to more effectively reduce poverty, advance racial equity, and improve health in neighborhoods across the United States.
Key Highlights:
[00:01 - 10:52] Open Segment
Dr. Jutte shares his background and work experience
The reason why pediatrics is one of his favorite specialties
How Dr. Jutte went from a primary care pediatrician to the executive director of Build Healthy Places Network
How pediatricians can work with other professionals to improve the health of their patients
[10:53 - 19:41] The Importance of Community Engagement
The importance of revitalizing low-income communities
Why having community engagement is key to addressing health disparities
What the social determinants of health are and why they need to be interconnected to improve individual health
The key components of thriving communities
[19:42 - 28:33] The Community Development Sector
How the Obama administration helped revitalize neighborhoods that may be experiencing gentrification
There is a lot of money available for various purposes, but it is not legislated or part of the regular budget
[28:34 - 38:44] Pediatricians and Healthcare Providers Are Essential Players
How for-profit affordable housing developers use federal affordable housing tax credits to make projects more affordable for low-income families
Methods community development centers use to help low-income residents
The role of Community Development Corporations (CDCs) in affordable housing
Why the government can’t just give money to non-profits directly
[38:45 - 48:48] We Underestimate The Power of our Doctor Title
Pediatricians need to be aware of and engaged with the issues surrounding community development
Pediatricians have a lot of power to advocate for their community and can help develop policies that support health
Why work as a pediatrician has the potential to have long-term impacts on children's health
[48:49 - 58:32] Final Takeaways
The path to your passion is not linear
Zipcode has more implications on health outcomes for children than genetic code
Lifting out of poverty is not just about lifting an individual or their family, but about lifting the neighborhood
When looking at heat maps for poverty and obesity, there is a perfect overlap with poor neighborhoods
The mission of Build Healthy Places Network is to transform...

84 Pediatric Firearm Injury Prevention: What You Need to Know

Wed, 13 Apr 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Trigger warning: suicide
Dr. Lois Lee’s work focuses on pediatric emergency medicine, health disparities, injuries, and health policy. This is grounded in her clinical work as a pediatric emergency medicine physician at Boston Children’s Hospital and Associate Professor of Pediatrics and Emergency Medicine at Harvard Medical School. At Boston Children’s Hospital, she is the Associate Program Director for Public Policy at the new Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion.
Eric Fleegler, MD MPH is a pediatric emergency physician and health services researcher at Boston Children’s Hospital and Assistant Professor of Pediatrics and Emergency Medicine at Harvard Medical School. He was a political science major at Brown University, received his MD from the University of Pennsylvania School of Medicine and his MPH from the Harvard School of Public Health. His clinical work includes attending to the emergency department as well as director of the sedation service at Boston Children’s.

[00:01] Opening Segment
Eric and Lois share their to the pediatrics space
Why they are focused on injury prevention?

[08:25] A Pediatrician’s Role in Firearm Injury Prevention
How enormous is the firearm injury problem in the United States?
Eric shares some important stats
The importance of limiting gun access to kids
The role of pediatricians and other healthcare professionals in preventing firearm injuries
Lois explains

[18:01] Safe Storage of Firearms
Lois talks about an interesting study about gun access among kids
How pediatricians should talk to families about storing firearms in the home
Listen to Eric and Lois
Where firearms can be stored if there is a child with a mental health issue in the home

[28:24] The Right Approach to Talk About Firearms With Families
Conversations about firearms are different from other common patient conversations
Here’s why
Storytelling is a great approach to forwarding advocacies on firearm injury prevention
Legislations and regulations around the country are varied regarding firearm injury prevention
Eric tells us how this is affecting children’s safety from firearms

[39:24] Institutional Changes to Prevent Firearm Injuries and Death
Connecting with government officials about firearm injury prevention
Gun manufacturers cannot be sued for any injury or death
Here’s what we can do
Institutional changes are key to firearm injury prevention
Lois explains

[48:10] How to Start Your Advocacy on Firearm Injury Prevention
The severity of firearm-related deaths according to Lois
Lois and Eric have messages for their younger selves
Listen to their messages too!
The role of the local chapters of the American Academy of Pediatrics

[55:54] Final Takeaways
Conversations about firearm injury prevention are painful and frustrating
Stats to consider in relation to firearm-related injuries and deaths
Children of color are at a higher risk of injuries and death from firearms
Suicide and firearm-related injuries and death
Access to firearms among children in the home
The parents keeping their children safe and the children’s curiosity about firearms
The role of pediatricians in preventing injuries and death from firearms
Mental health and access to firearms among children
Alternatives to keep the children safe...

83 Project ECHO: "All Teach. All Learn"

Wed, 06 Apr 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Sanjeev Arora is the founder and executive director of Project ECHO. He is also a distinguished professor of medicine with tenure at the University of New Mexico’s Health Sciences Center.
Previously, he served as executive vice chair and acting chair of the Department of Internal Medicine and president of the medical staff. He also served on the UNM Health Sciences Center board for five years. Dr. Arora has also served as president of the University Physicians Association.
Born in Nangal, India, Dr. Arora was raised in a household of physicians which gave him a strong sense of responsibility to give back to his community from an early age. In 1980, he moved to New York and, later, Boston to study medicine and become a gastroenterologist.
In 2003, he founded Project ECHO to ensure more people had access to best-practice care for hepatitis C. Today, the ECHO model is being used in nearly every country to solve the world’s greatest challenges in health care, education, and journalism, and more.

[00:01] Opening Segment
Dr. Sanjeev Arora shares his journey that started in his home country of India
He talks about the origins of Project ECHO

[07:36] The Four Key Principles of Project ECHO
The four key principles of the ECHO model
What does Sanjeev mean by “democratizing knowledge?”
Child psychiatry is one of the most underserved spaces in healthcare
How can this be solved?

[17:57] How to Scale the ECHO Model
Sanjeev talks about what should be the foundation of offering service
He shares some strategies to scale Project ECHO to other diseases
This is the way that Sanjeev and his team measure the outcomes of the ECHO model

[27:53] The Future of Project ECHO
Sanjeev gives his outlook for the future of the ECHO model
He shares an inspiring thought on the reality about happiness
Disease prevention and healthcare education are only two of their priorities
Here’s why they’re promoting these advocacies

[36:50] Final takeaways
A simple idea can move mountains
What it takes to take healthcare to the next level
The four key components of the ECHO model
Project ECHO has been participated by millions around the world
The strategy used by the Project ECHO
Learning by doing
The benefits of the ECHO model
Love and compassion as embodied in the ECHO model
The American Academy of Pediatrics serves as a learning hub for the ECHO model
The only way people can be happy

Key Quotes:
“If an expert, a specialist in a university, just shares their knowledge with primary care doctors [and] in rural areas, good things will happen.” - Dr. Sanjeev Arora
“The only way a human being can be really happy is by living a life of service.” - Dr. Sanjeev Arora
Email Sanjeev at Sanjeev.Arora@salud.unm.edu and visit https://hsc.unm.edu/echo/ to know more about Project ECHO.
THANK YOU FOR YOUR SUPPORT!
Pediatric Meltdown was listed as a Top 20 Pediatric Podcast on FeedSpot.
If you’d like to connect with me, you can find me on LinkedIn, Facebook,

82 Equity, Diversity, Inclusion: Awareness, Curiosity, Action

Wed, 30 Mar 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Lisa Lowery is a native of Grand Rapids and a graduate of Ottawa Hills High School. She attended Michigan State University receiving her Bachelor of Science Degree in Microbiology, with Honors. Her research during her fellowship concentrated on sexually transmitted diseases and reproductive health. While at the Johns Hopkins, she obtained a Master of Public Health in the Department of Population and Family Health Sciences with a Certificate of Concentration in Maternal and Child Health.
Currently, Dr. Lowery is an Adolescent Medicine specialist at Helen DeVos Children’s Hospital-Spectrum Health Medical Group. She has been on faculty since July 2004. Dr. Lowery also serves as Adolescent Medicine Section Chief and an Associate Program Director for the Combined Internal Medicine/Pediatrics Residency Program Michigan State University/Grand Rapids Campus.
She is the president of West Michigan Medical Society/National Medical Association and serves on the Grand Rapids Urban League Board of Directors and the Michigan Eating Disorders Alliance Board. In the summer of 2018, started serving on the Cherry Health Foundation Board and the Kent County Community Health Advisory Committee.

[00:01] Opening Segment
What’s been happening in Dr. Lisa Lowery’s career?
She gives an update
Lisa talks about their monthly series on diversity, equity, and inclusion

[07:01] Breaking Down Structural Racism
The next generation of physicians should have these qualities
Listen to Lisa
The impacts of the pandemic to the healthcare sector according to Lisa
Lisa talks about structural racism and why it matters in the healthcare sector

[17:48] Dealing With Oppression and Discrimination
Oppression and discrimination look different among teenagers
Lisa explains
The importance of making appointment-setting easy for teenage patients
What does being an “emotional container” mean?

[27:58] Being Vulnerable With Patients
Lisa shares a humbling moment she experienced as a medical practitioner
It is all right for physicians to be vulnerable with their patients
Lisa tells us why
The right way to communicate with a patient according to Lisa

[37:24] Learning About Bystander Interventions
Lisa reveals a secret about how she talks with her patients
The benefits of conducting Bystander Intervention Workshops
Recognizing privilege that people of color don’t have

[47:57] Making a Difference in the Healthcare Sector
How physicians can lend their voices to promote diversity, equity, and inclusion
Lisa’s reminder for physicians who want to make a difference in their workspaces
Here’s Lisa’s message for her younger self that you don’t want to miss

[56:29] Closing Segment
Final takeaways
Everyone has racial biases
Start with recognizing your own biases
The uncomfortable feeling of being curious
Addressing teenagers who are people of color and LGBTQIA+
The importance of empathy
Safety among children of our BIPOC brothers and sisters
Questions that physicians should ask their young patients
Why allyship is important
When to intervene as a bystander
Small changes can lead to radical shifts
Fixing racism is not a minority’s responsibility
Let’s all be lifelong learners

Key Quotes:
“...medicine is still a

81 Cannabinoid Use and Vaping: Teen Use and Prevention

Wed, 23 Mar 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Sheryl Ryan is Professor of Pediatrics, Chief of the Division of Adolescent Medicine, and Director of Outpatient Adolescent Clinical Services at the Penn State Health Hershey Medical Center. She is a pediatrician who is board certified in both Adolescent Medicine and Addiction Medicine.
Currently, she is focusing her research on the education of both school personnel and pediatricians in rural areas of Pennsylvania around screening and intervention for youth using alcohol and other substances – through a federally funded Project ECHO grant. She is also currently funded through an NIH HRSA grant to train addiction medicine fellows at Penn State, and increase the capacity of primary care and behavioral health care providers to treat individuals with substance use disorders.
As a board-certified specialist in adolescent medicine, Dr Ryan also continues to be clinically very active in providing both outpatient and inpatient care to adolescents and young adults with complex medical and mental health issues.

[00:01] Opening Segment
Why Dr. Sheryl Ryan became interested in pursuing a career in pediatrics
How did Sheryl realize that she could apply her pediatric skills to substance use?

[06:09] Current Data About Substance Use Among Kids
Substance use among kids has declined over the past years
Sheryl shares some data
The importance of asking the right questions to determine substance use
Screening tools that Sheryl suggests for at-risk kids and adolescents

[16:43] The Impact of Legalizing Marijuana Use
She shares her thoughts about making marijuana use legal
The relation of substance use on an adolescent’s brain development
The long-term effects of substance use among kids that doctors found out

[26:47] Influence of Parents on Their Kids
Sheryl talks about the Cannabis use disorder
Parents using substances or drinking alcohol have major influences on their kids
Sheryl explains
Don’t miss our interesting conversation about vaping

[36:50] Possible Interventions and Patient’s Consent
The role of pediatricians in dealing with substance use among kids
Listen to Sheryl’s insights
The different interventions that pediatricians can utilize to address substance use
Asking for consent from the patient regarding possible interventions is a must
Here’s why

[46:02] Legislative Measures to Deal With Substance Use
How to navigate this tricky situation of telling parents about their kids’ substance use
The legislative measures being put into place to deal with substance use among kids
Sheryl has an important message for her resident self, which you should not miss!

[56:30] Closing Segment
Final takeaways
Huge appreciation for Sheryl for joining us today
Substance use has dropped since the 1990s
Early use of substances may lead to a higher risk of substance use disorder and addiction
The short-term effects of legalizing marijuana use
There’s still so much to learn about the effects of substance use among kids and teens
Cases of accidental ingestion of THC are increasing
Safety measures available to patients
Effects of cannabinoids on an adolescent’s brain development
Possible long-term effects of substance use among kids
What cute cannabinoid intoxication among teens may look like
The results of the Adolescent Brain...

80 Alcohol Use By Kids: How to Ask. How to Help

Wed, 16 Mar 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Trigger warning: This episode includes discussions about suicide and depression
Dr. Joanna Quigley is a Clinical Associate Professor of Psychiatry at the University of Michigan. She has also been on faculty at the University of Pittsburgh and trained in Pediatrics, General Psychiatry, and Child and Adolescent Psychiatry at the University of Kentucky. She engages in a number of collaborative efforts to support mental health care in the primary care setting, the care of children with chronic illness and mental health care needs, as well as for adolescents struggling with substance use.
Dr. Quigley serves as a consulting child psychiatrist for the Michigan Child Collaborative Care (MC3) program at the University of Michigan providing outreach support to primary care pediatric, family medicine, and obstetric providers across the state of Michigan. Dr. Quigley was the lead author on the 2019 AAP Policy Statement “Alcohol Use by Youth.”

[00:01] Opening Segment
How serious is the problem of alcohol use among kids? Dr. Joanna Quigley shares her insights
What pediatricians and patients should know about the CRAFFT questionnaire

[06:29] Screening Tools for Kids
How to screen kids the right way for alcohol use according to Joanna
Joanna gives some tips to start a conversation with kids properly
Why families should watch out for binge drinking

[16:55] Alcohol Use and Related Issues
How mental health and substance abuse relates to alcohol use among kids
Pediatricians should also consider their pre-conceived biases when screening kids: Here’s why
These sectors have a high risk for alcohol use and substance use disorders: Listen to our discussion

[26:40] Family-Based Approaches on Alcohol Use
Is there a connection between alcohol use and ADHD and autism spectrum disorders?
The downsides of some resources in relation to substance and alcohol use abuse
The importance of family-based approaches in treating alcohol use among kids

[36:28] The Right Way to Talk With Kids About Alcohol Use
How to help the parents in talking with their kids about alcohol use
The latest data about the parents’ perception of underage drinking
The advantages of routine screening according to Joanna

[41:21] Closing Segment
Final takeaways
Acknowledgment of Joanna’s work for kids and pediatricians
Alcohol use being a common issue among kids
The evidence-based tool that pediatricians can use
Administering questionnaires both written and verbal
Substance Use Disorder transcends race, ethnicity, religion, gender, socioeconomic status, and sexual identity, among others
Our definition of binge drinking
An alternative way to talk about alcohol use with kids
Relation of comorbidities to drinking
Mental health and substance use disorder
Kids with a high risk of alcohol use
How treatment of alcohol use should be
Joanna’s message for parents to prevent substance abuse among their kids
Available resources below
What should be the end goal for kids

Key Quotes:
“When we're seeing patients and thinking about who should we be ‘worried’ about…it's not just teenage boys…binge drinking is a problem for girls as well.” - Dr. Joanna Quigley
“Family-based work is often essential when we're addressing substance use disorders in adolescents…that is a big component of the care. ” -...

79 Covid-19 and Mental Health: Our Patients and Ourselves

Wed, 09 Mar 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. V. Fan Tait is a pediatric neurologist with years of experience in child health and wellness, family-centered care in medical homes, children with special needs, health care delivery, and advocacy for children, families, and pediatricians. She earned a BS from the University of Alabama, her MD from the University of Kentucky Medical Center, and completed her pediatric residency and pediatric neurology fellowship at the University of Utah Medical Center.
For more than 10 years, Dr. Tait directed the Department of Child Health and Wellness which included many of the strategic priorities of the academy: early brain and child development; the Institute of Healthy Childhood Weight; Bright Futures and the National Center on Early Childhood Health and Wellness, which addressed health in Head Start and Child Care. In addition, she led the Disaster Preparedness Advisory Council (DPAC) from its inception and continues to be actively involved in the national climate change initiatives.

[00:01] Opening Segment
Dr. Fan Tait tells us the story behind her career as a pediatric neurologist
She talks about the advocacy that she only realized when she became a pediatrician

[05:46] Becoming a Member of the American Academy of Pediatrics
Here’s how Fan became a chapter president of the American Academy of Pediatrics
What she loves the most about working with her fellow pediatricians in the Academy
The main reason medical homes are a big issue for Fan
Fan leaves a message for her fellow pediatricians

[15:57] Coping with the Effects of the COVID-19 Pandemic
The effects of the COVID-19 pandemic on patients’ mental health
Listen to Fan’s thoughts
Fan shares some resources about how to address mental health issues
Pediatricians should accept the fact that they can’t fix everything
Here’s what they should focus on instead
The importance of education according to Fan

[30:39] Pediatricians Taking Care of Themselves
Why pediatricians should also take care of their health and wellness
Listen to our interesting exchange about “moral injuries”
Here’s our conversation about vaccines and vaccination programs
What’s the difference between self-sacrifice vs. self-preservation?

[45:17] Dealing with Negative Self-Thoughts
How pediatricians can deal with their negative self-thoughts
Fan gives us a sneak peek about the 2022 Healthcare Workforce Rescue Package
Link below
Fan sends a message for her resident self
Listen to her message!

[54:33] Closing Segment
Final takeaways
Acknowledgment for Dr. Fan’s contributions to the American Academy of Pediatrics
How to start an advocacy campaign for kids
The effects of the COVID-19 pandemic on our mental health
Resources about the COVID-19 pandemic accessible to you
Access to care services remains an issue
What pediatricians can offer to families right now
Screening for social determinants of health, depression, suicidal ideation, food insecurity, and housing
Don’t fix everything alone
Remember why we pediatricians are making sacrifices
What is a “moral injury?”
Dealing with burnout
The metaphor of the oxygen mask
The 2022 Healthcare Workforce Rescue Package
The economic impacts of COVID-19 on patients and pediatricians
Be honest about what you can and cannot do.
You are enough, always

Key...

78 Are You Ready?: Preparing Your Office For Behavioral Health Care

Wed, 02 Mar 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
It is challenging to manage kids with suicidal ideation and parents who rely on for you help with limited resources. In this episode, I share with you the best practices, resources, and tips that could help you manage your practice and avoid that stress so you could focus on giving your patients the best experience!
[00:30 - 14:30] Get Your Resources Ready!
The best online resources you could turn to
How to determine if you are ready
Checklist to ensure you have an efficient process workflow
Sharing best practices: Meet with bodies that have a play on a child’s emotional health
Managing the patient from home versus in an emergency room
Why having a social worker in your practice is critical

Key Quotes:
So don't underestimate the power of your voice.” - Lia Gaggino
Resources mentioned:
CALM: Counseling on Access to Lethal Means
Ask Suicide-Screening Questions (ASQ) Toolkit
Pediatric Meltdown Episode 38: Suicide Prevention in Primary Care: Save a Life!

THANK YOU FOR YOUR SUPPORT!
Pediatric Meltdown was listed as a Top 20 Pediatric Podcast on FeedSpot.
If you’d like to connect with me, you can find me on LinkedIn, Facebook, Instagram, and Twitter or email me at gagginol@medicalbhs.com or gagginol@yahoo.com. To learn more about me visit https://www.medicalbhs.com/
LOVE WHAT YOU HEARD? Leave us a 5-star review so we can continue to provide you with great content. Share this episode and help people know more about children’s health and well-being.

77 Pediatric Hospitalist Perspective: Toxic Stress and Resilience

Wed, 23 Feb 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Scott Grant is an academic primary care pediatrician and hospitalist working in Southeast Michigan. He completed his medical school in El Paso, TX, and was a pediatric resident and chief resident at Phoenix Children’s Hospital in Arizona.
His primary clinical interest is in behavioral health, especially the interaction of childhood adversity and trauma with developmental and behavioral outcomes. He recently took on a role as a District CATCH Facilitator with the AAP, which helps pediatricians engage with their communities more directly through grant-supported community partnerships.

[00:01] Opening Segment
Dr. Scott Grant shares the story behind his pursuit of pediatrics as a career
Here’s the part of pediatrics that Scott enjoys the most

[04:18] Tolerable vs. Toxic Stress: What’s the Difference?
Scott learned about this TED Talk that changed how he looked at pediatrics
Link below
The difference between tolerable and toxic stress
Scott explains
Scott talks about the importance of safe, stable, and nurturing relationships with patients
Scott shares the signs of a meaningful conversation with patients

[15:50] Relationship-building Tips For Pediatricians
Pediatricians need to make families feel that they’re humans too
Scott tells us why
How to build trust and relationships with families
Scott shares his experience working with fathers

[25:18] Emotional Regulation: What Is It?
Scott tells us how he decided to produce the Docs2Dads Podcast
Link below
What we should know about emotional regulation
How to replace bad habits among kids
Disciplinary actions are now changing

[35:43] Work-Life Integration is the Way to Go
Scott prefers work-life integration over work-life balance
He tells why
He wants to normalize saying good things to your spouses and children
What are its benefits?
Scott sends a message for his resident self
Listen to his message!

[42:23] Closing Segment
Final takeaways
Awareness of adverse childhood experiences
Nadine Burke Harris on TED Talk
Toxic stress is unbuffered stress
Adverse events can become tolerable if they are buffered by safe, stable, nurturing relationships
How to connect with patients and their families
How to regulate emotions
Why listen to the Docs2Dads Podcast
The role of dads in a patient’s life
Why silence and pauses are important too within patient conversations
Serving as emotional containers
Work-life integration

Key Quotes:
“Sometimes, before families need a physician, they need just a human being that understands that they're having the worst day of their life.” - Dr. Scott Grant
“You can't replace bad habits with no habits. You have to replace bad habits with good habits.” - Dr. Scott Grant
Resources mentioned:
Journal Article: Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health
Video: How childhood trauma affects health across a lifetime | Nadine Burke Harris
Pediatric Meltdown...

76 Pediatric Practice: Find Your Balance

Wed, 16 Feb 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Phil Boucher is a direct care pediatrician in Lincoln, Nebraska, and father of 6. He is also the host of two amazing podcasts. In Raising Good Parents Podcast, he focuses on helping parents enjoy parenthood more while in Pediatrics 2.0 Podcast, Dr. Boucher and his guests discuss the latest trends in pediatric practices from clinical updates to research advancements to revolutions in care delivery.
He paid a visit to Pediatric Meltdown to talk about his journey to pediatrics, his reasons for going solo, and the need for pediatricians to use their voices to inform the general public and our legislators in shaping our healthcare system for the better.

[00:01] Opening Segment
Dr. Phil Boucher talks about the story behind his pursuit of pediatrics
The fun about the science of pediatrics that we both enjoy

[05:08] Launching a Direct Primary Care Practice
The challenges that Phil needed to face early on in his pediatrics career
His motivations for opening a solo pediatric direct primary care practice
The difference between direct primary care from traditional practice
The benefits of launching a solo practice according to Phil

[15:24] Creating Content for Both Parents and Patients
The more difficult challenge brought about by the COVID-19 pandemic
What’s more difficult than physical and financial challenges?
Phil gives us an important reminder about our use of social media
The lessons that listeners can learn from his 2 podcats

[25:12] A Pediatrician’s Role in Shaping the Healthcare System
How pediatricians can use their expertise in sharing relevant information to the public
The role that pediatricians can play in informing legislators about health-related issues
Phil’s message for his younger self that you should hear too!

[35:51] Closing Segment
Final takeaways
Be brave and find what works for you
Why Phil pursued solo practice
Why create a podcast
What pediatricians can learn from Phil’s podcast, Pediatrics 2.0
Expert advice for parents that they can hear from Raising Good Parents Podcast
The opportunity to build relationships with parents and patients
Promoting our advocacies through social media
Connecting with legislators to advance our advocacies
Finding fellow advocates in your local community
Why we should embrace change

Key Quotes:
“Direct [primary care] really means a direct relationship with patients and the physician rather than having the insurance middleman that kind of dictates care.” - Dr. Phil Boucher
“If you can provide good information, you are able to capture attention and change hearts and minds because of your relatability, your authenticity, and your credibility as a physician.” - Dr. Phil Boucher
Resources mentioned:
Phil’s podcasts:
Raising Good Parents Podcast
Pediatrics 2.0
Pediatrics 2.0 previous episode: Interview with Dr. Paul Offit

Email pboucher@drphilboucher.com to connect with Phil or check out

75 Pediatric Mental Health Competencies: You've Got This!

Wed, 09 Feb 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Jane Meschan Foy has spent more than 35 years in pediatric primary care, public health, administration, and medical teaching. Her special interests include mental health services in pediatric primary care and school settings; access to health care for under-served populations; primary care of children with special health care needs; and residency training in mental health, community pediatrics, and advocacy.
Dr. Foy’s publications on mental health include 2 AAP textbooks (2018)—Mental Health Care of Children and Adolescents: A Guide for Primary Care Clinicians and Promoting Mental Health in Children and Adolescents: Primary Care Practice and Advocacy; the AAP Policy Statement “Mental Health Competencies for Pediatric Practice” and Technical Report, “Achieving the Mental Health Competencies” (both Pediatrics, 2019).
She recently edited a new publication to support clinicians at the front lines, Managing Mental Health Concerns in Pediatrics: A Clinical Support Chart. She currently serves as an associate editor of the AAP Textbook of Pediatric Care and as Associate Editor, Mental Health for Pediatric Care Online (PCO).

[00:01] Opening Segment
I introduce Dr. Jane Foy
Her journey from pediatrics to mental health

[05:34] Multidiscipinary Model in Pediatric Mental Health
An alarming observation from Jane about her patients’ childhood experiences
Jane talks about the importance of tapping other disciplines in helping patients
The reasons for building linkages with schools and communities
Protocols in dealing with difficult behaviors among kids in school

[15:46] Mental Health Competencies
Why it’s important to lay out mental health competencies
The cultural change that is happening in the mental health space
Jane shares the story about their advocacy on their Medicaid system
The barriers they’ve broken with this advocacy
Their mechanisms to ensure funds for mental health are being used appropriately

[30:27] Mental Health Monitoring Among Patients
Psychopharmacology education among healthcare providers’
Building trust between the therapist and the family
The “cheer up” model
A critical piece of anxiety treatment according to Jane
How to set up office systems that to monitor patients

[45:53] Resolving Health Problems as a Community
Jane’s advice for her resident self that you should also hear
The power of resolving obstacles with a community, and not alone
The truth about suicide prevention

[47:39] Closing Segment
Final takeaways
Jane’s vision on integrated behavioral health and collaborative mental health care
Creating team models as key to our work
Children who are not getting mental health care
Cultural change in mental health work among pediatricians
Our “pediatric advantage”
Barriers to providing mental health care
Systemic change is now ready to happen
Approaching mental health issues as emergencies
Brief interventions that pediatricians can offer
How to use the “cheer up” model
What you need to know about psychopharmacology
Look for champions in your social circles right now
You are not along. You’ve got this

Key Quotes:
“Listen to your instincts and also listen to your patients and follow them.” - Dr. Jane Foy
“When you do encounter obstacles in getting accomplished what...

74 Food Insecurity: No Child Should Go Hungry

Wed, 02 Feb 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Kofi Essel is a board-certified community pediatrician at Children’s National Hospital (CNH) in Washington, D.C. He serves as Assistant Professor of Pediatrics, the Director of the George Washington University School of Medicine and Health Sciences Culinary Medicine Program, the Director of the GWU Community/Urban Health Scholarly Concentration, and the Director of the GWU Clinical Public Health Summit on Obesity.
Dr. Essel has dedicated his career to advocacy/research around healthcare training, health disparities, and community engagement, with expertise and national recognition in the areas of addressing obesity and food insecurity in families.
[00:01] Opening Segment
Let’s get to know Dr. Kofi Essel
He talks about his journey that brought him to pediatrics

[04:40] The Reality About Food Insecurity
What pediatricians should understand about food insecurity
Kofi shares the latest statistics
How it relates to racism in the country
COVID-19 is not an equalizer, but a magnifier of existing social issues
Kofi explains
The first step to resolve food insecurity
Kofi breaks down what food sovereignty is

[17:53] Role of Poverty and Privilege in Food Insecurity
The “humanistic ability” that people should be able to possess
Why this is culturally relevant
Does working hard solve food insecurity among people living in poverty?
Listen to our exchange
How poverty is expensive and privilege is blinding
The connection between food insecurity and treatment approaches

[27:24] Screening Food Insecurity
What the Hunger Vital Sign is and how to use it
Privacy issues to consider when screening for food insecurity
Shame and guilt are major concerns
How to deal with food anxiety

[43:27] Holistic Approach to Resolve Food Insecurity
Here’s a quick guide from Kofi for pediatricians
Find an anti-hunger champion
A team is still needed even if there’s a champion or advocate
We talk about the evolution of pediatrics through the years
The importance of holistic approach in giving treatments to patients

[53:57] An Important Message for Healthcare Providers
A great resource for healthcare providers to resolve food insecurity
Link below
Kofi’s message to his younger self that you need to hear too
Giving yourself a chance to do something you want to do

[01:00:02] Closing Segment
Final takeaways
Hungry kids in wealthy countries
The problems magnified by the COVID-19 pandemic
Food sovereignty
Step-by-step goal-setting of food-insecure homes
Poverty as the root cause of hunger
“Work hard to succeed” is actually a myth
Structural racism
The pandemic is not the great equalizer
The likelihood of a person or family going hungry
Obesity paradox
Putting the best foot forward
Food insecurity and food anxiety
The two-question hunger vital signs
The importance of asking questions
Talking with a parent alone away from the child
My personal realizations while talking with Kofi
Looking for an anti-hunger champion
Use your voice to advance advocacies
No child should be hungry, ever

Key Quotes:
“The ability to choose one's food is a humanistic ability and ability we should be able to provide to people.” - Dr. Kofi...

73 Need a Child Psychiatrist's Help? Phone a Friend!

Wed, 26 Jan 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. John Straus is the Founding Director of the Massachusetts Child Psychiatry Access Program (MCPAP) and a 2020 Mom’s Inaugural winner of the Maternal Mental Health Hero Award. Dr. Straus is the mind and heart behind MCPAP, which has inspired and been the model for Maternal Mental Health doctor-to-doctor consultation programs across the U.S.
Dr. Sheila Marcus, meanwhile, is a Clinical Professor at the University of Michigan, Section Chief for Child and Adolescent Psychiatry and Co-Director of the Infant and Early Childhood Clinic (IECC). Her areas of interest include intergenerational transmission of illness, maternal child attachment and early risk factors for childhood psychiatric illness including presentation of autism in toddlers.

[00:01] Opening Segment
Let’s get to know Dr. John Straus and his role in the MCPAP
Meet Dr. Sheila Marcus, a clinical professor at the University of Michigan

[04:58] The Birth of the Massachusetts Child Psychiatry Access Program
John’s role in making the Child Psychiatry Access Program possible
Sheila’s motivation for joining and contributing to the Program
John talks about the pediatricians’ engagement so far within the Program

[15:10] Accessible Child Psychiatrist Support
The system in place to get help from a child psychiatrist
What they mean by “rightsizing mental health”
The limitations of psychiatry that psychiatrists should realize

[20:16] Sustainable Child Psychiatry Program
A major concern on the primary care side according to Sheila
The driving factors for states to adopt and sustain the child psychiatry program
The role of health insurance
The growth of the infant mental health lens
Treating a mother’s pre- and post-partum illnesses

[30:00] Mental Health Screening in Prenatal Care
We talk about the lack of mental health screening in prenatal care
The assignments of obstetricians in prenatal care
We have an interesting exchange about the specialty of pediatricians

[35:01] The National Network of Child Psychiatry Access Programs
The importance of offering substance use services
What to consider in administering medications to kids
The role of the National Network of Child Psychiatry Access Programs

[40:34] Distribution of Psychotherapeutic Resources
There are no intrinsic mental health issues
How patients and providers can capitalize on the Michigan program
The next big step now is distributing psychotherapeutic resources
Their message to their younger selves you’d want to hear too!

[47:28] Closing Segment
Final takeaways
The growth of a national child psychiatry program
The risk of mental health issues among kids
Mental health screening in prenatal care
The variety of child psychiatry programs per state
You’re not incompetent. Sometimes, cases are just hard to address
The life-altering benefit of the MC3
Diagnostic clarification is key
The impact of trauma on patients
Sending behavioral health consultants across Michigan
Available resources and programs in your state
The “Next Gen Training”
The importance of time among pediatricians
States with no child psychiatry access program yet
Go to nncpap.org to know where your state program is
Do what you love and enjoy the...

72 Happy 2022: What's Coming on Pediatric Meltdown!

Wed, 19 Jan 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Happy 2022! In this episode, we will discuss first what should be our priorities to help ourselves draw how we want this year to look like. We will also talk about the power of family and community not only to our personal growth but also to our individual health and why we should regularly make time for our loved ones. Lastly, we will be laying down all the important topics that are going to cover this 2022, topics that we feel should be talked about more in and out of the medical space.
[00:01] Here’s to a Fruitful 2022 For Everyone!
My biggest challenge in the previous year
Why resilience is key to overcoming the pandemic
Take a leap and here’s why
Follow your passion

[02:20] The 7 Priorities for the Self This Year
How to build safe, nurturing, and stable relationships
The 7 things we should prioritize for ourselves
Why we should make time for our loved ones
When to call a friend

[12:09] What to Look Forward to In 2022
The underrated benefits of sleeping regardless of age group
The important topics we will be talking about this year
The guests that we will be bringing back this year

[17:54] Closing Segment
Do you have topics in mind that you want me to discuss?
Links below
Final announcements

Key Quotes:
“I hope that there are those of you out there that want to take leadership roles and know that you deserve and belong there. Your voice is important because of what you do. You are an expert in your field. .” - Dr. Lia Gaggino
“Don't be afraid to take a leap. Sometimes it works. Sometimes it doesn't. But you have to try and follow your passion..” - Dr. Lia Gaggino
If you’d like to connect with me, you can find me on LinkedIn, Facebook, Instagram, and Twitter or email me at gagginol@medicalbhs.com or gagginol@yahoo.com. To learn more about me visit https://www.medicalbhs.com/
LOVE WHAT YOU HEARD? Leave us a 5-star review so we can continue to provide you with great content. Share this episode and help people know more about children’s health and well-being.

71 Depression: Naming the Monster

Wed, 12 Jan 2022 11:00:00 +0000

Trigger warning: depression, suicide
https://302.buzz/PM-WhatAreYourThoughts
Dr. Colleen Cullinan is a pediatric psychologist at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware. She specializes in integrated primary care within the Division of Behavioral Health. Dr. Cullinan completed her PhD in Clinical Psychology at Western Michigan University in 2015. Dr. Cullinan supervises psychology externs and interns, and she directs medical education efforts for Nemours’ residency training programs. Her presentation and publication records center around integrated care, family-based interventions, and experiential cultural humility training.

[00:01] Dr. Colleen Cullinan Shares Her Thoughts About Depression
Colleen’s thoughts about the effects of the pandemic on people’s mental health
What to do if depression hinders a person to live normal life
Why Colleen is veering away from symptom-based approach of depression

[08:15] What Matters Most to Kids Are Their Everyday Experiences
What matters most to kids that pediatricians should prioritize
Colleen breaks down the different therapies available currently
Here’s why problems are not always fixable according to Colleen

[18:32] How to Apply Acceptance and Commitment Therapy
Colleen gives us a background about Acceptance and Commitment Therapy
She gives us a lesson that we can learn from watching a horror movie
What is its connection to approaching depression?
She talks about diffusion and why people should know more about it

[28:10] The Power of the Brain in Helping a Child Going Through Depression
We talk about Motivational Interviewing
The right questions to ask to kids according to Colleen
A popular intervention under Acceptance and Commitment Therapy
How to train the brain to generate something that helps the kids

[43:31] Challenge the Frame, Not the Content
We have an interesting exchange about “creative hopelessness”
The role of values in Acceptance and Commitment Therapy
A great definition of goals that pediatricians should keep in mind
The messages that people receive everyday matter in therapies
Challenging the frame, not the content
Colleen explains further the Acceptance and Commitment Therapy

[58:43] Why People Should Not Be Serious Always
Colleen gives a few take home messages for pediatricians
Why people should not take everything so seriously
She talks about the transformative impact that pediatrics brought to her

[01:06:14] Closing Segment
Connect with Dr. Colleen Cullinan on Twitter @colleencullinan and @Nemours
Final takeaways:
Recognizing the “negative” emotions that we feel
Effects of impairment to the body
Cognitive behavioral therapy
Acceptance and Commitment Therapy
An important lesson from playing a beach ball
Naming the “thing”
Avoidance at the heart of suffering
Some crossovers with mindfulness
Curiosity and the suffering
Why language matters
Experiences and language
What the patient values
Connection and belonging
Safe, stable, nurturing relationships
Appreciation for Colleen!

Key Quotes:
“Avoidance is really at the heart of all mental [suffering] in my opinion.” - Dr. Colleen Cullinan
“There's a lot of data that shows that when people are more invested in the...

70 Being Brave: Resilience in the Face of Backlash

Wed, 05 Jan 2022 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Pediatricians get up every day thinking about how to meet the needs of children. And very often we forget about our own health. In this episode of Pediatric Meltdown, Dr. Lia and Dr. Michelle Fiscus discusses physician burnout, what it means to face identity challenges as a physician, and overcoming these challenges.
Dr. Michelle Fiscus is a board-certified pediatrician who practiced general pediatrics in Franklin, TN for 17 years before joining the Tennessee Department of Health in 2016. She most recently served as medical director of the Tennessee Vaccine-Preventable Diseases and Immunization Program until she was terminated from that position for sharing a memo regarding a 34-year-old case law that allows certain minors to consent for their own medical care. Dr. Fiscus was thrust into the national spotlight after she released a statement shedding light on the choice of those in leadership in Tennessee state government to place their political agendas over the best interest of the people they serve. She has used this platform to support the work of public health and reinforce the importance of vaccines and other public health measures in ending the COVID-19 pandemic.
Dr. Fiscus is an associate clinical professor in the Department of Pediatrics at the Monroe Carell Jr. Children’s Hospital at Vanderbilt. She is a past president of the Tennessee Chapter of the American Academy of Pediatrics and now serves on the Board of Directors of the American Academy of Pediatrics as District IV Chair.

[00:01] Dr. MIchelle Fiscus Shares Her Story With Us
Why she went into pediatrics
Suffering from significant burnout that led her to Public Health
Going into the Vaccine-Preventable Diseases and Immunization Program

[11:52] Covid-19, the Vaccine Rollout, and Controversy
Dr. Fiscus’ role in COVID mitigation and responses
Tennessee's hesitation in promoting COVID-19 vaccines
Controversy and pushback regarding vaccination in Tennessee
Dr. Fiscus choosing to acknowledge the expiration of her executive service

[21:06] The Interference of Politics and Public Health
The overstepping of political opinion into COVID-19 management
Dr. Fiscus’ exposure to National and International news
How it’s been for Dr. Fiscus and the difficulty and challenges of this exposure
The toll on mental health when facing criticism and pushback

[32:54] Being a Disruptor in Pediatrics
What’s next for Dr. Fiscus?
Pediatricians taking the darkest punches and overcoming challenges
If you could go back to when you were in residency what would you tell yourself?

[42:57] Closing Segment
Connect with Dr. Michelle Fiscus on twitter @drfixus
Final takeaways:
Pursue your passion
Burn out looks like exhaustion and unhappiness
Being a pediatrician can look like many things
The right thing keeps me going; I can move the needle, I am a problem solver, I will hold others accountable in the face of misinformation

Key Quotes:
“If you know that there's something that you would just love, then figure out how to go get it. You have to make yourself a little bit vulnerable to get there. But don't be afraid to pursue the thing that you think is going to make you happiest.” - Dr. Michelle Fiscus
“I honestly couldn't stomach the interference of politics in public health. Just the unwillingness to understand that the decisions that are...

69 Mindfulness in Medicine: The Joy Initiative

Wed, 29 Dec 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Miko Rose is the creator and Program Director of the “Joy Initiative,” a project she started at the Michigan State University College of Human Medicine and College of Osteopathic Medicine schools. In 2013, she was awarded the SAMHSA American Psychiatric Association Minority Leadership Fellowship Grant, from which she built the foundation to develop emotional resilience, happiness, and mindfulness training tailored to meet the unique needs of medical providers.
She now offers one of the first formal classes on happiness and joy in medical schools in the nation--which she has been teaching as a for-credit class in two medical schools for the past seven years. This curriculum has since expanded to provide training for peak performance for team coaches, trainers and student athletes.

[00:01] Dr. Miko Rose Shares Her Story With Us
Miko talks about her journey into the psychiatric field
We talk about trauma and how they affect patients

[06:40] What People Don’t Ask About Depression
How at-risk populations inform the approach of the healthcare system
Why healthcare providers should let parents lead the discussions
What people don’t ask about depression that we should know

[16:58] The Birth of the Joy Initiative
Healthcare providers have struggles of their own too
Listen to Miko’s story
The happiness and wellbeing programs that Miko started
The Joy Initiative and learning about the science of happiness

[28:54] The Power of Mindfulness Meditation
What can healthcare providers do with the Joy Initiative?
The four tiers that any wellness program should have
The different techniques to try to get one’s self to relax
We did an exercise that you can do with us right now!

[40:00] Why Mind Vacation is a Must
Mindfulness meditation also has a positive effect on the physical body
Connect with Miko with the links below!
The “mind vacation” that everyone should take everyday

[47:01] Closing Segment
Final takeaways:
Mental health conditions and trauma
Healthcare providers have their own struggles too
The power of empathy
The body of research about mindfulness continues to grow
Seeking our own healing to be a healer
The Joy Initiative and its mission
The four tiers of the Joy Initiative
One-minute vacations
How to start a mindfulness journey

Key Quotes:
“I knew that ultimately nobody needs to be alone just because we're expected to be superheroes.” - Dr. Miko Rose
“We don't need something outside of ourselves to be with ourselves.” - Dr. Miko Rose
Email mikorose@gmail.com to connect with Miko. Check out https://joyinitiative.com/ to know more about her work.
Resources Mentioned:
Joy Initiative-COSGP-SOMA Community

If you’d like to connect with me, you can find me on LinkedIn, Facebook, and

68 Trouble at School?: Listening to Families and Sorting Through the Possibilities

Wed, 22 Dec 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Alison Schonwald is a Developmental Behavioral Pediatrician and co-founder of Touchstone Neurodevelopmental Center. After her undergraduate education at Yale University and medical school at the University of Pennsylvania, Dr. Schonwald completed pediatric residency and Developmental Behavioral pediatrics fellowship at Boston Children's Hospital, where she served as faculty from 2001-2019.
Dr. Schonwald’s clinical interests include early diagnosis of autism and developmental delays, psychopharmacology for children with a variety of developmental disorders, cultural competence in families of children with developmental disorders, and transition to adult care. She is the author of two books, “Pocket Idiot’s Guide to Potty Training Problems,” and “ADHD in Adolescents: A Comprehensive Guide.” She currently serves on the American Board of Pediatrics Subboard for Developmental Behavioral Pediatrics and the MA Board of Early Education and Care, while maintaining a busy clinical practice and continuing to teach primary care pediatricians.

[00:01] Dr. Alison Schonwald Shares Her Story With Us
Alison talks about her pediatric career in the developmental behavior field
How to approach a parent who’s thinking their child has ADHD

[07:26] How to Identify Developmental Delays in a Child
The importance of knowing the history of the child
Alison talks about how she determines potential developmental delays
How language can help pediatricians point out potential issues in a child
Alison reveals her tips to ask about possible traumatic experiences
Parents should bring these pieces of information in the consultation

[17:35] Thoughts About Existing Screening Tests
Here’s why pediatricians should not be afraid to diagnose patients
How small and rural communities can help kids with ADHD
We talk about prescription medicines like stimulants and non-stimulants
Alison shares her thoughts about current screenings tests
She gives a few recommended resources that can access now

[27:22] The True Role of a Pediatrician in a Child’s Life
Alison shares some tips for pediatricians to improve their craft
Here’s an inspiring story about a patient who had made a friend
When the journey with the child patient really starts according to Alison
The true role of the pediatricians in taking care of a child

[37:40] Being a Healthcare Provider is More Than Just Diagnosis
The relationship among children, their families, and communities
Don’t miss these inspiring message from Alison to her younger self
Why you should listen to this TED Talk by Abraham Verghese

[41:38] Closing Segment
Final takeaways:
The first step is always listening to the story
Assuring families that they get the help they need
Developmental trajectories and ADHD
What to observe in a child
What to look for in teenagers
The possibility of trauma
Collateral information is key
Teacher feedbacks are important too
Being upfront to parents about your diagnosis
The role of stimulants in screening tests
Other possible factors that affect a child aside from ADHD
Available resources for parents and families
Diagnosis is not the start of the journey
Sorting through the many differential diagnoses

Key Quotes:
“The journey starts when you first recognize there is something different about your child.”

67 Child Health Transformation: Let Parents Lead the Way

Wed, 15 Dec 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Paul Dworkin is the Executive Vice President for Community Child Health at Connecticut Children's Medical Center and professor of pediatrics at the University of Connecticut School of Medicine. For 15 years, he previously served as physician-in-chief at Connecticut Children’s and chair of Pediatrics at UCONN. Dr. Dworkin’s interests are at the interface among child development, child health services, and child health policy.
Dr. Dworkin’s honors include teaching awards, visiting professorships, and named lectureships. He was the editor of the Journal of Developmental and Behavioral Pediatrics from 1997-2002 and was a member of the first entering class of the Academy of Distinguished Educators at the UCONN School of Medicine. Dr. Dworkin has served on the boards of numerous community-based organizations and recently completed his tenure as chair of the board of the Urban League of Greater Hartford.
[00:01] Dr. Paul Dworkin Shares His Story With Us
Paul talks about his journey into the pediatrics space
What’s his belief about the science of development and behavior?

[05:19] Biology of Adversity
Questions to ponder on about child health services
The driving factors that can make or break a pediatrician
Paul talks about the “biology of adversity”
The basic premises of delivering child health services
How to encourage a family-led agenda in a child health context

[15:13] The Decade of the Brain
The extremely important red flags to watch out for according to Paul
The power of surveillance and screening in detecting problems in the child
Assumptions about children that you should hear right now
Paul reveals the story behind their pilot study on children’s health
What’s the study about?

[26:47] Proactive Approach in Child Health Interventions
All relevant sectors should be consulted in crafting child health interventions
Here’s why
2 problems that healthcare providers encounter everyday
Why being proactive in checking up on children is a must

[36:23] Reach Out and Read
We have an interesting exchange about the Reach Out and Read program
Specific calculations to drive support to healthcare investments
Paul gives us a sneak peek on how they replicated the Reach Out and Read strategy
How to scale the existing systems and processes we have right now

[48:25] Politics and Healthcare
How to make sure that investments in healthcare will generate positive outcomes
The case for prioritizing child health services transformation
Data is important but should be relevant and appropriate
Listen to our exchange
Is there a correlation between political colors and child health services?

[01:01:07] Paul’s Advice for Resident Pediatricians
Lack of coordination among the supposed coordinators create a bottleneck
What kind of bottleneck and how to resolve it?
Here’s Paul’s message for healthcare providers today
Don’t miss his advice for his resident self!

[01:12:05] Closing Segment
Final takeaways:
Actionable steps for child health reform
Big ideas to consider such as child health promotion instead of prevention
Decade of Brain
Impacts of poverty and racism to children
Problems that providers encounter daily
Cross-sectoral efforts are the ways to go
“Help Me Grow,” a bold...

66 School Shootings: The Aftermath and Prevention

Wed, 08 Dec 2021 11:00:00 +0000

Trigger warning: suicide, gun violence
https://302.buzz/PM-WhatAreYourThoughts
Dr. Zakia Alavi is a Diplomat of American Board of Psychiatry and Neurology in general psychiatry and child & adolescent psychiatry. Dr. Alavi is an Associate Professor in the Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University. For the Department of Pediatrics, Dr. Alavi is involved with developing and training pediatric residents and general pediatricians about children’s mental health through a State of Michigan and HRSA funded grant.
Currently, Dr. Alavi provides psychiatric services to children through the Community Mental Health clinic in Jackson Michigan. Dr. Alavi is the chief medical officer for Midstate Health Network, and NorthCare Network which are Medicaid Managed Behavior health Plans for 21 counties in lower Michigan and Michigan’s Upper Peninsula, respectively.

[00:01] Dr. Zakia Alavi and I Talk about the Recent School Shootings
Why school shootings are still happening
How we should protect our kids from gun-related violence

[06:32] How to Discuss School Shootings With Kids
When to bring up discussions about gun violence
Looking at school shootings as awful tragedies
Who should also be considered as victims?
The appropriate things to say to early elementary children
Why adults should regulate their own emotions
What to say to children aged 9-10 years old
The topics that should be included in dinner conversations

[17:23] Resolving Gun Violence in Schools
Strategies from Zakia to discuss firearms as a public health hazard
The age group that is the easiest and most difficult to support according to Zakia
Gun violence is a public health problem and should not be a debate
The unique opportunity for healthcare providers to resolve gun violence
Warning signs to watch out for in relation to homicide risk
The dangers of the language that we use

[30:06] Take a Deep Breath Then Take Action
The right questions to ask to parents or families
The resources that families can access right now
Zakia’s message for patients and pediatricians alike

[38:33] Closing Segment
Final takeaways:
Appreciation to Zakia for raising awareness about gun violence in this episode
We are still prioritizing guns over children
Our job as adults in protecting children
The right words to say to kids and families
What to consider in talking with the youngest children
What to say to elementary school kids
The easiest and hardest age group to work with
How to talk to parents about guns in the household
Don’t glorify guns
How guns are stored at homes
Talk about intense emotions and the use of words and threats.
When should a parent worry about their child being either a risk to themselves or to others?
Talking with families about gun violence is inevitable
Why reach out to child psychiatrists
The time for change is NOW

Key Quotes:
“If your child is asking questions, then you've done a great job creating a safe holding environment at home.” - Dr. Zakia Alavi
“Take a deep breath and talk to each other, talk to your families. Give families, your children a big hug.” - Dr. Zakia Alavi
Email alavizak@msu.edu to connect with Zakia or check out

65 Working Pediatric Moms: The Myth of Work Life Balance

Wed, 01 Dec 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Whitney Casares is a private practice pediatrician, American Academy of Pediatrics author, and a mom to 2 young girls in Portland, Oregon. She says that her kids are her best teachers, but that she also went to school for forever. After completing her undergraduate degree in journalism, she completed her medical school training at the University of Vermont and pediatric residency training at Stanford University. She also holds a Masters of Public Health in Maternal and Child Health from the University of California, Berkeley.
Whitney said that after her daughters were born, she got lost in their needs and let hers fall to the wayside. When she went back to work postpartum, life got even more complicated as she layered on more responsibilities and added more to-dos. She had to dive deep to redefine what it means to be a successful mom. By flipping the switch and investing in her own social and emotional health, she stopped just surviving motherhood and started thriving.

[00:01] Dr. Whitney Casares Shares Her Story With Us
Whitney talks about her story as a privately practicing pediatrician
Here’s why she started blogging and podcasting

[07:11] Achieving Work-Life Balance
Whitney gives us a sneak peek into the life of a pediatrician mom
The pressure of being a working mom--regardless if you’re a patient or not
If pediatricians are always stressed, this is what will happen
Is work-life balance really possible?

[17:48] Dealing with Trauma and Stress
Here are some practical tips from Whitney to de-stress
How to deal with trauma as a pediatrician?
What listeners can learn from Whitney’s podcast
The priorities that working pediatrician moms should always have
Whitney’s life framework

[31:45] The Special Part of Working in the Pediatric Sector
Holiday hacks from Whitney that you should not miss!
Whitney has a message for her resident self
The special part of being a pediatrician according to Whitney

[39:27] Closing Segment
Final takeaways:
The reality of being a working mom
The harder we work, the less we have to give
What people should realize about work-life balance
You just can't be present if you don't feel good
Practical steps for working moms to improve their lives
Resources you can access in Whitney’s website
Whitney’s life framework that you can follow too
2 holiday hacks you can try
Why pediatricians should take care of themselves
Things to reflect upon this holiday season

Key Quotes:
“We can control how we show up for our own lives.” - Dr. Whitney Casares
“You are enough.” - Dr. Whitney Casares
Email info@modernmommydoc.com to connect with Whitney. Check out Modern Mommy Doc or her Facebook, Twitter, and Instagram pages to know more about her work.
Listen to The Modern Mommy Doc Podcast to learn tips and strategies to be successful as a working...

64 Narrative Medicine: Sharing the Patient and Family Story

Wed, 24 Nov 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Wendy is a writer, poet, and educator, is a former university vice president, professor, policy advisor, and attorney. She is also the founder and curator of the tiny poetry project – narrative medicine for the soul. She uses narrative medicine and medical humanities as a way of healing, understanding, teaching, and connecting to others regarding issues of illness and health.
In this episode, she shares her experience and the lessons that she learned when they found out her baby had a life-threatening congenital heart condition. A few lessons she talked about today include why pediatricians should introduce themselves properly, how immortality can be a normal topic between parents, and what patients should feel when they’re in the hospital.
[00:01] Wendy Hind, Ph.D. Hind Shares Her Story With Us
Wendy talks about how they found an irregularity in her baby
How she and her husband came up with the decision to keep their baby

[05:52] It’s Okay If You Don’t Know All The Answers
What being in a healthy marriage can do to a family
Wendy shares her experience of having to go to hospitals often
Wendy’s message for pediatricians who don’t know all the answers

[15:15] What Patients Need to Feel in a Hospital Setting
The importance of mentors in a pediatrician’s life
Why patients need to feel they are heard
The things that frustrate parents in a hospital setting

[20:12] The Power of a Simple Introduction
The pediatrician as the ringleader and conductor
Wendy explains
Why pediatricians should introduce themselves properly to patients
Talking about mortality between parents

[30:00] What You Should Know About Narrative Medicine
Wendy breaks down narrative medicine and why you should learn it too
The power of hearing another person’s story and humanity
Don’t miss this poem reading from Wendy!
Read more from her in the links below

[40:51] Closing Segment
Final takeaways:
Always keep humanity and basic kindness in mind
It’s okay for pediatricians to not know everything
The power of listening
Pediatricians should introduce themselves properly
Read the chart before you see the patient
Parents and patients know more about their own situation than you do
Parents and patients worry about outcomes and mortality
Deliver the important news yourself
Talk to the other specialists involved
Narrative Medicine allows patients and parents to tell their stories
A powerful poem from Wendy you need to read now
Find out more about Wendy’s work on the links below

Key Quotes:
“Never underestimate the power of a simple introduction and who you are and why you’ve come in the room.” - Wendy Hind, Ph.D.
“Poetry has been my mode of telling my story.” - Wendy Hind, Ph.D.
Email w_hind@hotmail.com or tinypoetryproject@gmail.com to connect with Wendy. Check out Tiny Poetry Project or its Facebook,

63 Eating Disorders: Feeding Our Kids

Wed, 17 Nov 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Emilee Young, RDN, LD is a Registered Dietitian dedicated to helping those in recovery. She has worked in both an intensive outpatient and a partial hospitalization setting where she has been able to support clients in recovery.
Emilee practices based on the philosophy that “all foods fit” and wants to help clients create a sustainable and joyful experience with food and movement. She specializes in binge eating disorder recovery and enjoys working with clients to establish peace with food. Emilee is a fat-positive and anti-diet dietitian working from a Health At Every Size © and Intuitive Eating model.
[00:01] Emilee Young Shares Her Story With Us
I introduce and welcome Emilee Young, RDN, LD
Emilee tells us the story on why she’s focused on eating disorders

[05:15] Weight is Not Health
What dieticians would advise to pediatricians
Listen to Emilee’s advice!
Here’s the truth about body mass index that you should know
Weight is not health
Emilee mentions some factors to consider when defining health
She breaks down her specialization in terms of food movement in the body

[15:44] Division of Responsibility
Emilee talks about “division of responsibility” in a nutshell
What is food bargaining and why is it not advisable?
No one is immune to the diet culture
Here’s what to do with it

[25:44] When to Refer a Patient About Eating Disorders
Our patients are the experts of their own body
Healthcare providers should always listen
When pediatricians should refer patients to other healthcare providers
Why patients should be allowed to eat their preferred food
How often should this be allowed?
How to deal with patients with food restrictions

[35:33] How to Build Safe Spaces for Kids
Having a team of experts is a good support system for the child
Pediatricians should choose their words very carefully
Kids are sponges
What pediatricians should understand about safe spaces
Healthcare providers should pay attention to these points of reflection
GIving autonomy to patients
Reflecting about patient-centered care

[42:37] Closing Segment
Final takeaways:
When pediatricians should refer their patients for eating disorders
Attitudes about weight, diet, culture and fat shaming among pediatricians
The right way to talk about the growth trajectory of a child
“Health at every size” and intuitive eating
A child’s food preferences change over time
Body mass index may be flawed
Factors to consider when looking into a child’s health
Division of responsibility for parents
Setting up rewards food is not advisable
Listen to the patient and validate their feelings
Interventions for patients with anorexia
The antidote to diet culture
Choosing our words wisely

Key Quotes:
“I think a part of that division of responsibility is making sure that your child has its preferred foods.” - Emilee Young, RDN, LD
“I think one of the biggest things that I've learned as a dietitian is being a good listener.” - Emilee Young, RDN, LD
Email emilee@couragetonourish.com to reach out to Emilee or follow her on Instagram. Check out

62 Eating Disorders: Recovery Coaches Strengthen the Healing Team

Wed, 10 Nov 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Jayne Mattingly is a masters-level eating disorder recovery coach and the owner and Chief Executive Officer of the Global Virtual Coaching Group Practice, Recovery Love and Care. Jayne identifies as fully recovered from a lifelong eating disorder and also lives with a chronic illness and is disabled, which has inspired her to help others within their own healing journeys.
Jayne’s coaching style is a collaborative approach where she perseveres with and advocates for each and every one of her client’s. She has a passion for helping those within their recovery, especially when it comes to body image conception, chronic illness, living with disability and body betrayal and helping others find self-compassion and body kindness.
Jayne’s overall mission is to help those within their eating disorder recovery find success within the hostile recovery environment in which we live!
[00:01] Jayne Mattingly Shares Her Story With Us
I introduce and welcome Jayne Mattingly
Why she pursued a career as an eating disorder specialist

[05:32] Eating Disorder Recovery Coaching
What do Jayne’s clients look like?
Not all of them have anorexia
How can eating disorders specialists work with physicians?
Jayne shares her experience
Eating disorders should be resolved with as much support as possible
She tells us how

[15:47] Misconceptions About Recovery Coaches
Children might misinterpret eating disorders
Here’s how to avoid misinterpretation
Jayne gives us a sneak peek at their body of knowledge
What recovery coaches are not according to Jayne

[25:16] Health At Every Size
What to know about intuitive eating and “health at every size”
The relation of weight and trauma according to Jayne
The connection between recovery and weight that you don’t want to miss

[35:25] The Reality About Diet Culture
Listen to our interesting exchange about diet culture
Don’t miss Jayne’s message to healthcare professionals
How to break our preconceived notions about body sizes

[45:02] Closing Segment
Final takeaways:
Common misconceptions about eating disorders
Team-based care for individuals offers a safety net
A health coach provides support with goal setting, not diagnosis
Reframing weight in the context of the 8 pillars of health
Health At Every Size: What does this mean?
Connection of trauma and weight
The effects of cognitive trauma
Our words matter when we're talking about the children's BMI, and using language like obese
How to not succumb to diet culture

Key Quotes:
“With eating disorders, you could not have too much support.” - Jayne Mattingly
“Listen to your patients and your clients because there's usually so much more going on than just the weight piece.” - Jayne Mattingly
Email recoveryloveandcare@gmail.com to reach out to Jayne or follow her on Instagram. Check out Recovery Love and Care to know more about her work.
Resources Mentioned:
Book
Health At Every Size

61 Eating Disorders: Prevention in Primary Care

Wed, 03 Nov 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Michaela Voss graduated medical school from University of Kansas Medical Center – Kansas City, KS, in 2010. She completed her pediatric internship and residency in 2013 at Children’s Hospital of Wisconsin – Milwaukee, WI. Afterwards, she pursued advanced training in the field of adolescent medicine, graduating from fellowship in 2016 at Seattle Children’s Hospital – Seattle, WA.
During this time, Dr. Voss was a Leadership and Education in Adolescent Health (LEAH) Fellow and participated in research under a T32 grant. Currently, Dr. Voss is Medical Director of The Eating Disorder Center at Children’s Mercy – Kansas City, MO. In addition to her clinical and administration duties, she enjoys educating medical professionals and the general community about adolescent health and eating disorders. She participates in multiple research and quality improvement projects to expand evidence based medical knowledge of eating disorders.

[00:01] Dr. Michaela Voss Shares Her Story With Us
I introduce and welcome Dr. Michaela Voss
Michaela shares why focuses on eating disorders

[04:45] Terms About Eating Disorders
Here are the terms that we need to be familiar with according to Michaela
anorexia nervosa
Bulimia nervosa
Binge eating disorders
Avoidant/restrictive food intake disorder
Orthorexia nervosa
Atypical anorexia nervosa
Being healthy “to the extreme” is also not healthy
Anorexia does not discriminate

[09:44] How to Prevent Eating Disorders
The role of the primary care pediatrician in preventing eating disorders
Here are a few resources that pediatricians can access now
Michaela shares some interesting insights about Body Mass Index
Health should be prioritized over weight

[19:15] Health at Every Size
Michaela talks about the concept of “health at every size” (HAES)
Children know how to eat intuitively
Michaela explains
What pediatricians should tell kids and adolescents about their bodies
Here’s an analogy about dogs that you should hear right now

[29:39] Plating at an Early Age
What if we never weigh a child?
Listen to our exchange here
Guidelines and checklists that pediatricians can use
Why kids should start plating their food at 3-4 years old
The things that primary care pediatricians should unlearn

[39:17] Eating Disorders and Mental Health
The reason primary care providers should advocate for more research
The right words to say and when to say them
Connections between eating disorders and mental health
Focusing on things that the patient can control themselves

[49:05] Learning From Other Disciplines
Listen to Michaela’s message for her resident self
The additional experience that might save a life
Resources about HAES that you can access now

[52:59] Closing Segment
Final takeaways:
Categories of eating disorders
Primary care providers and their role in preventing eating disorders
The importance of awareness about eating disorders among primary care providers
Rethinking body mass index
Weight guidelines that providers can use
Genetics and growth trends
Health parameters to considers, not just weight
The dangers of focusing on weight only
The concept of “health at every size”
Advice we can...

60 Autism Spectrum Disorders: Advice to Pediatric Clinicians from Individuals Living with Autism Spectrum Disorders

Wed, 27 Oct 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Our guests for today are brothers, Brandt and Evan Ingber. Brandt is a 23-year-old who works full-time and lives with his brother. Brandt enjoys Pokemon Go, Anime, lightsaber dueling and volunteering with Special Olympics fundraisers and at animal shelters. Meanwhile, Evan is a 25-year old who also works full-time and enjoys outdoor activities, boating, fishing, camping, yardwork, working with his hands and lightsaber dueling. Evan also volunteers in his spare time as a snowboard coach and at fundraisers for Special Olympics.

ACTIVITY CODE 91839
CME INSTRUCTIONS: Completion of these steps are required to earn CME credit.
TO OBTAIN CME CREDIT: SELF-ATTEST WITHIN 4 WEEKS. GO TO: https://cmetracker.net/MSU/Publisher?page=pubOpen#/EventID/91837/ (case sensitive)
Click on the Sign In option on the left menu.
You will be required to create a profile if you have not used the system before.
Enter the activity code provided on this sheet.
Complete the online evaluation, attest to your time in attendance, and follow the screen instructions to print your certificate. Make sure your computer is set to allow pop-ups from the site or the certificate will not show.

If you have any issues obtaining your certificate, please contact the CME Office at spring18@msu.edu or by calling 517-884-8871

CME Activity Information Sheet can be found here.

[00:01] Brandt and Evan Ingber Share Their Story
Welcome to the first CME series in Pediatric Meltdown!
What to expect in the 3rd episode of this series
How to get credits for CME
I introduce and welcome our guests, Brandt and Evan Ingber

[04:23] The Importance of Trust
Brandt talks about how he learned he has autism
Conversations are hard for people like Brandt
He tells us why
Parents should be supportive of their children
Brandt shares his experience with his mother
Brandt tells a story on how trust can be a big issue
Brandt’s message for doctors about people with autism
Is it hard to be in a romantic relationship?

[14:41] Going Through Depression
Brandt talks about his experience in reading emotions
What’s next for Brandt?
Evan shares his interesting thoughts about autism
Evan tells us the importance of practicing social skills among people with autism
He tells the story on how he got involved in social activities
Evan shares his experience with depression
When did he ask for help?

[25:04] The Right Kind of Care for People with Autism
Evan shares his experience getting help with his depression
How can doctors improve the way they help people with autism
Here’s Evan’s message for doctors that you don’t want to miss
The story behind Evan’s tattoos
What healthcare providers should realize about Autism Spectrum Disorders
How autism affects a person

[35:15] The Power of Sharing Your Story
What’s next for Evan?
Evan puts into perspective his life as a person with autism
His bravery for sharing his story with someone
How to earn CME credits

[40:52] Closing Segment
Final takeaways:
Doctors should realize autism is a spectrum disorder
Don’t break promises
The...

Child Injury Prevention: Safer Storage of Firearms Day-of-Action on 10/27/21

Tue, 26 Oct 2021 11:00:00 +0000

Dr. Joshua Prudent is a 3rd year pediatric resident at Nationwide Children's Hospital in Columbus, Ohio, and the District Resident Representative to the American Academy of Pediatrics for District 5 (Ohio, Michigan, Indiana, Ontario). He did medical school at the Johns Hopkins School of Medicine in Maryland, and initially came from the San Francisco Bay Area of California.
Following residency, Josh plans to spend some time working in an urgent care setting before pursuing fellowship in pediatric hematology/oncology. His advocacy interests include immigrant/refugee rights, vaccine advocacy, youth mental/behavioral health, childhood injury prevention and secure pediatric research funding.

[00:01] Dr. Joshua Prudent Shares His Story With Us
Welcome to the bonus episode of Pediatric Meltdown!
Here’s why this episode is special
I introduce and welcome Dr. Joshua Prudent

[02:09] Advocacy on Safe Storage of Firearms
Joshua gives us a sneak peek about the Trainees for Child Injury Prevention (T4CIP)
He talks about their advocacy on #saferstorage of firearms
Is there a 100% safe option?
How to give advice people who own firearms
Joshua shares the mission of the Day of Action on safer storage of firearms

[12:51] Participating in the Day of Action
How to participate in the Day of Action through our social media accounts
The kinds of images that we can use for the Day of Action
Attend T4CIP’s webinar on speaking up for child health
What people should realize about firearm injuries on children
The difference between young children and old children

[22:55] Closing Segment
Final takeaways:
4.6 million children live in a home with a firearm, and every two hours and 48 minutes a child dies as a result of a firearm injury.
The conversations are hard and the emotions run high. But we must be able to talk about keeping kids safe.
While the safest home for a child is one without a gun, safer storage is the next best thing.
Removing a firearm from the home needs to be a heart to heart conversation

Key Quotes:
“One of the big goals of this year's campaign is to try to get more families, more community organizations involved in the Day of Action.” - Dr. Joshua Prudent
“Firearm safety has always been a big topic of interest for advocates, especially in the realm of childhood injury.” - Dr. Joshua Prudent
Email johua.prudent@nationwidechildrens.org to reach out to Joshua or check out https://www.nationwidechildrens.org/ to know more about his work.
REGISTER to this webinar by the T4CIP on Wednesday, Oct. 27, 2021 at 12-1 p.m. ET: Why Ask?: Speaking Up for Child Health
USE the hashtag #SaferStorage to continue the conversation on Twitter at 2-3pm EST.
SHARE your thoughts and messages all day in all your social media platforms #SaferStorage
Join the conversation on Twitter @CIRPatNCH

Resources Mentioned:
Trainees for Child Injury Prevention

59 Autism Spectrum Disorders: Early Intervention and Referral is Crucial

Wed, 20 Oct 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Stephanie M. Peterson is an Associate Dean of the College of Arts and Sciences at Western Michigan University (WMU). She earned her doctorate in Special Education at The University of Iowa in 1994. She served two 3-year terms on the Board of Directors for the Behavior Analyst Certification Board and was appointed by the Governor of Michigan to the Michigan Board of Behavior Analysts, Michigan’s licensing board for behavior analysts. She served as Board President for 2 years.
Dr. Sheryl Rosin is a speech-language pathologist, professor, and certified autism specialist with 25 years of experience in the field. She has presented around the world and has been published in research journals on best practices in assessment and intervention for individuals with ASD. She is the owner and director of Palm Beach Speech-Language Specialists in south Florida and the Founder and Consulting Director of The St. Kitts Spectrum Services Centre in St. Kitts, the first autism clinic in the Caribbean.
Dr. Rick Solomon is a developmental and behavioral pediatrician with over 25 years’ experience diagnosing and providing intervention for children with ASD. Dr. Solomon is a nationally recognized expert in the field of autism science and intervention. He is in private practice at The Ann Arbor Center for Developmental and Behavioral Pediatrics in Ann Arbor Michigan and is the founder of The PLAY Project, an evidence-based, parent-implemented autism intensive early intervention model that uses a developmental, relationship based, and playful approach.
Kirsten Brown is a licensed Occupational therapist with over 25 years’ experience working with children and families. She is the owner of First Achievements, PLLC in Hebron Kentucky and provides home-based early intervention and office-based OT services. She has presented workshops for early intervention providers, therapists, and parents on the topic of addressing the social-emotional, sensory, and behavior challenges in early intervention. Kirsten co-authored the PLAY Project Tele-PLAY manual with Dr. Rick Solomon.
ACTIVITY CODE 91838

CME INSTRUCTIONS: Completion of these steps are required to earn CME credit.
TO OBTAIN CME CREDIT: SELF-ATTEST WITHIN 4 WEEKS. GO TO: https://cmetracker.net/MSU/Publisher?page=pubOpen#/EventID/91837/ (case sensitive)
1. Click on the Sign In option on the left menu
2. Enter your email and password to log into the system. You will be required to create a profile if you have not used the system before.
3. Enter the activity code provided on this sheet.
4. Complete the online evaluation, attest to your time in attendance, and follow the screen instructions to print your certificate. Make sure your computer is set to allow pop-ups from the site or the certificate will not show.
If you have any issues obtaining your certificate, please contact the CME Office at spring18@msu.edu or by calling 517-884-8871.

CME Activity Information Sheet can be found here.

[00:01] Early Intervention and Referrals
Welcome to the first CME series in Pediatric Meltdown!
What to expect in this series
I introduce and welcome our guests

[06:48] Raising The Question of Autism
Sheryl talks about her experience diagnosing autism
She shares her day-to-day
The possible red flags of...

58 Autism Spectrum Disorders: What Pediatric Clinicians Need to Know

Wed, 13 Oct 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Susan Hyman is a Board Certified Developmental Behavioral Pediatrician. She is chief of the division of Developmental Behavioral Pediatrics at the University of Rochester, which includes outpatient specialty services dedicated to diagnosis and ongoing medical consultation and behavioral care for children and youth with autism and other developmental disabilities for a large region of Central and Western NY.
The division provides inter-professional education for pediatric, nursing and other trainees and has a service that engages in community consultation. She is the Co-Principal Investigator of the Rochester Site of the Autism Cares Network sponsored by Autism Speaks. Her research interests include medical care and behavioral interventions for children and youth with autism spectrum disorders, diet and nutrition in children with autism, among other areas.
She has been very active in the American Academy of Pediatrics with a focus on supporting the primary care pediatrician in the identification and care of youth with autism and other developmental disorders in the medical home. Dr. Hyman served 14 years as chair of the Autism Subcommittee and 6 years on the Executive Committee of the Council on Children with Disabilities. To further these goals, she and her team have been actively involved in ECHO Autism for practices in the Central and Western NY region.

CME INSTRUCTIONS: Completion of these steps are required to earn CME credit.
TO OBTAIN CME CREDIT: SELF-ATTEST WITHIN 4 WEEKS. GO TO: https://cmetracker.net/MSU/Publisher?page=pubOpen#/EventID/91837/ (case sensitive)
1. Click on the Sign In option on the left menu
2. Enter your email and password to log into the system. You will be required to create a profile if you have not used the system before.
3. Enter the activity code provided on this sheet.
4. Complete the online evaluation, attest to your time in attendance, and follow the screen instructions to print your certificate. Make sure your computer is set to allow pop-ups from the site or the certificate will not show.
If you have any issues obtaining your certificate, please contact the CME Office at spring18@msu.edu or by calling 517-884-8871
CME Activity Information Sheet can be found here.
[00:01] Dr. Susan Hyman Shares Her Story With Us
Welcome to the first CME series in Pediatric Meltdown!
What to expect in this series
I introduce and welcome Dr. Susan Hyman
Susan shares why she pursue a career as a pediatrician

[07:12] The Clinical Report on Autism
Susan gives emphasis about the need of patients to receive holistic care
She raises some questions that pediatricians have to address for children with autism
We exchange ideas about this big myth about people with autism
The overall goal of their Clinical Report on Autism according to Susan
Physicians should convey to patients they have enough time
We discuss the first part of the Clinical Report
The privilege of being a primary care provider
The screening measures recommended

[20:13] Why Early Interventions Are Important
Susan discusses the importance of early interventions
Is there a difference between children who received early interventions and those who didn’t?
Susan shares an interesting...

57 Relational Health: Building Family Resilience in Primary Care

Wed, 06 Oct 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Sarah Stelzner is an academic pediatrician, and the focus of her career has been developing programs in Community Pediatrics and promoting team-based care in the medical home model.
She is currently the lead faculty in the Our Kids Our Community Advanced Training which was established in 2017 to improve health outcomes of children and youth served by Eskenazi Medical Group (EMG) and now other Pediatric Urban Teaching Clinicians through partnership with their medical groups.
Dr. Stelzner is the Physician Lead for the Addressing Social Health and Early Childhood Wellness (ASHEW) program for the Indiana Chapter of the American Academy of Pediatrics. She cares for patients and families and teaches medical students and residents in the International Marketplace neighborhood in a Federally Qualified Health Center (Eskenazi W. 38th st). Finally, she served as co-president of the Indiana Chapter of the American Academy of Pediatrics and is currently INAAP Legislative Chairperson.

[00:01] Dr. Sarah Stelzner Shares Her Story With Us
I introduce and welcome Dr. Sarah Stelzner
The mentors who’ve helped Sarah in her career

[05:03] Early Childhood Wellness
Sarah talks about the project, “Addressing Social Health and Early Childhood Wellness” (ASHEW)
Mitigating the harmful impacts of toxic stress and nurturing human relationships
How promising is the ASHEW Initiative and what is its potential to contribute in relational health?

[16:38] Survey of Well-being of Young Children
What you should know about the Survey of Well-being of Young Children (SWYC)
The features of SWYC that families and patients need to know
Does SWYC have any limitations?
What to do when positive screens appear
Sarah talks about the Help Me Grow National Center

[26:44] Mobilizing Family Leaders
What families should know about Aunt Bertha
How we can integrate community health worker models in our approach
The power of mobilizing family leaders
Sarah gives us a few tips to improve the language we used with patients

[36:14] Building Relationships and Identifying Strengths of Family and Community
How pediatricians can join these advocacy groups
Don’t miss Sarah’s message for her resident self
Pediatricians need healing too
Sarah explains
There have been promising improvements in the relational health space
Listen to our exchange

[42:27] Closing Segment
Final takeaways:
Relational health as a strengths-based model
Sarah’s body of work and its connection with the 2021 AAP Policy Statement on Relational Health
Learning collaborative models
Engaging family at the beginning of a treatment
Screening tools available right now
How to sustain our work
Explore resources in your state
The EBCD resources
Mobilizing family and community leaders
Closed loop referrals
How to ensure that the support provided is what the patient wants
The ASHEW Initiative
Keep looking or finding and rejoicing in the magic moments that we have with children and families

Key Quotes:
“...if we can help kids have those positive childhood events, it mitigates what they might be experiencing in terms of social drivers that have negative impacts.” - Dr. Sarah Stelzner
“Step back from trying to fix things and focus on building relationships and...

56 Toxic Stress: Safe, Stable, Nurturing Relationships are the Antidote

Wed, 29 Sep 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Andrew Garner, MD, PhD, FAAP, is a Clinical Professor of Pediatrics at Case Western Reserve University (CWRU) School of Medicine and a Primary Care Pediatrician with University Hospitals Medical Practices in Cleveland, Ohio. Dr. Garner is a product of the Medical Scientist Training (MD, PhD) Program at CWRU and the Pediatric Residency Training Program at the Children’s Hospital of Philadelphia.
Dr. Garner is the co-author of the American Academy of Pediatrics’ (AAP) original (2012) and recently revised (2021) Policy Statements on Childhood Toxic Stress. He has also co-authored an AAP-published book entitled “Thinking Developmentally.” Dr. Garner is a past-president of the Ohio Chapter of the AAP, and he has served on several AAP Leadership Workgroups, including Early Brain and Child Development, Epigenetics, and Poverty.
Dr. Garner is passionate about promoting the safe, stable and nurturing relationships that buffer toxic stress and build the rudiments of resilience
[00:01] Dr. Andrew Garner Shares His Story With Us
I introduce and welcome Dr. Andrew Garner
Why pursue pediatrics?
Andy shares his reasons

[06:00] Safe, Stable, and Nurturing Relationships
Andy talks about the effects of adverse experiences to children
He shares some interesting insights about biological changes due to toxic stress
Adversity is not destiny and here’s why
The role of relational health in resolving toxic stress and adverse children experiences
Why relationships should only be built, but nurtured as well
Andy explains

[17:40] Public Health Approach and Positive Experiences
Is there a connection between adversity and positive experiences?
The role of pediatricians in promoting positive experiences among children
How to apply public health approach in addressing adverse experiences
Don’t miss our exchange about the “universal prevention”
How pediatricians think in a multi-generational manner

[29:01] Strong Emotions Are Superpowers
Pediatricians can also support the parents, and here’s how
Our only lever for change
Andy breaks down the concept of bio-behavioral synchrony
What the society can improve on in terms of handling and showing emotions
He talks about how children can channel strong emotions into worthwhile endeavors

[39:35] Transform Pain, Not Transmit It
How people really deal with stress
Pain not transformed is transmitted to others
Listen to our exchange about anti-vaccine movements
How can healthcare providers simplify the benefits of vaccines

[48:20] Closing Segment
Don’t miss Andy’s message for his resident self
Final takeaways:
AAP’s policy statements on toxic stress and trauma
The relation between adverse childhood experiences and behavioral outcomes
Adversity is not destiny
Safe, stable, and nurturing relationships buffer and create positive experiences
Building partnerships and systems to lift kids up
The role of public health approach in promoting positive experiences among kids
What to understand about relational health
The social circles around the children
Building solid therapeutic relationships with parents and patients
How pediatricians can build their own resilience

Key Quotes:
“All kids need positive experiences to thrive.” - Dr. Andrew Garner
“What we all strive for as human beings is to

55 Trouble With A Child's Sleep?: If They Snore - Do More!

Wed, 22 Sep 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
I am honored to invite Dr. Hovig Artinian back to the podcast to talk about sleep. In this episode Dr. Artinian discusses obstructive sleep apnea and we delve a little deeper into the effects of sleep on behavior.
Dr. Artinian helps us create a differential diagnosis around the symptom of snoring and offers practical tips to help us determine when a sleep study may be indicated. We spend time discussing strategies for improving sleep and sometimes the answers are pretty straightforward - exercise and nutrition. Sit back, relax and listen , but don’t fall asleep!
[00:01] Dr. Hovig Artinian Shares His Story With Us
I introduce and welcome Dr. Hovig Artinian
Why Hovig loves to study sleep
6 Sleep Domains

[04:45] Obstructive Sleep Apnea 101
Hovig talks about the obstructive sleep apnea
What it is and isn’t
What to look for in a child if you find out they’re snoring
When to ask for a sleep study according to Hovig
How sleep can affect the behaviors of children

[14:50] How Sleep Impacts Children’s Behaviors
The red flags that parents should watch out for
The relationship between down syndrome and sleep
Hovig gives an interesting knowledge about growth hormones
The effects of the surrounding environment to a child’s sleep

[25:13] Preventing Sleep Disorders
There’s no such thing as too much love
Prevention strategies against sleep disorders
The connection between sleep and trauma
Don’t miss Hovig’s parting message for us!

[36:20] Closing Segment
Final takeaways:
What we should know about the 6 sleep domains
Does your child snore?
The BEARS Questionnaire might help
Dig a little bit deeper into the snoring of your child
Be uneasy of the child is always uneasy
Poor sleep among children can look like ADHD, depression, mood disruptions, and irritability
The environment has an effect on a child’s sleep
Sleep study as the gold standard to determine obstructive sleep apnea
The uses of CPAP masks
Other conditions where sleep disorders should be considered
Preventing sleep disorders

Key Quotes:
“Certainly, having sleep problems can cause behavioral problems. It can worsen inattention, it can worsen hyperactivity, or irritability.” - Dr. Hovig Artinian
“If they snore do more!” - Dr. Hovig Artinian
Email hovig.artinian@helendevoschildrens.org to reach out to Dr. Artinian and check out Helen DeVos Children’s Hospital to know more about his space.
Resources Mentioned:
Pediatric Meltdown Ep. 25: Kids and Sleep Why Getting Enough ZZZ's Matters
BEARS Questionnaire
Michigan Child Collaborative Care

If you’d like to connect with me, you can find me on LinkedIn, Facebook,...

54 Physician Burnout and Suicide: Wounded Healers

Wed, 15 Sep 2021 11:00:00 +0000

Trigger warning: suicide
https://302.buzz/PM-WhatAreYourThoughts
Dr. Zakia Alavi returns to the podcast to talk about physician burnout and suicide. This is a difficult conversation and for some this episode may be difficult and you may not be in a place to listen. If you are struggling please reach out to the National Suicide Prevention line 800-273-8255, the Crisis Text Line - text "HOME" to 741741 or the new Physician Support Line staffed by our psychiatrist peers - 888-409-0141.
We will be exploring the barriers physicians and other healthcare clinicians face when struggling with mental health concerns. The mental health stigma is real and many, even those in very dark spaces, may not seek help because of fear of repercussions, job loss and shame. While we may wear the superhero cape (stethoscope) and aspire to be superheroes, we are not super human only human. Many of us trained in an era of trial by humiliation and intimidation and learned that vulnerability of any kind was not an option. Today we share warning signs that you may be reaching your burnout threshold, crisis resources and a message of hope that we are here for each other.
[00:01] Dr. Zakia Alavi Shares Her Story With Us
I introduce and welcome Dr. Zakia Alavi
Zakia shares her thoughts about physician suicide
Suicide is more complicated than most people think

[07:13] Recognizing One’s Struggles
Healthcare professionals can also be “not okay” too
Why our competitiveness as humans can do us more harm than good
We often feel guilty for not accomplishing all our tasks during the day
How to stop this feeling

[17:06] Warning Signs Among Physicians
Zakia talks about the biopsychosocial model
What is it and why should we know about it?
Check yourself and your colleagues too!
Here’s how
The airport sign that can be applicable for physicians
We have an interesting exchange about physicians being difficult patients

[27:04] How Physicians Can Ask for Help
Here are some practical tips for physicians to take a break
Who can physicians call when they need help?
The number one thing we think about when we hear “trauma”
We talk about this certain stigma about physicians
Why medical students should be taught how to say “no”
The difference between suicide occurrences between male and female physicians

[39:53] Opportunities for Physicians to Help
Start speaking up to the healthcare leaders to make a positive change
Don’t miss the opportunity to help when you feel you or others need help
Contact details to take note of in case you need help

[44:02] Closing Segment
Final takeaways:
Warnings signs we should look out for
Impact of burnout on physicians
Self-care ingredients
When should you ask for help?
Suicide Prevention Hotlines

Key Quotes:
“A physician lost to suicide impacts so many people, so many more people than probably other professions.” - Dr. Zakia Alavi
“If you see something, say something...to yourself, to others.” - Dr. Zakia Alavi
Email alavizak@msu.edu to get in touch with Dr. Alavi and visit https://raind.msu.edu/ to learn more about her work.
Physician Support Line 1-888-409-0141 staffed by psychiatrists for...

53 Caring For LGBTQ Youth: Practice With Love

Wed, 08 Sep 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
The simple act of asking LGBTQ youth, “how do you want to identify yourself? '' is already a big step towards making the world a better place for them. Another point of discussion that should be raised regarding this matter is mental health, specifically on how we can transform the culture of stigmatizing and victimizing these young people to one that simply recognizes them as humans, regardless of their Sexual orientation or gender identity.. The right questions to ask LGBTQ youth, alongside other related topics on their mental health, are what we discussed with Dr. Erin Klein and Dr. Karen Bernstein today.
Dr. Klein is a third-year pediatrics resident at Northwestern University - Ann & Robert H. Lurie Children’s Hospital of Chicago while Dr. Bernstein is an Adolescent Medicine clinician and educator with special interests in adolescent reproductive health, adolescent weight management (including obesity and eating disorders), and adolescent primary care for underserved youth.
[00:01] Dr. Erin Klein and Dr. Karen Bernstein Share Their Story With Us
Erin and Karen talk about where their paths have crossed
Don’t miss our discussion about “coming out” among the LGBTQ youth

[07:32] The Right Questions to Ask
How “Queer” has been reclaimed by the youth of today
Language is crucial
Ask kids these questions if you want to know more about their sexual orientation
We discuss making the youth’s identity “official” in electronic medical records (EMRs)
Why confidentiality is a crucial factor for LGBTQ youth

[17:24] Making Mental Health Services Accessible
We have an interesting discussion about mental health among LGBTQ youth
Are mental health services accessible for the LGBTQ youth?
Advocacies don’t always need to be big projects
Here’s what Karen thinks

[27:28] How to Rally People to Join Our Advocacies
Do you want to learn more about mental health among LGBTQ youth?
Karen shares some resources you can check out now
The initiatives of the American Academy of Pediatrics on LGBTQ issues
Writing for publications is another powerful step to rally people and call on legislators

[37:57] What Erin and Karen Will Say To Their Younger Selves
Erin tells the young version of her that things will always get better
Don’t miss Karen’s message for her resident self

[42:24] Closing Segment
Final takeaways:
Words do matter
Don't make assumptions when you go into a room. Be open and listen
Questions to ask and how to phrase them
Many EMRs now capture sexual orientation and gender identity or SOGIE data to allow preferred pronouns and names.
The mental health of our teens is critical.
The current problem is stigmatizing and victimizing LGBTQ youth
Resources you can access now
Links below
Consider hospital committee policies and EMR options.
Reaching out to school boards can be powerful.
On the state and national level, learn about state legislation and speak up for LGBTQ youth
Write op-eds blogs and post on social media
If you're an AAP member, consider joining the section on LGBTQ health and wellness
Practice with love

Key Quotes:
“It’s not being LGBT that causes these mental health problems. It’s living in a household or attending school or being in a community or society that doesn’t affirm your identity that’s more...

52 Pediatric Meltdown: What a Year!

Wed, 01 Sep 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Welcome to the 1-year anniversary of Pediatric Meltdown! It’s been a year since I started this podcast, but I am only getting more addicted to it. This podcast has allowed me to do something that I really enjoy and made me realize that I love talking with people. Specifically, I love having conversations where we can just be in our genuine selves.
Join me today as I look back on the past 52 weeks and reflect on the countless conversations and moments I shared with my guests. As we start another year, may we find hope and courage to face all challenges and celebrate our wins with the people we love dearly.
[00:01] It’s Been a Year!
First of all: Thank you for joining me on this ride
My realizations during the COVID-19 pandemic

[02:10] My Realizations in Doing This Podcast
I really thought the public has lost trust in doctors and in science as a whole
Here’s what I learned
Medicine, as a practice and as an art, is magical, and here’s why
Hate can be contagious, and this is the antidote
My message to all the parents out there
Are you a therapist? You need to hear this
My open letter to my pediatrics colleagues

[09:58] Closing Segment
Final words and reminders

Key Quotes:
“Find time to take care of yourselves, and if you’re struggling, it’s okay to not be okay.” - Dr. Lia Gaggino
“The antidote to [hate] is steadfast courage and commitment to doing the right thing for the right reasons.” - Dr. Lia Gaggino
“Know that those of us in this helping profession do this for love, not money.” - Dr. Lia Gaggino
Resources Mentioned:
American Academy of Pediatrics

If you’d like to connect with me, you can find me on LinkedIn, Facebook, and Twitter or email me at gagginol@yahoo.com. To learn more about me visit https://www.medicalbhs.com/
LOVE WHAT YOU HEARD? Leave us a 5-star review so we can continue to provide you with great content. Share this episode and help people know more about children’s health and well-being.

51 Cultural Curiosity: Birthing Experiences in the Latinx Community

Wed, 25 Aug 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
We continue our discussions about birthing experiences, and this time, we’re going to talk about the experience of the Latinx community in our healthcare system. Kristina Ledlow and Dr. Karen Garcia join us to talk about ways to improve the services being provided for the community, especially for Latinx mothers. We can only broaden cultural competence by listening to others experiences and by stepping out of our own perspectives. Pediatric clinicians serve not only our newborns and infants but also support our moms and families. Thinking about how we embrace all of our families through their eyes only improves the care we give.
[00:01] Kristina Ledlow and Dr. Karen Garcia Share Their Story With Us
Kristina and Karen talk about the kind of work they are involved in
They give interesting details about birthing ourselves

[06:40] Latinx Mothers and Their Healthcare Experiences
The experience of Latinx mothers in the healthcare system
Kristina shares their approach in taking care of mothers during the prenatal stage
Karen gives a piece of advice that first-time mothers should hear
Ask from a place of curiosity and live with empathy

[16:46] Better Service for the Latinx Community
We have an interesting exchange medical insurance
How can providers improve how they serve the patients?
Kristina and Karen explain
Even if providers mean well, they might still deal trauma to the patients
Karen recalls her experience as an immigrant assimilating in the United States

[26:25] Knowing Other People’s Culture
How to communicate with your patients the right way
Kristina and Karen share some tips and resources
The books you can read and authors you can follow right now
The beauty of discovering other people’s cultures

[36:14] No Explanations Needed
Kristina has a message for her younger self that you should not miss
Karen sends a message for her resident self you’d want to hear
“No” is a complete sentence, and you don’t need to always explain yourself

[42:35] Closing Segment
Final takeaways:
It is hard to recognize that much of our medical system is white-centric.
Culturally, Latinx families see physicians as powerful and are differential
There are many barriers to accessing care
The sentence, “Tell me about who is living in your household.”
The patriarchy in Latinx families
Don't make assumptions or rush to judgment and other messages for providers
Be aware of your own biases
Reading books by Latinx authors can be a start to your awareness and curiosity

Key Quotes:
“I think that if we are validating to our patients, if we validate their stories, and we come from a place of curiosity and empathy, that's a really good starting point..” - Kristina Ledlow
“It’s okay not to know. It’s okay not to be sure what [the patients’] cultural beliefs and backgrounds are so come from a place of curiosity and ask them so you can better support them.” - Dr. Karen Garcia
Email ledlokr@bronsonhg.org to connect with Kristina then garciak@bronsonhg.org to reach out to Karen. Check out

50 Radical Change: Birthing Experience in the BIPOC Community

Wed, 18 Aug 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Erica Guthaus has been supporting families in their childbearing years since 2008 and has been part of the professional birth community since 2014. A highly skilled communicator, educator, and encourager, she specializes in transformative growth, empowerment, and wisdom keeping.
As the Conjuror of Birth Reclamation at Rootead, Erica is bringing her skill set to life by supporting Red Birth Green birth workers and families in claiming compassionate, inclusive, and respectful care for the entire family dynamic during childbearing years. Born and raised in Kalamazoo, she currently lives in Lansing with her husband, 4 kids, and 6 rescue pets.
[00:01] Erica Guthaus Shares Her Story With Us
Erica shares her journey in becoming a “doula”
She breaks down what a doula is and why you should have one

[07:05] People Over Policy
Erica talks about their mission of restoring humanity
Do not treat people as numbers and statistics
Why her tagline in life is “People Over Policy”
The simple and easy step to decolonize spaces
Why curiosity is uncomfortable according to Erica

[17:25] A Young Black Woman’s Experience in the Healthcare System
The experience of a young Black woman in a healthcare setting
Erica offers a unique perspective
Why delivering information the right way is crucial in interacting with patients
Erica shares interesting insights about the healthcare system
A frightening position and place for a pregnant or first-time mother

[28:43] Pursuing Racial Reconciliation and Diversity
What you should realize about racism according to Erica
Why engaging with people is like peeling off an onion
Erica gives her thoughts about engaging the youth in their initiatives
She talks about our progress in racial reconciliation and diversity

[39:09] Generating Sincere Patient-Provider Conversations
The very first question that providers need to ask to their patients
How to generate sincere conversations with patients
No is a complete sentence that providers should accept from patients
Believe the patients even if you can’t understand them yet
The most fulfilling part of working in the healthcare sector

[54:45] Closing Segment
Final takeaways:
A doula provides non-clinical, social-emotional support for pregnant mothers
Thinking about the people that the healthcare system really serves
People over policy
Why asking questions is important to change the system
Why people assume and judge others first before understanding them better
Real experience starts on the phone
Many women of color still don’t feel like they’re being taken care of
What Erica would do if she can change the system
Many of the things we can do to change the experience of BIPOC patients are free.
Not seeing color is racist. Period
No is a complete sentence that should be accepted
Incremental change is happening; be part of the change now
We need to believe the patients, to see them, and to not dismiss them

Key Quotes:
“All of the things that actually would have the most change are free.” - Erica Guthaus
“It should not take a high-profile situation for the situation to be believed.” - Erica Guthaus
Email

49 Infant Mental Health: Finding the Beautiful Moments

Wed, 11 Aug 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
We all picture the joyous new mother. Happy, put together and radiant. The reality is often very different. Many moms are relieved that their baby. A mother’s mental health has a direct impact on her baby and we as pediatric clinicians are in a perfect position to support her. Dr. Rena Menke, a clinical psychologist with 15 years of experience working with pregnant and postpartum mothers, walks us through a model of care that promotes parenting skills and supports infant mental health. Dr. Menke describes how we can help parents by finding “beautiful moments” between a caregiver and their baby.
[00:01] Dr. Rena Menke Shares Her Story With Us
How Dr. Menke shares her journey to the infant mental health field
What to expect in infant mental health according to Dr. Menke

[04:13] 3 Moments Between a Mother and Her Baby
Why pediatricians need to consider mental health in treating patients
Dr. Menke connects a mother’s mental health to that of her child
The reality about motherhood you need to realize
She talks about her program, “Early Relational Health”
Is it exclusive for mothers?
When is it best implemented?
The 3 types of moments to watch out for between a mother and her baby

[14:20] Creating Beautiful Moments
How to advise mothers in overcoming challenging moments with their babies
Dr. Menke shares how to practice empathy with parents
What pediatricians can learn from the infant mental health field
Check out some resources on early relational health!
Links below
Building a “partnership” with parents to create beautiful moments

[24:28] Building Meaningful and Healthy Relationships
We talk about the things that pediatricians do best
What confidence brings to parents in terms of taking care of their children
Simple exercise parents can do when talking about their kids
How meaningful and healthy relationships are built

[32:31] Closing Segment
Final takeaways:
Infant mental health was pioneered by Selma Fraiberg, author of “The Magic Years”
Perinatal mood and anxiety disorder prevalence is about 40%.
Early relational health is an intervention developed by pediatrician, David Willis
A primary care physician or provider may identify an infant-parent dyad that may need some support.
Identifying the 3 key moments between the mother and her baby
We may need to take a breath and pause as we help guide through interactions that we are concerned about
There's formal online training for interested clinicians to learn more about upstream prevention intervention
Rena’s contact details below
Child psychiatry access programs are available across the country. Links below
For information on how to develop integrated behavioral health in your practice, please reach out to me in the show note links

Key Quotes:
“I think what's wonderful is we now know that there are so many different resources for moms and babies… ” - Dr. Rena Menke
“When parents are feeling confident and able to care for their children, then they have more ability to choose what they're doing.” - Dr. Rena Menke
Email renam@med.umich.edu to connect with Dr. Menke or check out http://med.umich.edu/ to know...

48 Perinatal Mood and Anxiety Disorders: Treatment Risks and Benefits

Wed, 04 Aug 2021 11:00:00 +0000

(Trigger warning: suicide)
https://302.buzz/PM-WhatAreYourThoughts
My guest today is Dr. Samantha Shaw, a psychiatrist specializing in women’s health, with an emphasis on perinatal health. She drops by the podcast today to talk about women’s experiences and safe treatment options. Dr. Shaw shares information about helpful resources and virtual support groups and encourages clinicians to screen, identify and refer early.
[00:01] Dr. Samantha Shaw Shares Her Story With Us
How Dr. Shaw became a psychiatrist specializing in women's and perinatal health
We talk about obstetricians and using the Edinburgh Postnatal Depression Scale

[04:36] A Baby’s Mental and Emotional Well-Being
When to prescribe Selective serotonin reuptake inhibitors (SSRIs) to women
Are they safe during pregnancy?
The impact of a mother’s feeling and emotions to her baby
We have an interesting exchange about postpartum depression and anxiety
What could’ve been their evolutionary causes?
Don’t leave depression and anxiety during pregnancy untreated
Dr. Shaw tells us why
30% of babies goes through this kind of experience

[14:24] Mental Health of Mothers
Dr Shaw breaks down what is called the Poor Neonatal Adaptation Syndrome
She gives important pieces of information about breastfeeding
Don’t let the name “antidepressant” fool you
Dr. Shaw explains
Dr. Shaw shares her experience on mothers with more complex mental health situations
Controlling ADHD among women
How to find someone like Dr. Shaw
Common questions you should ask to Dr. Shaw

[24:01] Responsibility of Pediatricians
Don’t believe sensationalized news about mothers
Many mothers struggle with “intrusive thoughts”
Dr. Shaw’s Public Service Announcement about mothers you should hear now
The important clue for providers on how to manage a mother’s intrusive thoughts
How providers should handle mothers with suicidal thoughts
Pediatricians and their responsibility in taking care of mothers

[34:54] Dads Experiencing Postpartum Depression and Anxiety
Virtual support groups that mothers can participate in
There are groups even for dads!
We talk about dads going through postpartum depression and anxiety
Normalizing shame and eliminating stigma among mothers
Dr. Shaw shares her message for her resident self
The beautiful thing about motherhood

[42:25] Closing Segment
Final takeaways:
Mothers with PMAD may have difficulty bonding with their babies
Are medications safe?
SSRIs are safe to use
Atypical antipsychotics can be used during pregnancy and postpartum period
Lithium does pose some cardiovascular risk
Depakote and Tegretol are big no no’s during pregnancy
Teaming with psychiatry is essential for complex drug regimens
Psychiatric programs can be pediatric and perinatal
Dealing with a mother’s intrusive thoughts
Think twice about contacting CPS or referring families to the emergency room
One in 10 dads may experience PMAD
Suicide risk is real
It is our job as champions for babies to care about and protect our mamas.

Key Quotes:
“Whether you're depressed, whether you're anxious has no bearing on how good of a mother you are.” - Dr. Samantha Shaw
“There’s no shame in struggling.” -...

47 A Parent's Story: "On the Loving End of Crazy"

Wed, 28 Jul 2021 11:00:00 +0000

(Trigger warning: suicide)
https://302.buzz/PM-WhatAreYourThoughts
In this episode, Faith McDonald, a writer and an assistant professor at Penn State University, shares her experience helping her son who struggles with mental illness. His struggle is a familiar one to many parents and clinicians as they are prevalent among children and young adults, and the journey to wellness is often a difficult one.
Faith talks about the power of “sharing your brokenness” with others as a way to find wholeness. The weight of worry is lightened knowing that you are not alone. We have the incredible honor of being with our patients and families and the opportunity to weather the journey through the highs and the lows.
In times of distress, Mr. Rogers advised to "look for the helpers." We are the helpers.
[00:01] Faith McDonald Shares Her Story With Us
Faith talks about her experience as a parent
Dealing with her son’s mental health issues
Determining the trigger
How she realized her son needed help

[07:06] A Young Adult’s Mental Health
Mental health issues on young adults
Dealing with a young adult’s mental health issues
From a physician’s perspective
We talk about privacy and how it factors into a young adult’s mental health
The possible physical symptoms of a mental health issue
Here are Faith’s suggestions for doctors to better serve their patients

[17:31] “He's Going to Get Better”
The questions that parents should expect from physicians
We have a conversation about suicide
Faith’s experience of dealing with her son’s paranoia
The different kinds of support available for parents and their children
Being comfortable with the uncomfortable
The words that brought Faith hope
The different types of therapy for young adults

[27:37] Sharing Our Brokenness
The benefits of exercise and meditation
You should not be silent about your problems
Faith explains
Parents asking permission to help their children
Faith gives us a sneak peek about her book, “On the Loving End of Crazy”
Sharing our brokenness

[37:22] The Purpose of Suffering
The impact of sharing her son’s story
What Faith realized about helping her son with his mental health challenges
The purpose of suffering according to Faith

[45:10] Closing Segment
Final takeaways:
Parenting is hard regardless of the child’s age
The connection between the mind and the body
Parents don't always think that their child could be thinking about suicide
Safe talks and the Question-Persuade-Refer approach
Parents working with partners in the mental health and school spaces
Routine screening and why it’s important
Balancing giving support and nurturing independence
Caregivers need to take care of themselves
Sharing brokenness is healing

Key Quotes:
“Our kids are paying attention in ways we don't maybe necessarily realize.” - Faith McDonald
“We have to, as people functioning as a community of faith, be comfortable with sharing our brokenness.” - Faith McDonald
“There's purpose in your suffering. For me, it's strengthened my faith, it's enlarged my compassion for people...” - Faith McDonald
Email...

46 Moral Dilemmas: Where Medicine and Ethics Meet

Wed, 21 Jul 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Welcome back to Pediatric Meltdown. Ethics is not just for philosophers! The field of bioethics infuses medicine with a thoughtful process for decision making when the choices are not clear. The choices between what we can do and what we should do is often a murky place.
Dr. Tyler Gibb has authored dozens of peer-reviewed publications on the intersection of health law and medicine and examines clinical ethics, medical narratology, the politics of medicine, medical education pedagogy, and professional misconduct and professionalism in healthcare. His work and expertise can ease our own distress when faced with moral and ethical dilemmas and can guide us as we seek clarity for our patients, families and for our teams.
[00:01] Dr. Tyler Gibb Shares His Story With Us
Dr. Gibb shares his background in the medical bioethics space
The question that clinical ethics answers

[06:20] Making the Tough Decisions
Dealing with end-of-life situations the clinical ethicist way
Here’s a story from Dr. Gibb about “moments of introspection”
What does this mean?
When team members don’t agree with one another…

[16:34] Divulging All Information to the Patient
Telling everything to the patient, even the bad news
How Dr. Gibb approaches this situation
Ethical considerations during the COVID-19 pandemic
Putting yourself first before anyone else

[26:28] Primary Care and Ethics
The interaction of primary care and ethics
We have an interesting exchange about handling transgender patients
Addressing mental health issues among patients

[36:24] Takeaways for Clinicians
Share your burden
Find your moral voice
Dr. Gibb’s message for his younger self

[46:44] Closing Segment
Final takeaways:
Bioethics is the meta ethics and focuses on the theoretical.
Clinical medical ethics brings theory into practice.
The question, “Why is this decision a concern versus another decision?”
What we should do vs. What we can do
Ethical considerations and issues rose to the top and became familiar due to COVID-19
Ethical dilemmas often arise within medical teams when individuals don't agree
Primary care specialists should also consult with ethicists
You are not alone in your struggles
The burden you feel can be shared
Be vulnerable, ask for help
Find your moral voice and train yourself to hear the moral voices of others.
Preserve your humanity by drawing boundaries

Key Quotes:
“Mental health is not something that physicians can tackle alone. It's not something that social workers can tackle alone.” - Dr. Tyler Gibb
“You are not alone...the burden that you feel can be shared and ought to be shared.” - Dr. Tyler Gibb
Email tyler.gibb@med.wmich.edu to connect with Dr. Gibb or check out Western Michigan University Homer Stryker School of Medicine to know more about his work.
Resources Mentioned:
Dr. Gibb’s podcast: Bioethics for the People Podcast
Journal

45 Pharmacogenomics: How Genetic Testing Can Help Us

Wed, 14 Jul 2021 09:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Welcome to another episode of Pediatric Meltdown. My guest for today is Dr. Lisa Namerow, a Board-certified psychiatrist triple-boarded in pediatrics, child psychiatry, and general psychiatry. She has been in the pediatric healthcare space for almost 30 years, directing the consultation services to in-patient pediatrics, and the access to mental health programs for pediatricians.
Her areas of research have been pharmacogenetics, and the impact of clinical pathways and standardized care for eating disorders, somatic symptoms, and related disorders, and delirium, and serves on the American Academy of Child and Adolescent Psychiatry Committee on the physically ill child.
[00:01] Dr. Lisa Namerow Shares Her Story With Us
Dr. Namerow shares how she became a child and adolescent psychiatrist
She introduces the field of Pharmacogenomics
Pharmacogenomics vs. Pharmacogenetics

[06:12] Genetics 101
Myths about Pharmacogenomics
Pharmacodynamic Genes and Pharmacokinetic Genes
What we need to know
Dr. Namerow’s analogy for genes
The relationship between medicines and gene findings

[16:19] Deciding if Gene Testing Can Be Helpful
What oncologists should know about prescribing medicines
How a pediatrician can utilize genetic testing
The screening questions to help pediatricians decide on genetic testing

[26:37] Genetic Testing in ADHD, Depression, and Anxiety
Talking with parents about genetic testing
How the serotonin transporter works in the body
Genetics in the context of ADHD, depression, and anxiety

[36:10] The Best References for Primary Care
Dr. Namerow’s interesting insights about primary care
Her message for clinicians that you should not miss
Dr. Namerow’s message for her younger self

[46:10] Closing Segment
Our advice for all working moms out there
Final takeaways:
The role of certain relevant genes in drug response
The industry's detailing can be misleading
There are some very relevant gene medication pairs
An analogy about Gentamicin you should not miss
Using Venlafaxine
Facts about Cytochrome P450
Screening questions to decide if genetic testing can be helpful
Select medications based on evidence and guidelines

Key Quotes:
“What is true is that genes do code for both the enzymes that metabolize medicines, and they also code for the proteins that are the site of the action of medication.” - Dr. Lisa Namerow
“[It’s] heartbreaking that we don't have a system that cares for these kids in the way that they should be cared for, and that it falls on primary care.” - Dr. Lisa Namerow
Email lnamerow@connecticutchildrens.org to connect with Dr. Namerow or check out Connecticut Children’s Medical Center to know more about her work.
Resources Mentioned:
Pharmacogenomics: An Update for Child and Adolescent Psychiatry
Child Psychiatry Access Programs by state

44 Anxiety Disorders in Children: Treatment Pearls

Wed, 07 Jul 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
My guest today is Dr. Jeffrey Strawn, a Professor of Psychiatry, Pediatrics and Clinical Pharmacology at the University of Cincinnati and at Cincinnati Children’s Hospital. He is the Director of the University of Cincinnati Anxiety Disorders Research Program and the Associate Vice Chair of Research in the Department of Psychiatry & Behavioral Neuroscience at the University of Cincinnati.
In his clinical practice, he works with youth with anxiety and related disorders and with their families and supervises residents and fellows. Dr. Strawn has authored more than 160 peer-reviewed publications and co-authored two textbooks on the treatment of children and adolescents and on contemporary psychotherapy. He is a distinguished fellow of the American Academy of Child & Adolescent Psychiatry and has received multiple awards for teaching, mentorship and research.

[00:01] Dr. Jeffrey Strawn Shares His Story With Us
Dr. Strawn shares how he landed in the child psychiatry space
The potential of over-screening patients
Dr. Strawn shares his thoughts
Dealing with different levels of anxiety per Dr. Strawn’s experience

[06:54] The Severity and Frequency of Anxiety
The criteria that Dr. Strawn uses to determine the level of anxiety of his patients
The questions to ask to tell how severe the anxiety is and how frequent it happens
What parents should expect in assessing their kid’s anxiety
The factors that can affect moods, not necessarily anxiety disorders
Does your child need medications?
Listen to Dr. Strawn’s explanation

[16:35] The Right Medication for Anxiety
Dr. Strawn shares his approach to giving medications on anxiety
Giving medications is one thing, managing the dosage is another
Avoid making the patient expect they will have problems with this simple statement
Overlaps between anxiety and depression symptoms

[26:18] Side Effects of Medications
How do we know if the medicines are working?
Mania vs. difficulty in sleeping and bipolar disorder
Dr. Strawn talks about boxed warnings
Managing insomnia and sleepiness

[36:25] Managing Panic Attacks
Taking medications with or without food
Dr. Strawn shares his thoughts
Dr. Strawn shares his thoughts about managing anxiety among young adults
His clever strategy to handle panic attacks among young adults
He shares his thoughts about cannabis use

[47:29] Marijuana Use Among Young Adults
The difference between alcohol and marijuana users
Dr. Strawn’s parting advice for listeners
The impacts of anxiety about the growth of a child

[52:46] Closing Segment
Final takeaways:
The question, “How often do you worry?”
Treatments for different levels of anxiety
Severe symptoms of anxiety we should watch out for
The SCARED tool for anxiety
SSRIs are safe as first line of medication for anxiety and depression in children
“start low and go slow”
The time to onset of actions of different medicines
Side effects of medications that we should know
Managing side effects
Monitoring can be done in person or via televisits
A more strategic approach to handle...

43 Neuropsychology Evaluations: When a Brain-based Lens Makes All the Difference

Wed, 30 Jun 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
My guest today is Dr. Stephanie Nelson, a board-certified pediatric neuropsychologist. Dr. Nelson walks us through the nuances of neuropsychological assessments and how they can help us coordinate care for our patients.
Dr. Nelson specializes in complex differential diagnosis. Her day-to-day work involves comprehensive neuropsychological assessments and outreach to the community through presentations, workshops, and volunteer work. She also spends half her time providing consultation to psychologists and neuropsychologists who specialize in pediatric assessment.

[00:01] Dr. Stephanie Nelson Shares Her Story With Us
Dr. Nelson wanted to be a teacher at first but ended up as a neuropsychologist
She tells us what happened
Dr. Nelson tells us the difference between clinical psychology and neuropsychology

[06:55] Differentiating Dyslexia from Other Learning Disabilities
Neuropsychologists like to say they’re psychologists first, then neuropsychologists second
Dr. Nelson tells us why
The other things that neuropsychologists test aside from memory
Should you go to a neuropsychologist or clinical psychologist first?
Don’t be confused with Dyslexia, Dysgraphia, and Dyscalculia with these explanations from Dr. Nelson!
She talks about Rapid Naming
Factors that affect comprehension

[18:07] Determining the Right Intervention for the Child
Determining the true situation of the child to choose the right intervention
The top question that neuropsychologists get from parents and pediatricians
Special education in schools
Qualifying for special education services
Resources with informative content for pediatricians and parents
Links below

[28:11] Determining the Right Intervention for the Child
The role of neuropsychologists in helping children with Down syndrome
Learning multifactorial skills
What Dr. Nelson always tells the parents when asking for a neuropsychological evaluation
How pediatricians should read neuropsychological reports
3 things for families to know more about their children

[38:32] The Right Time to Seek Evaluation
How Dr. Nelson writes her neuropsychological reports
The challenge in giving treatments to kids who exhibit learning disabilities
Dr. Nelson shares her insights about seeking an evaluation for children
Dyslexia is heritable

[44:29] Closing Segment
Final takeaways:
A neuropsychologist goes one step farther than the clinical psychologist
A neuro psych evaluation may be really helpful for specific cognitive concern
Neuropsych testing tackles cognitive domains language, sensory-motor, executive function, and social cognition, just to name a few.
Consider Dyslexia
Math and writing disorders are also multifactorial
Special education in schools should address the needs of students
Dr. Nelson's goal of creating a roadmap of needs that meets challenges and come up with a diagnosis that makes sense
Family history is crucial
When to consider neuropsychology

Key Quotes:
“Writing is just language on paper. So if you have trouble with language, it's going to show up in your writing.” - Dr. Stephanie Nelson
“ADHD has similar...

42 Deciphering Psychological Assessment Reports: What You Need to Know

Wed, 23 Jun 2021 08:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
On this episode of Pediatric Meltdown, I welcome Dr. Chris Barnes, Chief Executive Officer at Kalamazoo Counseling and Assessment Center. We discuss psychological assessment reports and why we should still read and understand them. Dr. Barnes also shared some tips to write these reports in an engaging manner and in a language that the target readers can understand.
This is because psychological reports are often too long and use language most can't comprehend. This leads Dr. Barnes to an ever-flowing state of creativity and translates this into his clinical work through refining clinical assessment documents and leveraging technology to meet the needs of providers and other stakeholders. Chris's hope is to increase the efficiency of clinical communication without sacrificing clinical care.
Dr. Barnes is a licensed clinical psychologist whose clinical work is focused on integrative clinical assessment. As an assessment psychologist, he is passionate about effective communication and customer service. He will join us today to talk about psychological assessment reports and why medical practitioners should still make an effort to understand them.

[00:01] Dr. Chris Barnes Shares His Story with Us
Why Dr. Barnes wanted to be a clinical psychologist
Science and human interactions in one
What revealed Dr. Barnes’ “inner nerd?”
Dr. Barnes makes a difference among social work, counseling psychology, clinical psychology, and assessment psychology
The thing is that they should not be lumped together

[07:10] The Right Assessment to Determine the Patient’s True Situation
Dr. Barnes shares his thoughts about pediatricians partnering with psychologists when assessing patients
Specificity and sensitivity in utilizing measures
We talk about the key differences between screening tools and diagnostic tools
You should consider psychological assessments if the situation meets these criteria
The right assessment should be administered to fully determine the situation and think of a plan for the patient
Why feedback is important

[17:34] A Readable and Engaging Psychological Assessment Report
Communicating the results of a psychological assessment report
Many of us are actually over-documenting and here’s Dr. Barnes’ advice to break this habit
It’s about identifying the target audience groups of the report
How to spot a good psychological report
Diagnosing learning disabilities
The challenges of school systems not following the recommendations of a psychological report

[32:53] The Right Way to Refer Someone for an Assessment
Dr. Barnes talks about the metaphor he often uses for his patients
The two common reasons for holding an Individualized Education Program meeting as discussed by Dr. Barnes
Why we should keep our colleagues close to us according to Dr. Barnes
A better understanding among kids about why they will be diagnosed with a treatment plan is crucial
If you’re referring someone for an assessment, here’s what you need to do

[47:19] Closing Segment
Dr. Barnes shares some points to consider when referring a patient to someone like him
Is writing assessment reports boring?
Dr. Barnes weighs in
Final Takeaways:
Referral to a therapist or psychologist can mean several...

41 Parenting Styles: Cool Dad, Anxious Moms

Wed, 16 Jun 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Welcome to Pediatric Meltdown! I’m your host, Dr. Lia Gaggino. Today, I'm welcoming both of my daughters Elyse and Julia and they're going to be talking about parenting styles; their dad’s and mine.
I just thought it might be fun to hear from an adult “kid's” perspective what it's like growing up in a household when Mom's a doctor and dad is way more fun. My husband has gotten us through the ups and downs of parenting. And I really couldn't have done it without him. So this podcast is really a tribute to him. And this conversation with my daughters was just really fun! So sit back and enjoy.
I hope it's something light and that you'll find something you can relate to.
[01:55] A Fun Chat with Elyse, Julia and Dr. Lia on Childhood Memories
Walking through Elyse and Julia’s lives and what it was like parenting them from birth to toddler years
Elyse and Julia share fun things about bath time that they remember as children
Healthy meals, nutritious food, and Pop-Tarts: Mom vs. Dad
While Dad let the girls eat in front of the TV, bought Pop-Tarts, and packed the girls fun lunches with cards, Mom preferred to feed the girls nutritious food. Mom makes a killer noodle casserole and Dad’s culinary creativity went a little too off the rails, sometimes.
Fun activities with Dad and Mom
Dad was the supportive, easy-going coach who brought snacks to the girls' games and took them to the carnival. Mom did fun activities outdoors, bike rides, swimming, and crafts. Mom gets extra points for party planning!
Gift giving
Dad gives very interesting gifts.

[14:23] Personality Differences Between Mom and Dad
Dr. Lia, Elyse, and Julia talk about more differences between ‘Mom and Dad’ especially mentally and emotionally. Mom and Dad’s differences balanced each other out and in a way completed each other.
Dr. Lia talks about lessons learned in wanting to always rescue her girls from emotional discomfort right away.

[20:32] Parenting Advice From the Adult ‘Children’
Dad’s Fashion Collection
Advice from Elyse and Julia on parenting
Find your complement, not your clone
Try not to take it so seriously
If you're going to break the rules. talk to dad, not mom

[24:17] Closing Segment
Final words from Dr. Lia

Key Quotes:
“Find your compliment, not your clone. You need a little balance.” - Elyse Parzyck
“How about you do also like tie knots take it so seriously.” Julia Parzyck
“And I just want to reassure you not to worry too much about being perfect and that our kids are resilient. And if we have those safe, stable, nurturing relationships with adults and kids, we can get them through and be resilient. So trust yourself, do the best you can, and give yourself a break.” - Dr. Lia Gaggino
“Don't take yourself too seriously, relax, and you get a lot of brownie points just for trying.” - Dr. Lia Gaggino
If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter or email me at

40 First Baby Worries: A Psychologist Shares Her Own Experiences and Advice for Primary Care Clinicians

Thu, 10 Jun 2021 12:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
On this episode of Pediatric Meltdown, I welcome Dr. Jenn Kuhn. We discuss everything from baby worries to how we as practitioners can help our patients as they enter parenthood. Being a parent is difficult, but it does bring some of the greatest rewards, so it’s ok to give yourself a break.
Dr. Jenn Kuhn is a pediatric psychologist working in integrated primary care at Nemours Alfred I duPont Hospital for Children in Wilmington, Delaware. She received her bachelor's degree and master's degree in psychology from Tulane University in New Orleans and received her Ph.D. in clinical psychology from Western Michigan University in Kalamazoo, Michigan in 2016. Dr. Kuhn and I crossed paths when she completed her pre-doctoral internship in Pediatric Psychology at the Munroe Meyer Institute at the University of Nebraska Medical Center in Omaha, Nebraska, and completed her postdoctoral fellowship in pediatric integrated behavioral health at Nemours Alfred I duPont Hospital for Children.
In her current role, she works in two pediatric primary care clinics. Her clinics serve patients aged 0 to 21. She is responsible for providing prevention-based services, psycho-educational services, consultation and education to medical trainees and staff, warm handoffs and consultation with patients, short-term therapy, and brief intervention assessments.
Her specific areas of interest include early intervention services, postpartum depression, and anxiety screening, postpartum wellness, management of disruptive behaviors, ADHD, assessments, anxiety, and sleep in providing clinical services. She supervises psychology residents, postdoctoral fellows, and provides behavioral health education to medical students and residents.
Clearly, Dr. Kuhn is very busy in pediatric clinics. Stay tuned for the interview and hopefully, you can see where this might fit into your practice.

[00:01] Dr. Jenn Kuhn Shares Her Story with Us
Why Dr. Kuhn wanted to be a clinical psychologist
Dr. Kuhn first heard of integrated behavioral health from a book and then in the middle of her graduate school career. Wanting to get involved in more preventative measures rather than reaching kids at their breaking point, she began to pursue integrated behavioral health
How integrated behavioral health serves the patients Dr. Kuhn sees and why it should be regularly practiced

[13:23] New Babies and Postpartum Mothers
On Dr. Kuhn’s newborn baby! And whether or not being a pediatric psychologist prepared her to be a mom
Why OBGYNs should ask how mothers are doing mentally and administer the Edinburgh Postnatal Depression Scale (EPDS)
Looking to patient’s partners to know them best and when to get help
40% of moms have some risk factor

[22:07] What Do Parents Need From Their Pediatrician?
Guidance, education, reassurance, and validation
With so much fear, shame, and bad advice surrounding motherhood, we as practitioners need to support our patients by giving them a nurturing environment in which they are comfortable to ask questions and not ashamed.
Ask how your patients are doing: The asking is in and of itself therapeutic, because it helps kind of chase away shame that if I'm asking you, it must not be that bad, that you would share that something difficult happening
Don’t worry if every moment of motherhood doesn’t feel magical
Even if all you can do is provide some resources, and be there to listen, that helps...

39 Microaggressions: The Things We Say That May Hurt Others

Wed, 02 Jun 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
I am so excited to welcome another pediatric trainee to the podcast. My guest, Dr. Nina Kuei, MD has always aspired to be a physician. After a long journey, including 6 years of working in the medical field between undergrad and medical school, she’s found herself in her happy place; Pediatrics. Nina received her medical degree from the Medical College of Georgia and completed her pediatrics residency at the Grand Rapids Helen DeVos Children's Hospital in Michigan. She'll be moving to Cleveland, Ohio for her Developmental-Behavioral Pediatrics Fellowship and wishes to pursue a Sleep Medicine Fellowship afterward.
Nina has a passion for diversity, equity, and inclusion topics in clinical medicine. Nina co-founded the pediatric program’s Diversity and Inclusion Committee. Today, we’ll be talking about Microaggressions and how we can improve the clinical medicine workspace for everyone.
[00:01] Dr. Nina Kuei Shares Her Background With Us
Growing up and receiving her medical training in the south, Dr. Kuei moved out to Grand Rapids, MI to be a Pediatrics Specialist
She didn’t plan to go into pediatrics initially, but she discovered how fulfilling it was for her.
She initially wanted to pursue a fellowship in Sleep Medicine, but then decided to go for Developmental-Behavioral Pediatrics first

[06:05] What Are Microaggressions?
With the current social climate of rampant hate crimes against Asians and the unrest surrounding George Floyd’s death, microaggressions are a topic we need to be discussing.
Dr. Kuei explains what microaggressions are
Acts or language that communicates bias towards another person or group
Stems from systemic racism
Often times are subconscious
How microaggressions feel to the receiver
Dr. Kuie explains microassaults, microinsults, and microinvalidations
Educating ourselves and seeking to understand

[16:53] How We Can Educate Ourselves To Understand and Avoid Causing Microaggressions
Implicit bias testing
See links below for articles, podcasts, and resources for self-educating on this topic
If you witness a microaggression, do something about it
Microaggressions that are prevalent in the medical field
Microaggressions from patients
Microaggressions within an interprofessional team
Dealing with microaggressions as the receiver
The power of self-affirmation

[27:14] Dr. Nina Kuei’s Quality Improvement Project Regarding Microaggressions
An educational intervention
Taking medical providers from a 17% to a 63% level of confidence in their ability to identify microaggressions
Standing up for victims helps validate them and opens up doors for conversation
The importance of discussing microaggressions
Being comfortable with being uncomfortable
We all have our own innate biases
We have to be vulnerable enough to admit our own weaknesses without shaming

[37:24] Closing Segment
What advice would you give your younger self?
I would allow myself a lot of grace
Final Takeaways:
Nina describes microaggressions as small signals towards marginalized populations that may demean, insult or hurt the...

38 Suicide Prevention in Primary Care: Save a Life!

Wed, 26 May 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Today’s episode is a wrap-up of May’s Mental Health Month on our Suicide Prevention series and will feature a clinician who is using the Ask Suicide-Screening Questions (ASQ) Toolkit in real life.
Dustin Bogan is a Board Certified Pediatric Physician Assistant and a Fellow of the American Academy of Physician Assistants, The Virginia Academy of Physician Assistants, and The Society for Physician Assistants in Pediatrics.
After growing up in rural Virginia, he attended Shenandoah University for his bachelor's degree in Biology. He minored in Psychology and then got his master’s degree as a Physician’s assistant. After graduation, he began working immediately in primary care pediatrics.
He is at Pediatric & Adolescent Health Partners and strives to combine his personal background, medical knowledge, and passion for mental health in his career. He serves as a care coordinator and facilitates the trauma-informed leadership team in his practice. He is also an adjunct professor at South University, educating students on pediatrics and topics related to mental health.
The Hotline for Suicide Prevention is 1-800-273-8255. Crisis Text Line: text HOME to 741741
[02:31] Dustin Bogan Shares His Background
Growing up in a rural area in Virginia, Dustin didn’t have access to a pediatrician
Seeing so much needed around him inspired Dustin to go into a helping profession
At Pediatric & Adolescent Health Partners Dustin met Dr. Abernathy
There are only 8000+ Child Physiatrists in the whole country

[07:02] The Impact Dustin Sees on Mental Health in His Practice
The uptick of suicidality due to COVID-19

[09:28] Why Dustin’s Practice Decided to Start Generalized Screening for Mental Health
Dr. Abernathy and Dr. Horowitz opting to do a research study which led to findings of 12% of patients with suicidal ideations
Barriers to implementation
Are parents upset about it?
workforce issue in terms of flow
How are nurses and staff able to get involved
Dustin shares a story of how the ASQ Toolkit identified a patient in his practice with suicidal ideations and help save his life
Being able to convince the staff to adopt general screening when they saw its necessity firsthand
Parents reactions to the general screening
The ages that Dustin’s practice screens
How to screen kids that come in with chronic headaches, tummy aches
Research has proven that kids that come in with chronic abdominal pain, chronic headaches, etc., are likely to have a history of trauma or an underlying mental health disorder
How to handle positive screening results
Building a smooth process for handling patients that screen positive
Zero Suicide Framework
Lead, Train, Identify, Treat, Engage, Improve, and transition
Creative ways practitioners can partner up with experts
Get comfortable with being uncomfortable
Tools and resources (Links below)
Creating a Trauma-Informed Leadership Team

[41:53] Closing Segment
What advice would you give your younger self?
Embrace the moment, learn from the present and not take opportunities for granted.
Final Takeaways:
Dustin’s group started screening for suicide risk intentionally after Dr. Abernathy...

37 Screening Youth For Suicide Risk: Using the Ask Suicide Screening Questions Tool

Wed, 19 May 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Today’s episode is an encore of an interview I did with Dr. Lisa Horowitz last fall. Suicide is the second leading cause of death in youth 15-24. Dr. Horowitz talks about how pediatricians can incorporate the Ask Suicide Screening Questions (ASQ) screening tool into their practice to help identify children and adolescents at risk of suicide and to link them to coordinated care.
Dr. Lisa Horowitz is a Staff Scientist and Pediatric Psychologist at the Nation Institute of Mental Health Intermural Research Program at NIMH. The major focus of her research has been detection of suicide risk in the medical setting. She is the head PI in several ‘Suicide Prevention Protocols’ using the ASQ Toolkit. She assists hospitals, schools, and pediatric centers in implementing Suicide Screening of patients.
The Hotline for Suicide Prevention is 1-800-273-8255. Crisis Text Line: text HOME to 741741
[00:01 - 10:54] Dr. Lisa Horowitz Shares Her Story
I introduce my guest, Dr. Lisa Horowitz
Dr. Horowitz shares a bit of her background
How Dr. Horowitz got into her line of work
Realizing the need for developing a suicide screening tool
The Creation of ASQ

[10:55 - 22:25] How To Implement Suicide Risk Screening When It’s Outside of Your Medical Training
The pushback Dr. Horowitz experienced when trying to implement Ask Suicide Screening Questions (ASQ) Toolkit
Creating a script for Nurses or practitioners that will help parents and patients feel comfortable
Using appropriate language when checking up on patient’s mental health
Doctor’s fear about patient’s screening positive for suicide risk

[22:26 - 49:48] How What Dr. Horowitz Did in the Emergency Room Translates To Primary Care
Despite suicide being the 2nd leading cause of death, most health care professionals are not trained in dealing with it
Dr. Horowitz tells a pediatrician superhero story about Dr. Ted Abernathy
“He’s not worried about all the ones he’s going to catch. He’s worried about the ones he’s going to miss.”
What a practitioner should do if they get a positive screening
Conducting the 2nd tier safety assessment
Creating safety plans for the patient with the ASQ toolkit
Having experts with mental health experience and training in the clinic is ideal
Partnering with mental health professionals or partnering with your local crisis hotline
Having the patient return to your office in a few days until you can secure them with a mental health professional
Asking about access to lethal means particularly firearms
Disrupting at-risk patient’s means of suicide can be a big lifesaver
Fostering resilience
Checking your own emotional regulation

[49:48 - 00:00] Closing Segment
Pediatricians can make a difference
To learn more about the ASQ, please refer to the link below
Final Takeaways:
The ASQ is a lot more sensitive than the PHQ9
It is OK to ask parents to step outside the room
It’s a myth that asking will put suicidal ideas who weren’t thinking about suicide
This can be implemented in a primary care setting; Listen to next week's episode on how it can be implemented in a way it makes sense
We can make a difference by using these 5 questions
Never forget to ask...

36 "We Burnout, We Break, We Die" Author Christopher Veal Speaks Out About Medical Student Mental Health and Suicide

Wed, 12 May 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
My guest today is Christopher Thomas Veal, a 4th-year medical student at The Larner College of Medicine in Vermont. Christopher earned his Bachelor of Science in Studio Art and Biochemistry at The University of Vermont. He has served on the Vermont Governor’s Council for Child and Family Prevention Programs and has led several activist groups while in medical school. He has also published essays centered on mental health advocacy and social justice in the annals of internal medicine and academic medicine. Currently, he is directing a film series centered on medical student’s mental health called The Larner Stories Project
Caution: This episode discusses the subject of suicide and may be a trigger for some. If you or someone you love struggles with suicidal thoughts, please reach out. The Hotline for Suicide Prevention is 1-800-273-8255 or Crisis Text Line: text HOME to 741741
[00:01 - 36:20] Christopher Shares His Story
As Christopher journeyed into medical school, the heavy pressure of failure, expectation, discrimination, and isolation drove him into depression.
Calling his late friend’s mother saved his life. Christopher began going to therapy, got the support system that he needed, and embraced failure as an avenue for growth.
In 2020 Christopher experienced an awakening in recognizing the role he had in activism after experiencing the pain, death, discrimination and financial turmoil COVID-19 brought onto minorities
Christopher began sharing stories of lived experiences in order to help others

[36:20 - 46:54] The Longing for Belonging
Christopher felt the importance of letting people know suicide is not the only option.
Dr. Lia and Christopher discuss how the privilege of accessing mental health may not even have been something people of color realized was an option for them.

[46:55 - 54:14] Christopher’s Activism in Kenosha
Mental and Physical health care is a right, not a privilege.
Christopher’s pursuit into psychiatry and primary care comes from a hope to serve his community and provide a place of belonging for people of color who have been minoritized

[54:15 - 00:00] If You Could Go Back and Give Yourself Advice What Would It Be?
To recognize that failure will build you into who you will become. To not live in fear but to live honestly, passionately, and authentically.
To connect with Christopher Veal please visit the links and resources below
Main Takeaways:
It is critical that medical training programs create a safe and welcoming place for medical students.
Out of hopelessness, there is hope and help.
Medical training continues to promote the stigma of failure and culture of perfectionism
As a black man Christopher shared a painful reality. “There is a target on my back that follows generations of racism and dehumanization.”
Black patients may not seek mental health because it historically has not been seen as an option. This is exclusionism.
Activism is an obligation to change minds and change hearts.
A message to medical students; Asking for help works, therapy help and there is no shame in failure.

Tweetable Quotes:
“When I started looking at failure as an opportunity instead of a liability, that’s when things started to turn around.” - Christopher Veal
“We burn out, we break from the...

35 Talking About Suicide With Our Patients: Get Comfortable Being Uncomfortable

Wed, 05 May 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
May is Mental Health Awareness month and today’s episode begins a 4 part series dedicated to suicide prevention.
My guest today is Anne Moss Rogers the Emotionally Naked public speaker, registered suicide prevention trainer, TEDx storyteller, and NAMI Virginia fundraising chair. Anne Moss is the author of the award-winning book, Diary of a Broken Mind, and her second book Emotionally Naked: A Teacher's Guide to Preventing Suicide and Recognizing Students at Risk will be out in August of 2021.
Anne Moss helps people foster a culture of connection to prevent suicide, reduce substance misuse, and find life after loss.
Caution: This episode discusses the subject of suicide and may be a trigger for some. If you or someone you love struggles with suicidal thoughts, please reach out. The Hotline for Suicide Prevention is 1-800-273-8255 or Crisis Text Line: text HOME to 741741
[00:01 - 16:43] Anne Moss Shares Her Story About Her Beloved Son, Charles
Anne Moss highlights the difficulty in being able to get a diagnosis or the help they needed from health professionals
Charles had seen 3 health professionals in the 2 week period prior to his suicide
In Trying to deal with the devastation Anne Moss started the Emotionally Naked blog and started writing about her experience.
Her writing went viral, reaching those who shared her story
The moment Charles lost faith in the Mental Health system
Shame is a focus on self, guilt is a focus on behavior. Shame is “I am bad.” Guilt is “I did something bad.” - Brene Brown

[16:44 - 27:02] What Do Pediatricians and Primary Care Practitioners Need to Know?
Looking out for signs of self-harm and drug use
Anne Moss’ Free Ebook resource titles ‘Signs of Drug Use’ (links below)
Relationship disruptions
Transitions
Susceptible to physical illness
Identity issues
Mental health issues
Previous attempts
Exposure to suicide
Pediatricians need to be prepared for their patients’ honesty and answers if they are going to be screening for suicide prevention

[27:03 - 32:10] Get Comfortable Being Uncomfortable
Set the expectation that you will be uncomfortable
Asking and listening with empathy is the best thing one can do
We need to make kids a part of their treatment process
Ensure the child to know that somebody is in their corner

[32:11 - 40:49] Things Pediatricians Can Do If Their Patient Admits to Being Suicidal
Brief assessments
Ask Suicide-Screening Questions (ASQ) Toolkit (link below)
The potential that universal suicide screening for every visit has to intervene and save lives
Approaching and having the conversation with the patient’s parents
Taking a gentle but authoritative approach
Recovery is possible and probable. We can offer hope by listening and riding the ride.

[40:50 - 48:15] Closing Segment
To connect with Anne Moss check out her links and resources below
Anne Moss shares her finals thoughts
My Takeaways:
Medical Personal didn’t want to discuss suicide and ignored mental health subjects because they felt frozen
Get comfortable with being uncomfortable
If someone has disclosed that they have suicidal thoughts, the next strategy and phase...

34 An Upcoming Series: May Mental Health Month and Suicide Prevention

Wed, 28 Apr 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
This May for Mental Health Month, I have dedicated 4 episodes to suicide prevention. Suicide is the second leading cause of death in youth, and we have to know what to do and how to help. Our kids and families are depending on us!.
[00:01 - 03:39] An Upcoming Series for Mental Health month
In the upcoming episodes, you will hear stories of lived experiences, suicide prevention screening, and universal suicide screening.

[03:40 - 05:40] Being an Advocate for Our Patient’s Well-Being
Please send feedback and share this series with others.
How we provide mental health care in this country is flawed and fractured.
We are aiming for change and a better system for all
Every patient must have access to mental health care as well as physical health care

[05:41 - 06:40] Trigger Warning
A word of caution, some of the topics discussed are going to be very sensitive. If they are a trigger for you or a loved one the Hotline for Suicide Prevention is 1-800-273-8255 or Crisis Text Line: text HOME to 741741

Tweetable Quotes:
“We have to start looking at children and all of us as whole beings. No matter where you are, your emotional being is with you and it's with our patients too. If we’re not paying attention to that then we're going to miss the boat and we may even make the wrong diagnosis.” - Lia Gaggino
“My goal is that everyone will take this to heart and be an advocate for our patients’ emotional well-being.” - Lia Gaggino
Resources Mentioned:
Youth.Gov: May is National Mental Health Month
CDC: Underlying Cause of Death in Youth, 1999-2019

If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter or email me at gagginol@yahoo.com. To learn more about me visit https://www.medicalbhs.com/
LOVE WHAT YOU HEARD? Leave us a 5-star review so we can continue to provide you with great content. Share this episode and help people know more about children’s health and well-being.

33 Mental Health Education and Advocacy: Pediatric Trainee Voices

Wed, 21 Apr 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
In this special episode dedicated to medical students, residents and fellows, Dr. Josh Prudent and Dr. Amrit Misra join me as we talk about mental health training, mental health advocacy, addressing our own biases as practitioners, how ACE impacts the populations we serve, and the stigmatization around practitioners' own mental health struggles.
Mental health concerns affect all areas of medicine and pediatrics is no different. Because pediatrics provides an opportunity for prevention and early identification, it is critical that our trainees receive in-depth mental health training in order to promote emotional well-being.
Josh Prudent is a 2nd-year Pediatric Resident at Nationwide Children's Hospital in Columbus, Ohio, and the District 5 resident representative to the American Academy of Pediatrics. He completed medical school at the John Hopkins School of Medicine. Dr. Prudent is pursuing a fellowship in Pediatric Hematology-Oncology. His advocacy interests include immigrant and refugee rights, vaccine advocacy, youth mental health and behavioral health, and secure patient pediatric research funding.
Amrit Misra is a 3rd-year Pediatric Cardiology fellow at Children's Hospital of Michigan. He completed medical school at the University of Michigan and completed his Internal Medicine-Pediatrics training at Detroit Medical Center. He served as one of the Pediatric Chief Residents at Children’s Hospital and his clinical interests include adult congenital cardiology, community and global health, and transitional medicine.
Please join me in welcoming Dr. Prudent and Dr. Misra
[00:01 - 03:54] Opening Segment
Dr. Amrit Misra talks about his background and his involvement in the American Academy of Pediatrics.

[03:55 - 8:54] Advocacy Projects for Mental Health
Dr. Misra talks about the AAP’s Section On Pediatric Trainees’ focus on mental health for this year’s annual advocacy campaign

[08:55 - 15:42] Are Medical Students, Residents, and Fellows Receiving Adequate Mental Health Training?
Dr. Misra’s thoughts on how medical school and residency can further bridge the gap of training required to fit the vast needs of mental health.
Dr. Josh Prudent joins the interview and gives his thoughts.

[15:43 - 29:41] How Are You Integrating Your Adverse Childhood Experiences Training Into the Work You Are Doing?
Dr. Prudent incorporates ACEs into his patient’s medical care and talks about the nuances of approaching these conversations with clients.
Dr. Misra shares where he sees ACEs impact his patients
The need to provide more holistic care and for pediatricians to uncover biases within themselves in order to properly diagnose
Approaching biases with a level of humility and desire to improve patient care.

[29:42 - 44:06] Medical Students and Mental Health
The stigmatization around mental health and the shame and fear of failure surrounding getting help.
Burnout and the shift in perspective of making sure medical students are aware of their wellness
Dr. Prudent and Dr. Misra share their appreciation for very good attendings

[44:07 - 49:37] IWhat Advice Would You Give Your Younger Self?
Dr. Misra would tell his younger self to relax and enjoy the process.
Dr. Prudent advises to maintain strong relationships with your friends at every stage in your...

32 Disruptive Behaviors: Insights and Strategies from a Child Psychiatrist

Wed, 14 Apr 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Children that exhibit aggressive and disruptive behaviors can be hard to manage and treat especially if the root causes are not clearly understood. Paresh Patel, M.D., PhD, joins us in this episode to talk about exploring what may be behind difficult behaviors and offers management and treatment strategies.
Dr. Patel emphasized that behaviors are often symptoms of deeper problems. Pediatric clinicians can begin to peel back the layers, and with the support of mental health professionals, find strategies that address what is really going on with kids. He also believes that medication should only be administered with the intent to stop the medication. Take a listen to his thoughts about the role of psychotropic medications and aggressive and disruptive behaviors and when we can lean on our colleagues in psychiatry.
Although the first stop for many parents whose kids are struggling with difficult behaviors is the pediatric office, it is really about a team approach that includes our friends in psychiatry and mental health.
Tune in for a thoughtful discussion about aggression and disruptive behaviors in kids with Dr. Patel!
[00:01 - 07:23] Opening Segment
Let’s welcome, Paresh Patel, M.D., PhD
His path to child psychiatry

[07:24 - 21:57] Disruptive Behaviors
What Paresh learned under the MC3 Program
Medication is only a smart part of treatment
Handling children with disruptive behaviors
Paresh shares his experience
Behaviors are symptoms
Non-verbal vs. verbal communication
Some key insights from Paresh

[21:58 - 36:13] Free Will Among Children
Paresh’s message for parents on how to be “super parents”
He talks about the notion of free will among children
Here’s a true story from Paresh you should not miss

[36:14 - 51:29] Longitudinal Relationships and Trust
Building relationships and trust among pediatricians
When to resort to antipsychotic medication for children
We break down the different therapies available to children

[51:30 - 58:21] Closing Segment
Paresh’s message for his resident self
Finals takeaways
Children do well if they can
Behavior is a symptom
Turning parents into “super parents”
No bad kid or bad parent
Start medication to stop medication
Involve the therapist in the therapy
Jump with both feet and pay attention

Tweetable Quotes:
“The behavior is just a symptom of a deeper problem, and a deeper problem can be along the child continuum.” - Paresh Patel, M.D., PhD
“Start medication with the intention to stop it.” - Paresh Patel, M.D., PhD
Resources Mentioned:
Michigan Child Collaborative Care Program
Pediatric Meltdown previous episode: Autism Spectrum Disorders in Primary Care: Recognizing Early Signs and Initiating Treatment‬
Book: The Explosive Child

Email pdpatel@med.umich.edu to connect with Paresh and check out Michigan Medicine to learn more about his...

31 Social Media: What are our kids up to and should we be worried?

Wed, 07 Apr 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. David Hill, author of “Dad to Dad,” and a co-host of the AAP Pediatrics on Call podcast joins me to discuss social media use and our kids. He shares thoughts on how to reinforce its positive impacts and to navigate the pitfalls Dr. Hill outlines strategies to share with parents and talking points for pediatric clinicians
Take a listen and learn to promote the positive use of social media among kids!
[00:01 - 06:53] Opening Segment
Let’s welcome, Dr. David Hill
His path to broadcasting and podcasting

[06:54 - 16:15] Impact of Social Media on Kids
The positive impact of social media on kids
Care for yourself with these tips from us
David talks about divorce and separation

[16:16 - 28:56] Self-Efficacy Among Kids
The negative effects of social media on kids
Reinforce self-efficacy among kids
David tells us how
Listen to David’s thoughts about gaming disorders

[28:57 - 39:25] Advice for Parents
Hear David’s insights about the role of sleep in our lives
What parents should learn from David
David’s message for his resident self

[39:26 - 46:35] Closing Segment
Finals takeaways
Social media can be positive
When does social media become a concern?
Problematic internet behaviors
Suggestions for parents to regulate social media use among kids

Tweetable Quotes:
“This line that separates the electronic world and the real world is a very fuzzy, fuzze line, and sometimes it’s just not there at all.” - Dr. David Hill
“We want to put our kids in charge of their own wellbeing.” - Dr. David Hill
Resources Mentioned:
David’s books:
Sole authorship: Dad to Dad
Co-authorship: Co-parenting Through Separation and Divorce
Other books:
The Body Keeps the Score
Caring for Your Baby and Young Child, 7th Edition: Birth to Age 5
Individuals to follow:
David Sedaris
Dr. Joanna Parga-Belinkie
Pediatric Meltdown previous episodes:
Mental Health Advocacy: A Conversation with AAP President Lee Beer‪s‬
Kids and Sleep Why Getting Enough ZZZ's Matter‪s‬
Family Media Plan
YouTube video: Caring for yourself

Email davidhillmd@gmail.com to connect with David and check out his website to learn more about his work. Listen to his podcast.
If

30 Who's the Boss: A Primer for Parents and Pediatric Providers

Wed, 31 Mar 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Arthur Lavin returns to the podcast and offers practical advice on parent-child conflict and problem solving strategies. Tantrums are a teaching opportunity where children learn to solve the problem and parents are the guides.
Dr. Lavin shares highlights from his book “Who's the Boss: Moving Families from Conflict to Collaboration” that he authored with colleague Susan Glaser and presents a framework to tackle tantrums and meltdowns
Let’s listen to this primer for parents and pediatric providers from Dr. Lavin!
[00:01 - 03:57] Opening Segment
Let’s welcome back, Dr. Arthur Lavin
Let’s all be cautious for a few more months
Listen to Arthur’s message

[03:58 - 14:09] Teaching Children to Solve Problems
How Arthur turned a 12-year collab into a book
He did it with his colleague
Teaching children to solve their problems
Why Arthur likes “neutral questions”

[14:10 - 24:04] Like A Computer Freezing
Understand tantrums better with this analogy
How to handle tantrums better
Arthur talks about anger flares among adults

[24:05 - 35:40] The Line of Concern
The alternative to listening and problem solving
Arthur shares a sneak peek about his next book
Listen to his message to his resident self

[35:41 - 41:38] Closing Segment
Finals takeaways
Teach children to solve problems themselves
Who will find the solution, the parent or the child?
Adopting a neutral tone
Structuring conversations better
The approach with 100% success rate
Children create the consequences, aside from solutions
Tantrums are like computers freezing
Teen tantrums are more complicated

Tweetable Quotes:
“The secret to success always lies in finding some way to create a situation or an understanding or a stance freely whereas the child [has] the freedom and the ingenuity and the creativity to solve that problem themselves .” - Dr. Arthur Lavin
“Listen to that voice, stay close to that voice, and stay true to that voice.” - Dr. Arthur Lavin
Resources Mentioned:
Pediatric Meltdown episode 9: School Struggles ADHD or is it‪?‬
Arthur’s books
Who's the Boss
Baby and Toddler Sleep Solutions For Dummies

Email alavinmd@gmail.com to connect with Arthur and visit https://www.advancedped.com/staff/ to learn more about his space.
If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter or email me at gagginol@yahoo.com. To learn more about me visit

29 Goldilocks, Tigger and Eeyore: Regulation and Childhood Behaviors

Wed, 24 Mar 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
It is my great pleasure to welcome Dr. Mark Sloane back to the podcast for the second time to talk about mood regulation in children using Goldilock’s “just right” metaphor
We can all imagine a rambunctious Tigger, a forlorn Eeyore and a contented Goldilocks. Now use that imagery and apply it to children’s behaviors and you come away with a unique perspective and framework for understanding the ultimate meltdown and a harmonious middle ground.
Put your headphones on and take a listen to Dr. Sloane’s thoughts on mood regulation and how we can better help kids find their “just right” place.
[00:01 - 12:03] Opening Segment
Let’s welcome back, Dr. Mark Sloane
Listen to Mark’s mindset when he’s asked for help
Don’t miss this story from Mark about an untreated ADHD

[12:04 - 26:00] Behavior Regulation
What does Mark mean by regulation?
The connection between regulation and resilience
Regulating a baby?
Listen to Mark

[26:01 - 40:43] Intrinsic Motivation
Listen to Mark and learn how regulation works in the brain!
Mark breaks down intrinsic motivation
What do kids call this motivation?
He talks about the fight-or-flight response
From Eeyore to Tigger

[40:44 - 56:44] Power of Mindfulness
How powerful is mindfulness?
Different strategies that doctors use to train mindfulness
What are overwhelmed brakes?

[56:45 - 01:04:51] Regulation in Social Models
Mark talks about their social model and how regulation fits in it
Listen to our interesting exchange about marijuana use
Mark’s message to his resident self

[01:04:52 - 01:08:51] Closing Segment
Finals takeaways
Consider an integrated lens for children with difficult behaviors
Resilience is not automatic
The prefrontal cortex or the “breaks”
Think about Tigger, Goldilocks, and Eeyore
Strategies to get from Tigger to Goldilocks
Widen the Goldilocks Zone
Any adult can make a difference

Tweetable Quotes:
“Regulation is the epicenter of our universe.” - Dr. Mark Sloane
“Mindfulness is powerful.” - Dr. Mark Sloane
Resources Mentioned:
Pediatric Hero: Building Safe Spaces for Kid's Emotions with Dr. Mark Sloan‪e
The Brain-Behavior-Resilience Connection

Email mark.sloane@wmich.edu to connect with Mark and visit https://wmich.edu/ to learn more about his space.
If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter or email me at gagginol@yahoo.com. To learn more about me visit

28 Caring for Kids on the Autism Spectrum: What Parents Want and Need from Us

Wed, 17 Mar 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Mary Barkholz is a special education teacher and mother of 2 young men on the autism spectrum. She is passionate about giving support and guidance to families and their children with special needs. In this episode, she shares her experience as a parent raising her children, how her work as a special education teacher plays in the situation, and how healthcare providers can better connect with families.
Let’s listen to Mary and learn what parents want and need from us!
[00:01 - 06:05] Opening Segment
Welcoming today's guest, Mary Barkholz
How she realized her children are on the autism spectrum

[06:06 - 17:00] The Importance of Honesty
Mary recalls how she landed in the special education space
Educational diagnosis vs. Medical diagnosis
Mary breaks them down
The importance of honesty for Mary

[17:01 - 29:46] Connection Between Families and Healthcare Providers
Mary’s approach in raising children in the autism spectrum
How starting a conversation is crucial to a child’s growth
The disconnect between families and healthcare providers

[29:47 - 41:45] Guardianship and Parent Networks
Are there any parent networks you can join?
Mary’s thoughts about guardianship on children in the autism spectrum
How parents can assist children in making decisions

[41:46 - 50:55] Relationship-Building Advice
Listen to this parenting advice from Mary you don’t want to miss!
The power of building relationships with children

[50:56 - 59:01] Closing Segment
Finals takeaways
The parents’ readiness to be informed on autism
Emotions are a mixed bag
Medical diagnosis vs. Educational diagnosis
Path to adulthood for children with special needs
Bridges that connect healthcare, community, and education sectors
Giving children options
Guardianship
Children in the autism spectrum are not numbers but persons
Letting the child take the lead

Tweetable Quotes:
“I always say that honesty is the only way I can function.” - Mary Barkholz
“We do have to let [our children] fall down, let them figure things out.” - Mary Barkholz
Resources Mentioned:
An Approach to Transition Assessment and Planning
Guardianship
Autism Alliance of Michigan
Book: Raising Your Spirited Child
Pediatric Meltdown episode: Pediatric Hero: Building Safe Spaces for Kid's Emotions with Dr. Mark Sloan‪e ‬
Pediatric Meltdown episode: Across the Divide: Building Bridges between Primary Care and Community Mental Health Providers with Dr. Zakia Alav‪i‬
Pediatric Meltdown episode: Caring for Kid's Mental Health During Covid: How Parents Can Help with Dr. Zakia Alav‪i‬
Pediatric...

27 Child Abuse and Neglect: Asking the Hard Questions

Wed, 10 Mar 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Victims of child abuse and neglect and sexual assault should be handled carefully by healthcare providers due to the sensitivity and severity of what happened to them. Dr. Sarah Brown joins us in this episode to talk about the difficult questions we must ask children and families in order to keep kids safe. We also discussed when and where to ask them and when to call authorities, if needed. Timing is as important as the questions themselves.
Let’s listen to Dr. Brown and learn how to ask the hard questions to victims of child abuse and neglect!
[00:01 - 04:45] Opening Segment
Welcoming today's guest, Dr. Sarah Brown
Her path to child abuse and neglect and pediatrics

[04:46 - 14:54] Let The Child Talk
How to build a safe space for children and adults
Our role as healthcare providers
The power of small words
The first step in asking about abuse from children
What are the right questions to ask?
Introducing things that are NOT okay

[14:55 - 26:17] Talk About Abuse Somewhere Else
The protocols in handling sexual assaults for healthcare providers
How to efficiently report sexual assault
What Dr. Brown does not recommend on talking about abuse

[26:18 - 38:44] Be Careful with Telehealth Services
The overlap between domestic violence and child abuse and neglect
Hear Dr. Brown’s thoughts about telehealth services
Don’t miss Dr. Brown’s insights about the Safe and Together model

[38:45 - 43:52] Relax and Take One Day At a Time
How healthcare providers can take better care of themselves
Listen to Dr. Brown’s advice
Dr. Brown’s message for her resident self

[43:53 - 50:06] Closing Segment
Finals takeaways
Believing the child is important
Asking when you suspect child abuse
Having an exam as soon as possible
Informing the Child Protective Services
Remembering that domestic violence and child abuse
Being mindful with telehealth services
Taking care of yourself

Tweetable Quotes:
“That goal of not interrupting as long as the child is narrating is important.” - Dr. Sarah Brown
“Relax and take things one day at a time.” - Dr. Sarah Brown
Resources Mentioned:
Safe and Together Institute
National Health Resource Center on Domestic Violence
CUES: an Evidence-Based Intervention
Sexual Behaviors in Young Children: What’s Normal, What’s Not?
National Children's Alliance
Effective Discipline to Raise Healthy Children
The Evaluation of Suspected Child Physical Abuse
Understanding the Behavioral and Emotional Consequences of Child...

26 The 3 B's - Brain, Body, Behavior: Managing Anxiety

Wed, 03 Mar 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Anxiety is normal. In fact, anxiety is “a perfectly normal, natural, [and] not actually dangerous” behavioral response according to Dr. Colleen Cullinan. It is the body’s response when we feel scared, threatened, or stressed, which happens to all people. The primary care’s job is to not allow that anxiety to interfere in a person’s daily life, not to take it away completely. The former is achievable; the latter is impossible.
Let’s listen to Dr. Cullinan and learn how to manage anxiety better!
[00:01 - 08:53] Opening Segment
Welcoming today's guest, Dr. Colleen Cullinan
Her path to clinical psychology
Hear her wake-up call

[08:54 - 20:53] Normalizing Being Anxious
Mental healthcare and physical healthcare are the same
Dr. Cullinan explains
The role of primary care in a child’s mental healthcare
It’s normal for people to be anxious
Listen to Dr. Cullinan

[20:54 - 35:17] Managing Anxiety
How to manage anxiety and other negative emotions
What is Cognitive Behavioral Therapy (CBT) at its core?
We would not want anxiety to disappear
Dr. Cullinan tells us why

[35:18 - 48:59] Accessing Available Resources
The most challenging part of managing anxiety
The resources you can access right now
Links below
Why partnerships are important in primary care

[49:00 - 52:43] Closing Segment
Finals takeaways
Primary care and parent-patient trust are key components of integrated behavioral health
Normalize anxiety
Brain, body, and behavior: one activates the next
Grounding strategies “to manage anxiety
“Feelings are not facts
The rules of emotions
Cognitive behavioral therapy at its core
How to start a conversation with patients

Tweetable Quotes:
“Whether we like it or not, primary care is the de-facto mental healthcare system in the country, especially for kids.” - Dr. Colleen Cullinan
“Anxiety is designed to protect us. It’s an essential feature of who we are as humans. It’s an evolutionary function.” - Dr. Colleen Cullinan
Resources Mentioned:
KidsHealth
Book: Raising An Emotionally Intelligent Child
Book: The Thriving Adolescent
Pediatric Meltdown episode: Mental Health Advocacy: A Conversation with AAP President Lee Beer‪s
Facts For Families Guide

Email colleen.cullinan@nemours.org to connect with Dr. Cullinan and know more about her space here.
If you’d like to connect with me, you can find me at LinkedIn, Facebook, and

25 Kids and Sleep Why Getting Enough ZZZ's Matters

Wed, 24 Feb 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Dr. Hovig Artinian found his way to sleep medicine after teaching 8th grade science and happily says that practicing medicine is much easier! Sleep is critical to our physical and mental health from infancy into our golden years. The behaviors that surround sleep determine the quality and quantity of sleep. Medications for sleep difficulties fall way down the list on interventions with behavior modification rising to the top. Primary care providers can help parents teach their children about good sleep habits and emphasizes that parents need to pay attention to their own sleeping habits too.
Listen in as Dr. Artinian shares strategies and insights to ensure that everyone gets a good night's sleep.
[00:01 - 07:04] Opening Segment
Welcoming today's guest, Dr. Hovig Artinian
His transition from education to medicine
His path to sleep medicine

[07:05 - 16:50] Getting Your Baby Sleep Through The Night
Why you should have enough sleep according to Dr. Artinian
How long should you sleep?
Bedtime solutions for babies
There’s no one right solution

[16:51 - 26:20] Training the Child To Sleep Easily and Quickly
Toddlers know how to control adults
How can adults reclaim control?
Overnight awakenings are actually normal
Dr. Artinian explains
Getting toddlers to go to sleep
Patience and consistency are keys

[26:21 - 38:19] Waking Up Teenagers With Enough Sleep
Dr. Artinian’s message for parents in the postpartum period
How Dr. Artinian do sleep treatment
The best medicine he can give you
What about the sleeping habits of teenagers?
Listen to light therapy here

[38:20 - 50:55] Using Marijuana To Sleep
Using your phone before sleeping?
Don’t miss this reminder from Dr. Artinian
What about marijuana use?
Hear Dr. Artinian’s thoughts about it
Facts about pediatric sleep you should know

[50:56 - 55:52] Closing Segment
Dr. Artinian’s message for his resident self
Finals takeaways
Most problems are totally curable and work within weeks
Sleep environment
Cognitive bliss about sleep
Sleep schedule on non-schedule days vs. schedule days
Circadian rhythm shifts
Parents regaining control
Light therapy
Take a deep breath and forgive yourself

Tweetable Quotes:
“You are not alone when you need to ask for help.” - Dr. Hovig Artinian
“Take a deep breath. Forgive yourselves for the mistakes that you’ve made, Know that you’re growing...and know that you belong.” - Dr. Hovig Artinian
Resources Mentioned:
The Postpartum Stress Center
Bedtime Problems
Tip about sleeping

Email hovig.artinian@helendevoschildrens.org to connect with Dr. Artinian and know more about his space here.
If you’d like to connect with me, you can find me at

24 Provider Wellness: Are You Taking Care of Yourself?

Wed, 17 Feb 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
As healthcare providers we pour our energy into caring for our patients and often we forget to take care of ourselves, leading to burnout. It is crucial that we take time to take a breath and to recharge. Dr. Martha Middlemist shares the work of the AAPs Wellness Advisory Group and offers concrete steps we can all take to manage stress.
Let’s listen to Dr. Middlemist and learn how healthcare providers can take better care of themselves!
[00:01 - 06:13] Opening Segment
Welcoming today's guest, Dr. Martha Middlemist
Dr. Middlemist’s talks about her background

[06:14 - 16:55] Taking Care of Healthcare Providers Better
The steps they’ve taken to take better care of healthcare providers
How healthcare initiatives are conceptualized
Don’t miss Dr. Middlemist’s tips for healthcare providers!

[16:56 - 27:01] Going on a Therapy and Other Wellness Services
Dr. Middlemist talks about this kind of stress among healthcare providers
The importance of realizing that things are not working well
Therapy is an option too for healthcare providers
Dr. Middlemist explains

[27:02 - 39:34] Giving More Time For Yourself
Dr. Middlemist shares her observations during the COVID-19 pandemic
She gives a few creative suggestions for healthcare providers to have fun
Her message to her resident self

[39:35 - 43:42] Closing Segment
Finals takeaways
An idea can go a long way
Wellness silos should be considered
Peer support and networking with like-minded individuals are important
What you can do to take care of yourself better
Exercise
Eat well
Get enough sleep
Speak up and speak out
Ask for help
Wellness activities you can practice

Tweetable Quotes:
“I think you also have to have workplace wellness by...having supportive caring people around you...” - Dr. Martha Middlemist
“From the beginning, take more time for yourself.” - Dr. Martha Middlemist
Resources Mentioned:
National Academy of Medicine
Clinician Resilience and Well-Being
Physician Health & Wellness
Improving Physician Well-Being, Restoring Meaning in Medicine
What can individuals, organizations do to promote joy in pediatrics?
Pediatric Meltdown episode: Caring for Kid's Mental Health During Covid: How Parents Can Help with Dr. Zakia Alav‪i‬

Connect with Dr. Middlemist and know more about her space here.
If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter...

23 Psychiatry Support in the Inpatient Pediatric Setting: Consult Liaison Services

Wed, 10 Feb 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Pediatrics and Psychiatry are two distinct fields that Dr. Nasuh Malas wants to marry. As a consultation-liaison psychiatrist, his personal philosophy is to deliver timely care for young people and families.
He joins us today to talk about how psychiatry support can be integrated into an in-patient pediatric setting. We also have a great exchange about how healthcare professionals can take care of themselves better.
Let’s listen to Dr. Malas to learn more about psychiatric support in a pediatric setting!
[00:01 - 05:29] Opening Segment
Welcoming today's guest, Dr. Nasuh Malas
Dr. Malas talks about his background

[05:30 - 16:46] Delivering Healthcare Services Virtually
Dr. Malas’ role as a consultation-liaison psychiatrist
Are telepsychiatry services possible?
The rise of virtual psychiatric care

[16:47 - 29:08] Improving the Youth’s Mental Health
Dr. Malas talks about psychiatric services in a pediatric setting
His thoughts about the effects of the pandemic on the youth’s mental health
The steps that adults can take for the youth’s mental health

[29:09 - 40:24] Take Care of the Healthcare Professionals
How healthcare professionals can avoid burnout
Here’s Dr. Malas’ reminder for healthcare professionals
The importance of having a supportive team

[40:25 - 50:57] Being an Effective Physician
The reflections that should happen in a residency training
The privilege of working with families to address health issues
What’s his message for his resident self?

[50:58 - 56:36] Closing Segment
Finals takeaways
The role of consult liaison
A psychosocial lens for psychiatry and pediatrics
Unique issues due to the pandemic
Fostering care for healthcare professionals
Medicine is a marathon, not a sprint

Tweetable Quotes:
“My philosophy as a consultation liaison psychiatrist is to really facilitate getting the right type of care to youth and families in a timely way.” - Dr. Nasuh Malas
“The more we can spotlight and highlight the importance of mental health for our youth, the more that things will change to really support patients and families.” - Dr. Nasuh Malas
Resources Mentioned:
Michigan Child Care Collaborative Program
Pediatric Meltdown episode: Psychiatric Consultation: The Doctor is In‪!‬
American Academy of Pediatrics
American Academy of Child & Adolescent Psychiatry
Practice Parameters for the Psychiatric Assessment of Children and Adolescents
Depression in Medically Ill Children
Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department

Email: nmalas@med.umich.edu to connect with Dr....

22 Pediatric Genetics and Behavioral Health: Implications for Testing

Wed, 03 Feb 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Today, we are going to talk about genetics and behavioral health with Dr. Caleb Bupp, Division Chief of Medical Genetics and Genomics Spectrum Health at Helen DeVos Children's Hospital.
You might be wondering why we have invited a geneticist on a podcast about emotional and mental health in the pediatrics space. Well, our space intersects with genetics more frequently than you can imagine. Dr. Bupp will break these intersections down, explain genetics in a manner that you can also explain it to others, and highlight the importance of genetic testing with consent.
Let’s listen to Dr. Bupp to learn more about genetics in behavioral health!
[00:01 - 06:55] Opening Segment
Welcoming today's guest, Dr. Caleb Bupp
Why Dr. Bupp chose genetics

06:56 - 16:49] Genetic Issues
We talk about the 3 intersections of genetics and mental health
Understand genetics better with this analogy from Dr. Bupp
Dr. Bupp tells us why every health issue is genetic

[16:50 - 27:49] Genetic Testing
What is Dr. Bupp’s advice for children with autism
Genetics will be of no use under one certain scenario
Dr. Bupp elaborates
Genetic testing will be valuable in learning about behavioral health issues
Dr. Bupp explains
The worst part of being a geneticist for Dr. Bupp

[27:50 - 39:22] Genetic Data
We talk about the importance of consent in genetic testing
The value of a person’s genetic data as explained by Dr. Bupp
What is pharmacogenomics and why we should understand it

[39:23 - 47:22] Closing Segment
Listen to Dr. Bupp’s reminder for us
What’s his message for his resident self?
Finals takeaways
Consent is a must in genetic testing
Genetic testing has become mainstream
The different types of genetic testing
Children with autism should be offered genetic testing or consultation about it
A main barrier right now in genetic testing is cost

Tweetable Quotes:
“When you’re working underneath somebody who loves what they do, it’s just infectious.” - Dr. Caleb Bupp
“... every health issue is genetic. In some way, shape, or form, we just have to get granular enough to figure out what exactly the genetic cause for that [issue] is.” - Dr. Caleb Bupp
Resources Mentioned:
Genetic Information Nondiscrimination Act of 2008
What is informed consent?
Locating a genetics clinic here
Pharmacogenomics FAQ

Email caleb.bupp@spectumhealth.org to connect with Dr. Bupp. Also, visit https://www.spectrumhealth.org/ to learn more about his space.

If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter or email me at gagginol@yahoo.com.

21 Mental Health Advocacy: A Conversation with AAP President Lee Beers

Wed, 27 Jan 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
We always say that “prevention is better than the cure,” but prevention won’t happen if the necessary infrastructures, institutions, and support systems are not in place. Dr. Lee Beers, the new President of the American Academy of Pediatrics, recognizes this problem and aims to advocate for an integrated approach that can also address the issues that plague our children, particularly those relating to their mental health.
Let’s listen to Dr. Beers to learn how to advocate for mental health services better!
[00:01 - 06:01] Opening Segment
Welcoming today's guest, Dr. Lee Beers
Her story as a navy physician

[06:02 - 17:23] Parenting Impacts
Her memorable 18-month experience as a physician overseas
Dr. Beers talks about the impact of parenting on infant development
The challenges of dealing with mental health among children

[17:24 - 29:04] Integrated Behavioral Health
Dr. Beers breaks down integrated behavioral health
She talks about the status of mental health in the United States
Are there enough pediatric mental health providers?
Is there enough access to quality health care?
How to advocate for an established mental health support system

[29:05 - 40:27] Accessible Health Services
Why health services should be accessible in the long-term
Here’s an old reminder from Dr. Beers that you should hear
The services that the American Academy of Pediatrics offers

[40:28 - 49:32] Closing Segment
Dr. Beers’ message for her resident self you should also hear
Final Takeaways
The parents’ wellbeing and health are crucial too
The importance of family support
Integrated behavioral health
Delivery of health services
The place to make a change
Don’t be afraid to take risks

Tweetable Quotes:
“It’s really important for us to make sure that access to [health] services is sustainable.” - Dr. Lee Beers
“Each and everyone of us has that power to make a change.” - Dr. Lee Beers

Resources Mentioned:
American Academy of Pediatrics
Through a Different Lens: Examining How We Care for Adolescent-Headed Families
Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting
Healthy Children website
Pediatric Meltdown episode: Caring for Children in Foster and Kinship Care: Keeping a Trauma-Informed focus with Moira Szilagyi

Email lbeers@childrensnational.org to connect with Dr. Beers. Also, visit https://childrensnational.org/ to learn more about her space.

If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter or...

20 Talking to Teens about Sex, Drugs, Rock and Roll and Hip Hop: Stay in the Non-Judgement Zone

Wed, 20 Jan 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Sex and drugs remain taboo in society, and the reluctance to talk about these topics only leads to misinformed and misguided teenagers who feel unnecessary judgments for themselves. It’s now high time to raise the awareness of teenagers about these topics to let them know of the safe spaces where they can freely express themselves. Dr. Lisa Lowery, an Adolescent Medicine specialist at the Helen DeVos Children’s Hospital-Spectrum Health Medical Group, joins us today to give tips on how to normalize these topics that should have been normal already. We are sexual beings after all and we should not deny it.
Let’s listen to Dr. Lowery to learn how to stay in the non-judgment zone!
[00:01 - 05:40] Opening Segment
Welcoming today's guest, Dr. Lisa Lowery
Her path to adolescent medicine

[05:41 - 17:42] Build a Safe Space
Dr. Lowery talks about the importance of mentors
Hear Dr. Lowery’s interesting insights about teenagers
Why they’re easier to work with than babies
Honesty and consistency are keys
Dr. Lowery shares a patient story that you should hear!
Why we do what we do

[17:43 - 32:18] Normalize Sex Talks
We talk about the responsibility that physicians carry
A humbling experience
Normalize sex and talking about it
Dr. Lowery explains
The right questions to ask
We discuss intimate partner violence

[32:19 - 44:21] Take Care of Yourself Better
The proper way to talk about sex trafficking with teenagers
Behavioral health should be present in all practices
Dr. Lowery tells us why
Physicians should know social and mental health workers in their circles
We talk about the benefits
Physicians should take care of themselves too

[44:22 - 50:04] Closing Segment
Parting words from Dr. Lowery
Final Takeaways
Providing a no-judgement zone
Strategies to ask teenagers about sex
Tips to discuss drugs and relationships with teenagers
How to get into an adolescent’s head?
Link below

Tweetable Quotes:
“Your mentor doesn’t have to look like you.” - Dr. Lisa Lowery
“We [physicians] have to learn how to take better care of ourselves emotionally.” - Dr. Lisa Lowery

Resources Mentioned:
Getting into adolescent heads: An essential update

Email lisa.lowery@helendevoschildrens.org to connect with Dr. Lowery. Also, visit http://www.helendevoschildrens.org/AdolescentMedicine to learn more about her space.

If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter or email me at gagginol@yahoo.com. To learn more about me visit https://www.medicalbhs.com/

LOVE WHAT YOU HEARD? Leave us a 5-star review so we can continue to provide you with great content. Share this episode and help...

19 Autism Spectrum Disorders in Primary Care: Recognizing Early Signs and Initiating Treatment

Wed, 13 Jan 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
We have a special episode for today because of two important guests. Dr. Sheila Marcus is the Section Chief of the Child and Adolescent Psychiatry of Michigan Medicine at the University of Michigan while Dr. Sarah Mohiuddin is the Director of the University’s Multidisciplinary Autism Program. They join us to discuss autism spectrum disorders and how we can detect them in as early as 4-12 months. We will learn that the symptoms of these disorders are often subtle and that early detection is critical
Let’s listen to Dr. Marcus and Dr. Mohiuddin to learn more about autism spectrum disorders.
[00:01 - 02:51] Opening Segment
Welcoming today's guests, Dr. Sheila Marcus and Dr. Sarah Mohiuddin,
We introduce our topic for this episode

[02:52 - 13:24] Observe the Baby
Dr. Marcus tells us what to look out for in a 4- to 12-month old baby
A baby should learn how to love the parents by this time
Listen to Dr. Mohiuddin’s advice for pediatricians
Encourage the patient’s parents to come back
Use appropriate language that only subtly expresses your concern
Observe the baby with the parent without your presence

[13:25 - 23:31] Consider Virtual Evaluations
They talk about the pros and cons of virtual evaluations
Hear the parents’ voice, see the baby
The importance of early interventions for babies exhibiting signs of autism
Dr. Marcus explains

[23:32 - 34:02] Explain the Spectrum
They explain why autism disorders are located in a spectrum
Not a matter of “you have it” or “you don’t have it”
Dr. Marcus talks about the common tests to detect autism spectrum disorders early
What are the usual treatments for autism spectrum disorders?

[34:03 - 47:43] Don’t Always Fill in the Gaps
Adults can let the conversation with a kid remain uncomfortable
Dr. Mohiuddin explains
Why should adults “not fill in all the gaps?”
We talk about how kids with autism build social relationships
Dr. Mohiuddin reminder on giving medications

[47:44 - 57:53] Think About the Kid’s Future
We share some useful resources to educate you more about autism
Links below
The challenging part of transitioning to adolescence and adulthood
They talk about the importance of thinking about the kid’s future
Independent living skills, work, and preferences, among others

[57:54 - 01:06:15] Closing Segment
Parting words from Dr. Marcus and Dr. Mohiuddin
Final Takeaways
Always listen to parent concerns and take them seriously
Early identification and evaluation make all the difference
Delivering the diagnosis can be hard and painful for patients
Early symptoms are sometimes too subtle
Applied Behavior Analysis and Early Start Denver Model
Older language with strong language skills can be missed easily
Don’t always fill in the gaps
Think early about the kid’s trajectory in the future
Medications should only be considered in extreme cases
As adults, kids may do well regardless of their skills

Tweetable Quotes:
“...if a parent who’s an astute observer and somebody whose opinions you’ve always trusted sensed [the possibility of autism], number one, believe them.” - Dr. Sheila Marcus
“In doing an evaluation of an older kid who...

18 Across the Divide: Building Bridges between Primary Care and Community Mental Health Providers with Dr. Zakia Alavi

Wed, 06 Jan 2021 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
In this episode, I invite Dr. Zakia Alavi, a child and adolescent psychiatrist and an assistant professor at Michigan State University who teaches medical students about the integration between basic and clinical sciences to the podcast. She has been providing psychiatric services to underprivileged children in Jackson, Michigan, and has published many peer-reviewed articles on psychopharmacology and polypharmacy.
Let’s listen to Dr. Alavi and learn more about building bridges between primary care and community mental health providers!
[00:01 - 06:02] Opening Segment
Welcoming today's guest, Dr. Zakia Alavi
Her path to child and adolescent psychiatry
Touching one generation with one child

[06:03 - 16:12] Convincing Families
A supportive community mental health system
How to convince “professional” families to treat mental health
Building a two-way communication with children

[16:13 - 25:35] Building Networks and Relationships
Primary care providers shouldn’t go beyond their comfort level
Find out why
How can physicians make a change within their systems?
The importance of network- and relationship-building

[25:36 - 32:09] Creating a Safe Space for Children
Trust and comfort among children as priorities
Mental health stigma during and after the COVID-19 pandemic

[32:10 - 41:53] Closing Segment
Dr. Alavi’s parting words
Trust the patients more
Final Takeaways
Connect with child psychiatrist
The importance of humility among child psychiatrists
Supportive systems in the community mental health world
Building relationships and work on a team
Trust the system and the patient more
Sometimes, it’s better to not do anything

Tweetable Quotes:
“If I can touch one life, one child, that’s like a whole generation. You can affect so many people by just touching one child’s life” - Dr. Zakia Alavi
“Remember that you work in a community. You’re not in a silo.” - Dr. Zakia Alavi
Resources Mentioned:
Michigan Child Care Collaborative
Ep. 13: Psychiatric Consultation: The Doctor is In!
National Network of Child Psychiatry Access Programs
Understanding the Use of Psychotropic Medications in the Child Welfare System: Causes, Consequences, and Proposed Solutions
When stimulants “fail” for children with attention-deficit/hyperactivity disorder

If you’d like to connect with Dr. Alavi, email alavizak@msu.edu. Also, visit https://raind.msu.edu/ to learn more about his space.
If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter or email me at gagginol@yahoo.com. To learn...

17 Caring for Kid's Mental Health During Covid: How Parents Can Help with Dr. Zakia Alavi

Wed, 30 Dec 2020 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
I have the pleasure of having Dr. Zakia Alavi for the second time (you will hear from her again in 2021!) to talk about a very relevant topic for pediatricians, mental health professionals, and parents – Covid and its effects on children’s mental health. Dr. Alavi is a child and adolescent psychiatrist and an assistant professor at Michigan State University. She teaches medical students how to integrate basic and clinical sciences and provides psychiatric services in Jackson, Michigan to those children who are in most need. Dr. Alavi offers age-specific coping strategies to mitigate the impact Covid on our children’s emotional well-being.
Join me and learn from Dr. Alavi about the ways pediatricians and parents can help children cope during the COVID-19 pandemic.
[00:01 - 03:51] Opening Segment
Welcoming today's guest, Dr. Zakia Alavi
I introduce the topic for this episode

[03:52 - 18:43] Children’s Responses to COVID-19
Dr. Alavi’s insights on the effects of COVID-19 to 5-year olds and younger
Parents and caregivers should also be considered
Her thoughts on the most affected age group of the COVID-19
Teenage meltdowns to watch out for according to Dr. Alavi

[18:44 - 32:36] Parents’ Routines
What parents should realize about their routines or lack thereof
Parents are the children’s personal clocks
The age group where verbal reassurance has the most impact
Dr. Alavi’s tips for teenagers that parents should know
Her reminders for parents in coping with COVID-19

[32:37 - 37:01] The Right Questions to Ask Now
Dr. Alavi’s insights about mental health issues during COVID-19
What questions to ask for spouses and children
Other related issues that should be addressed

[37:02 - 47:49] Closing Segment
Dr. Alavi’s parting words
Silver linings in the pandemic
Educating people about vaccines
Final Takeaways
COVID-19’s impact on children of different ages
Sense of safety for kids under 5 years of age
Parents’ response to COVID-19
Children regressions and meltdowns
Sleep should be addressed for all children
Routines will go a long way
Mark the passage of time
Verbal reassurance for middle schoolers
Saving grace for teenagers
Safety from lethal means

Tweetable Quotes:
“As long as the home environment remains safe and their attachment, as well as the figures that they are attached to, remains safe and accessible and available, these younger kids can actually do really well.” - Dr. Zakia Alavi
“Parents are in charge in many ways and now more than ever their self-regulation is how the kids are going to regulate.” - Dr. Zakia Alavi

Resources Mentioned:
COVID-19 Parental Resources Kit – Early Childhood
Helping Kids Cope with the Holidays During the Pandemic
Resources for Helping Kids and Parents Cope Amidst COVID-19
Parenting in a Pandemic: Tips to Keep the Calm at Home
Body Keeps The Score

16 My Holiday Gift to You: Pediatricians are Awesome! with Dr. Michael Klein

Wed, 23 Dec 2020 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
Today, my gift to you is Dr. Michael Klein’s inspiring words that has carried me forward since the first time I heard them. Dr. Klein is a retired pediatric surgeon who served as chief of pediatric surgery at the Children’s Hospital of Michigan in Detroit for almost 40 years. His swan song in clinical surgery was a two-month service in Liberia with Doctors Without Borders. He joins us in this episode to share his unwavering commitment to invest in children, who he believes are the driving force that can move the world forward. In order for children to change the world they need guidance and care, and this is where pediatricians can help shape the future.
Let Dr. Klein’s words inspire you!
[00:01 - 08:13] Opening Segment
Welcoming today's guest, Dr. Michael Klein
Dr. Klein’s road to pediatric surgery
Overseas work
Two greatest medical inventions for Dr. Klein

[08:14 - 24:44] Pediatricians are Awesome!
Dr. Klein talks about the American Academy of Pediatrics
Democracy at its best
Dr. Klein tells us why pediatrics is wonderful
Who are we serving?
What’s the most important force for human progress?
Vaccine education is a must

[24:45 - 37:08] Pediatricians are Crucial
Dr. Klein talks about thriving under pressure
He tells us why pediatricians are crucial in the community
Why should pediatricians join chapters and national associations?
Issue-based politics benefitting children

[37:09 - 42:26] Closing Segment
Love your pediatricians
Dr. Klein’s parting words
Final Takeaways
The American Academy of Pediatrics
A pediatrician’s role in making the world better
Children are the answer
Return of Investment of children
Toxic stress

Tweetable Quotes:
“It really takes a lot of courage to go into the office, see a patient, make a decision, and walk out and realize that you’re gonna be wrong.” - Dr. Michael Klein
“If we want to improve the economy, if we want better symphonies or better jazz, if we want better athletic teams or better social relationships, the way to get them is to invest in children.” - Dr. Michael Klein
Resources Mentioned:
Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
Thinking Developmentally
Heckman Early Childhood Development ROI
Doctors Without Borders

If you’d like to connect with Dr. Klein, email mdkleinmd1@me.com. Also, visit https://www.miaap.org/ to learn more about his space.

If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter or email me at gagginol@yahoo.com. To learn more about me visit

15 Caring for Transgender Youth with Compassion: What Pediatricians Must Know

Wed, 16 Dec 2020 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
We have an important discussion today about LGBTQIA+ patients. Dr. Dan Shumer, Clinical Director of the Child and Adolescent Gender Clinic at Mott Children’s Hospital, will join us to share his story about caring for his transgender youth patients. His observations are promising as the youth are now becoming more and more vocal about their sexual orientation, gender identity, and gender expression (SOGIE). It is critical the healthcare providers understand the needs of this population. Creating a safe space in our practices supports not only the youth but also their families.
Let’s listen to Dr. Shumer and learn how pediatricians can care for transgender youth with compassion.
[00:01 - 05:59] Opening Segment
Welcoming today's guest, Dr. Dan Shumer
Dr. Klein’s talks about his clinic for transgender youth
Melting anxiety and shame

[06:00 - 13:37] The Tasks of Adolescents
Dr. Shumer’s thoughts about transgender youth
The difference between gender identity and gender dysphoria
The role of parents on their child’s growth

[13:38 - 23:48] Caring and Compassion
Mental health of LGBTQIA+ patients
Building a safe space for trans patients
A difference in gender identity and biological sex is normal
Find out why this is not a problem
Educational materials about caring for transgender youth
Links below

[23:49 - 32:21] Ethics of Care
Dr. Shumer’s treatment approach
“Pausing” puberty
Ethical issues to consider

[32:22 - 38:48] Closing Segment
Dr. Shumer’s parting words
Compassion is the first step to care for trans patients
Final Takeaways
Difference in gender identity and biological sex is normal
Parents’ dreams for their kids might differ from what the kids really want
Parent education is a must
Relevant educational resources are available
Timing and intervention are crucial in treatment
We need to look for mentors who can guide us
Compassion can make a big difference

Tweetable Quotes:
“...there are some things that parents can do to show that they love and support their kid even if they’re having some internal conflict...” - Dr. Dan Shumer
“Gender identity is a normal human characteristic and having a difference in gender identity compared to biologic sex itself is not a medical problem or a mental health problem.” - Dr. Dan Shumer

Resources Mentioned:
UCSF Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People
World Professional Agency for Transgender Youth – Standards of Care

If you’d like to connect with Dr. Shumer, email dshumer@med.umich.edu. Also, visit https://www.mottchildren.org/ to learn more about his space.

If you’d like to connect with me, you can find me at LinkedIn, Facebook, and

14 Racism: Its Impact on Children's Wellbeing and Changing the Narrative with Dr. Lynn Smitherman

Wed, 09 Dec 2020 11:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
The impact of racism on the health and wellbeing of children is significant and we must first examine our own implicit biases if we are to bring about change. We need to understand the differences between equity and equality and to advocate for our children, but in order to do so we have to educate ourselves and begin the change within. In this episode Dr. Lynn Smitherman, Vice Chair of pediatric education at Wayne State University School of Medicine walks us through definitions and constructs to better understand racism and antiracism.  Dr. Smitherman is the AAP District V champion for equity, diversity and inclusion and has long been advocating for children’s social wellbeing.
Let’s dive right in and hear Dr. Smitherman’s thoughts about the impact racism has on children and the need to change the narrative.   Dr. Smitherman offers strategies for change at the institutional, practice and individual level and provides multiple resources to drive change.
[00:01 - 08:39] Opening Segment
Introducing today's guest, Dr. Lynn Smitherman
Dr. Smitherman path to pediatrics
Comfort in talking with children and parents

[08:40 - 26:09] Racism
Dr. Smitherman talks about restorative justice
She talks about some terms related to racism
Bias
Explicit
Implicit
Discrimination
Prejudice
Racism
Institutional/Structural
Interpersonal
Internalized

[26:10 - 40:01] People of Color
Dr. Smitherman talks about racism in the context of medicine
She talks about ways to handle racism
For children
For pediatricians
Having allies from different backgrounds is crucial

[40:02 - 52:07] Education
We talk about addressing racism in the medical field
Educate yourself
Reflect on your current values
Dr. Smitherman shares some relevant resources. Links below.
How to tackle racism in childhood and adolescence
Positive messaging
The root of the problems

[52:08 - 58:00] Closing Segment
Dr. Smitherman tells us why we should stand against racism
Children are vulnerable
Final Takeaways
Differences among bias, prejudice, and discrimination
Racism’s impacts on children
Equity, diversity, and inclusion
Intentional effort to participate in change
Trust as a bridge to people of color
Personal change, practice change, and organizational change
Representation in the medical field

Tweetable Quotes:
“We all have biases because we are all human beings and we all have ideas and thoughts of things we like and don’t like.” - Dr. Lynn Smitherman
“...for racism to exist, there has to be not only that prejudice but also a feeling of superiority that one group is superior over another group.” - Dr. Lynn Smitherman

Resources Mentioned:
For Kids:
Your Kids Aren't Too Young to Talk About Race: Resource Roundup
They’re Not Too Young to Talk About Race
Embrace Race
How...

13. Psychiatric Consultation: The Doctor is In!

Wed, 02 Dec 2020 11:00:00 +0000

https://swiy.co/WhatAreYourThoughts
Today’s guest is Dr. Joanna Quigley, a clinical associate professor of psychiatry at the University of Michigan. She trained in pediatrics, general psychiatry, and child and adolescent psychiatry at the University of Kentucky and is part of the Michigan Child Collaborative Care (MC3) project at the University of Michigan, an outreach consultative program for primary care pediatrics, family medicine, and obstetrics.
Let’s dive right in and hear Dr. Quigley’s thoughts about common mental health concerns we see in primary care and how psychiatric child collaborative care programs can offer us support.
[00:01 - 08:47] Opening Segment
Introducing today's guest, Dr. Joanna Quigley
Dr. Quigley’s path to child psychiatry
The differences between pediatrics and child psychiatry

[08:48 - 13:36] Collaborative Child Care
We talk about the benefits of collaborative child care programs
Learning from one another
Leveraging one another’s resources
Looking for collaborative care programs
State health departments
Keywords
Telephone consultation programs
Collaborative care consultation programs
Psychiatric collaborative consultation

[13:37 - 25:13] Psychiatric Consultation
Dr. Quigley shares some tips to make consultations easier
Current condition
Trauma history
Symptoms
She talks about a few best practices on selecting medications
Where to access these best practices? Links below

[25:14 - 40:27] Child Psychiatry
Managing screen time and media exposure of children
Setting limits is okay
Practical tip: Turn off the WIFI
Dr. Quigley talks about collaborations with primary care providers
Be intentional in your collaborative efforts
Be open to the fact that one visit won’t solve everything
We talk about this game-changing service in child psychiatry

[40:28 - 46:24] Closing Segment
Finding joys with patients and colleagues
Final Takeaways
Collaborative child care
Difficulties of primary care providers
Psychiatric and pediatric trainings
Trauma and anxiety
Symptom relief
Resources of best practice guidelines
Parent management of children’s social media use
“No question is too small, too stupid”

Tweetable Quotes:
“I do think that...it is okay [for parents] to set limits. Kids thrive on structure and consistency with expectations.” - Dr. Joanna Quigley
“You don’t need to solve everything that’s going on in one visit.” - Dr. Joanna Quigley
Resources Mentioned:
Michigan Child Collaborative Care
HealthyChildren
American Academy of Child and Adolescent Psychiatry
National Network of Child Psychiatry Access Programs
Stahl's Essential Psychopharmacology
American Academy of Pediatrics

If you’d like to connect with Dr. Quigley, email joannaq@med.umich.edu. Also, visit

12. Therapy for Children: Collaborating with our Mental Health Colleagues

Wed, 25 Nov 2020 11:00:00 +0000

https://swiy.co/WhatAreYourThoughts
Physicians rely on our mental health colleagues to provide comprehensive behavioral health treatment, but we often speak different professional languages. Today’s guest leads us through the mental health alphabet soup of therapies and explains what we can expect when we make mental health referrals. Sheryl Lozowski-Sullivan, MPh, LP, PhD, is a clinical psychologist specializing in evidence-based interventions and psychological assessments for adults and children.
Dr. Lozowski-Sullivan founded the Integrated Behavioral Health Psychological Services, which provides talk therapy, testing and assessment, feeding, toileting, and parenting support, cognitive behavioral therapy for insomnia, hypnotherapy, occupational therapy, and intuitive art therapy.
Building collaborative relationships with our mental health colleagues benefits our patients and families and improves our skills as well. I am delighted to welcome Sheryl to the podcast and she has been a trusted colleague in the development of interprofessional partnerships.
[00:01 - 05:55] Opening Segment
Introducing today's guest, Sheryl Lozowski-Sullivan, MPh, LP, PhD
Expertise and work
Sheryl gives some background on her story
Personal battle against cancer
External practicum program with me
Integrated behavioral health
Health interventions on pediatric conditions

[05:56 - 17:55] Why You Should Not Always Believe Your Thoughts
Choosing a specific type of therapy
Sheryl talks about mental health in the United States
Clinical psychology and social work
Mental health as a discipline
Behavioral therapy
Referral source rates
Combination of behavioral therapy and medication
Cognitive Behavior Therapy
Automatic thoughts
Counter thoughts
Thought-restructuring
Need for a coach

[17:56 - 33:50] 7 Things to Feel Better
We talk about “selling” therapy to the child’s family
Recognizing that whatever the child experiences is real
Listening to the child
Dealing with anxiety disorders
Sheryl walks us through the Activation Therapy
Experiential
Determined by and dependent on the patient
She talks about not needing to know the diagnosis always
Changing behaviors in therapy
We talk about how to feel better, especially during the COVID-19 pandemic

[33:51 - 43:01] Collaborating with our Mental Health Colleagues
Sheryl shares how to increase visit rates to therapy
Mind-body dichotomy is artificial, not real
Educating parents and guardians about pediatric conditions
The importance of a mental health professional near you
Can we separate the mind from the body?

[43:02 - 49:38] Closing Segment
I give my thoughts about the role of mental health professionals in therapy
We need to address low patient referral rates
Final Takeaways
Types of therapy
Areas of expertise of therapists
Integrated behavioral health
This should be advocated and funded
Mental health has long been waited by psychologists

Tweetable Quotes:
"Don’t believe everything you think … Just because a thought pops in your head doesn’t mean you have to believe it.” - Dr. Sheryl Lozowski-Sullivan
"Make sure, if you’re suspecting anxiety of any sort, of which OCD is one, please make sure that you’re referring to someone who’s doing evidence-based practice. Talking about anxiety doesn’t fix anxiety.” -

11. Collaborating with Child Psychiatrists: Promoting Optimal Mental Health Care for Our Most Vulnerable Children with Dr. Jeanette Scheid

Wed, 18 Nov 2020 11:00:00 +0000

https://swiy.co/WhatAreYourThoughts
Dr. Scheid is a practicing Child and Adolescent Psychiatrist and Associate Professor at MSU whose primary research interests are in the area of mental health services and public policy for children and adolescents with limited resources and multiple needs. Dr. Scheid’s work encompasses the full scope of child and adolescent psychiatry including disruptive behaviors, mood, and anxiety disorders, and eating disorders and much of her focus is on improving the health and well-being of the youth served by the Michigan Department of Health and Human Services. She welcomes collaboration with primary care providers to promote optimal care to some of our most vulnerable children.
Let’s dive right in and hear Dr. Scheid’s thoughts about improving psychiatric care for all children and particularly those in the child welfare system.

[00:01 - 09:13] Opening Segment
Introducing today's guest, Dr. Jeanette Scheid
Expertise and work
How we know each other
Dr. Scheid gives some background on her story
Started in pediatric hematology
Always wanted to work with kids
First rotation in psychiatry
First mentors at MSU
Dr. Scheid talks about shifting careers
What is it that excites you
Look around and look at your colleagues
Thinks about the day to day aspects

[09:14 - 24:45] Dealing with Child Trauma in the Welfare System
Dr. Scheid talks about her consultancy with the Child Welfare System
Interests in trauma
Working in Pittsburgh
Open doors to become a consultant
Dr. Scheid’s training focuses
Understanding the other point of view
Foster parents lack empowerment
You can’t assume
Everyone brings in their own experience
Experiences and lessons with children in bio-families
Everyone has a unique experience
How can we support the parent
Strengths and weaknesses analysis
All or nothing may not be the answer
Dealing with gaps in background information
How do you find out the best practices for the individual
Acknowledge what we don’t know

[24:56 - 36:56] Deprescribing and Polypharmacy
Dr. Scheid’s insights on polypharmacy
The presence of other problems
Hard to know a single diagnosis
Take a step back and look at the history
Is there evidence of benefits
Back away based on risk
Start slow as you go down
I summarize my own experience
Dealing with dependency
Depression example
Gauging this impact of symptoms
Aggressive behavior assessment
Psychosocial intervention
Links you can find below
The issues of diagnosing
The levels of confidence

[36:57 - 44:12] Building Relationships with Psychiatry Colleagues
Dr. Scheid’s thoughts on relationships with colleagues in psychiatry
It all requires time and energy
Getting the most recent documentation and records
Having open communication
Dr. Scheid’s example
Getting to know your colleagues
It’s fun and informative
Making friends and connections

[44:13 - 53:19] Closing Segment
Dr. Scheid talks about resources that can help
Links below
Dr. Scheid’s advice to her younger self
Dealing with the answer no
Don’t be afraid to name your lack...

10. Meeting the Educational Needs of Children - Collaborating with Our Colleagues in Schools

Wed, 11 Nov 2020 11:00:00 +0000

https://swiy.co/WhatAreYourThoughts
Let’s have some tough conversations around special needs, race and disabilities in school. I’ll be discussing this with today’s guest and my friend Rikki Saunders. Rikki is the director of special education at Kalamazoo Public Schools. She has also worked as a social worker in school and the community. Her role today is to find and identify children with disabilities who are enrolled in public schools in the Kalamazoo district and in need of special education and related services. She also helps educate staff to ensure they have the capacity to fulfill their responsibilities to execute Child Find under the Individuals with Disabilities Education Act.
I’m excited to learn more from Rikki on meeting the educational needs of children, and how to collaborate with colleagues in the schools.

[00:01 - 08:45] Opening Segment
Introducing today's guest, Rikki Saunders
Expertise and work
Rikki gives some background on her story
Always had a love for children
Time and degree at UMich
School social work
Passionate about special education
Preparing them for life
We can do better

[08:46 - 14:54] Changing Our Thinking of School
Rikki talks about needing to change our approach
We are here to serve
We don’t turn people away
People come in with trauma
Some are even homeless
Consistency is key
This system has everything the kids need
The impact on children
It’s their day to day existence
Teachers spend as much time with kids as parents
It goes beyond reading and writing

[14:55 - 26:56] How Schooling Involves the Medical Community
Rikki talks about kids coming into school with disabilities
Qualifying for 504
Diabetes example
The options you have
Teachers are responsible to accommodate needs
Qualifying for IEP covered through IDEA
The school has to show qualifications
The issue of behavior
Determining if behaviors are a disability
Can you progress?
Response to an Intervention RTI
Burden of proof
The autism example
It has to impact education to qualify
The social side of disabilities
Rikki’s procedure
Can they do what their peers are doing?
Social is part of the disability

[26:57 - 53:56] Speaking to Bias and Race and Asking the Questions
Rikki talks about her responsibility
The main mission
Environmental vs. eligibility
The African American Male example
Rikki talks about analyzing the race and social climates of certain communities
Diversity is in the school
Home is separate
Cultural relevance training
Being culturally aware
We need to be included in the conversation
It’s not the answers, it’s the discussion
It’s uncomfortable but we need to talk about it
What Rikki does to enter the conversation
What do you know for sure, and what do you think?
Challenging certain ideas
Be clear on what you know for sure
You can’t ignore the issues
How Pediatricians should go about talking about police safety
Having The Talk
Know that it can be stressful for families
How certain areas are affected over others
Ask the questions
Do you feel safe?
Giving the feeling of

09. School Struggles ADHD or is it?

Wed, 04 Nov 2020 11:00:00 +0000

https://swiy.co/WhatAreYourThoughts
Maybe it’s not ADHD, maybe it’s something else we’re not seeing. I’ll be discussing this with today’s guest Dr. Arthur Lavin. Dr. Lavin was educated at Harvard (BA) and Ohio State (MD). At Harvard, Boston Children’s Hospital, and MIT, he completed training, became board-certified in general pediatrics and the subspecialty of newborn medicine, taught, and published original research in such journals as Science. He has been in pediatric practice for more than 25 years and has served on several national committees of the AAP, as president of the Northern Ohio Pediatrics Society. Dr. Lavin is also co-author of the book, “Who’s the Boss? Moving Families from Conflict to Collaboration.
Let’s dive into Dr. Lavin’s incredible insights on school struggles, childhood experiences, and ADHD.

[00:01 - 07:57] Opening Segment
Introducing today's guest, Dr. Arthur Lavin
Expertise and work
Dr. Lavin gives us a bit of his background
Experience in Harvard training
Passionate to work with people through relationships
Dr. Lavlin’s experience in the Neo-Natal ICU
Building trust with families
Dr. Lavin’s thoughts on psycho-social
It’s our entire experience
Connecting with people

[07:58 - 19:05] Let Them Solve the Problems They Started
Dr. Lavin talks about writing his book
Meeting the co-author
The collaboration process
Dr. Lavin shares about speaking on struggles and family dynamics
Most intense discussions
It’s not the parent’s job
If the child creates the problem let the child solve it
Person A can’t solve the problem that person B started
The adolescent makes the choices
Looking at yourself as the parent
What makes you care so much about this issue
It may not be all about the child

[19:06 - 34:32] Impairing Childhood Behaviors; Is it Really ADHD?
Dr. Lavin shares his insights on ADHD
Coming at ADHD like it’s a fever
Why do you have a fever?
It is a symptom of underlying issues
When you treat the better explanation
A 3rd of the kids coming in for ADHD didn’t actually have it
AAP article - link below
Understanding the underlying issues
My own analogy
Do the drugs work?
Learning disabilities, anxiety, messy family
How relationships come into play
An opportunity to help
These issues tend to be mutually exclusive
What is the engine driving the issues?
Good relationships get answers
The diagnosis is in the history

[34:33 - 40:50] The AAP Guidelines
Dr. Lavlin talks about the changes in the AAP
The two papers on the guidelines - links below
Differential Diagnosis
Looking at all the possibilities and resources
We talk about other helpful resources
Look at the resources below

[40:51 - 52:03] Closing Segment
What would you say to a younger Dr. Lavin?
Recognize that the MD carries a lot of power
Thoughts on burn out and relationships
The music analogy
Final Takeaways
It’s all about relationships
Child behavior problems take reframing
Think bigger to include other issues
The fever analogy
Use your title
Do...

08. Screening Youth For Suicide Risk: Can it be done in a busy pediatric practice?

Wed, 28 Oct 2020 11:00:00 +0000

https://swiy.co/WhatAreYourThoughts
As a pediatrician screening for suicide, it’s not about the ones you find positive for suicide, it’s about the ones you may miss. Today’s guest Dr. Horowitz is a Staff Scientist and Pediatric Psychologist at the Nation Institute of Mental Health Intermural Research Program at NIMH and for years she has been helping health care professionals not let kids slip through the cracks. She excels in Suicide Risk Detection and is head PI in several ‘Suicide Prevention Protocols’ using the ASQ Toolkit. She assists hospitals, schools, and pediatric centers in implementing Suicide Screening of patients.
Let’s dive in a learn how we as busy professionals can incorporate this suicide screening in our practices.
[00:01 - 10:01] Opening Segment
Introducing today's guest, Dr. Lisa Horowitz
Expertise and work
Dr. Horowitz gives us a bit of background on his story
How Dr. Horowitz got into her field of work
Late 90’s, mental health patients flooding hospitals
Saw the need for a suicide screening tool
Used as a Fellowship Project
Push back from nurses
Moved to DC to get a job at NIH
Dr. Horowitz story developing screening for the hospital
Creation of ASQ

[10:02 - 15:56 How To Implement Screening Even if You’re Not an MH Expert
Dr. Horowitz talks about how doctors who aren’t mental health experts can ask screening questions
Pilot study results
60%-80% response rate
Asking parents to step out
Nurses asking the kids without parents in the room
Creating a Script to model
Most parents responsive
Are there risks to the screening?
Studies show that you can’t plant the idea of suicide if it’s not there
Asking the questions help, they don’t hurt

[15:57 - 22:07] Getting Comfortable with the Whole Script for the Busy Practitioner
Dr. Horowitz talks about giving the whole script
A fear for busy doctors
Don’t change the questions
Getting comfortable with the language
Getting over the worry of screening positive
Positive screenings are very rare
When you have one, you can save a life
It’s not one size fits all, not everyone has to go to the emergency room

[22:08 - 41:38] Translating From Emergency Room to Primary Care
Dr. Horowitz talks about how this can translate into Primary Care
Suicide is the second leading form of death
Training that pediatricians receive is very little towards what actually kill kids
The problem of don’t ask don’t tell
The facts of fighting suicide
We haven’t made a dent in rates in over 50 years
Dr. Horowitz story of Pediatrician using the screening
Worried about the ones you miss, not the ones you don’t
A lot of people go to health care before their death
The difficulties of these screenings
Are they safe?
What to do if you get a positive
What is included in the ASQ toolkit
Screening vs. assessment
BSSA for Pediatricians
Very rare if you need to get them to an emergency room
The value of having MH experts in your practice
My own experience in risk assessment
Clinical pathway
Using the guide is not as hard as you think
Other ways to learn and work with families at risk

[41:39 - 55:07] Closing Segment
Alternative measures to preventing risk
Ex: safe storage of...

07 The Art of Conscious Parenting with Dr. Robert Saul

Wed, 21 Oct 2020 14:00:00 +0000

https://302.buzz/PM-WhatAreYourThoughts
It’s apparent now more than ever, our children need advocacy. Today I’ll be speaking about this with Dr. Robert Saul. Dr. Saul completed his pediatric training at Duke University Medical Center. He deeply cares for all children, and after seeing the need for child advocacy in society he was led to write several books for parents. Dr. Saul believes we need constant reminders about the optimal nurturing of children, and his work provides a multi-dimensional approach to parenting that is refreshingly new.
Let’s dive in and learn the art of conscious parenting for our own family, and for the parents of our patients.
[00:01 - 07:03] Opening Segment
Introducing today's guest, Dr. Robert Saul
Training and studies
Author of several books - links below
Dr. Saul gives us a bit of background on his story
Finished residency in the mid-’90s
A need to connect to the community
Devoting resources to be the solution
The impact of Columbine on Dr. Saul
Wrote articles in the newspaper to educate
The 5 steps to community improvement
Inspired to write books to teach himself

[07:04 - 14:59] My Children’s Children
Dr. Saul’s own experience from childhood
Parents divorced at the age of 9
Verbally abusive household
Read back on his mother’s journals when she passed
Becoming the evil parent for your parent
Dr. Saul’s insights on parenting and pediatrics
The paternalism and maternalism of pediatrics
Child advocacy project
SSNR vs. SSRI
You need both, but SSNR will create lasting change
Identifying and boosting SSNR’s

[15:00 - 24:15] The Art of Conscious Parenting
Dr. Saul talks about the basis of Conscious Parenting
Dr. Saul’s story with his own child
Based on forgiveness
The model of the Parental Awareness Threshold
Dr. Saul’s story of Conscious Leadership
Above the line vs. Below the line
Being conscious of where you are on the line
Parenting works the same way
How to make a conscious effort as a parent
Pause, assess, and choose
Example

[24:16 - 33:06] Being and Raising a Good Citizen
Separating approaches by age range
The value of having a partner along the journey
Another point of view
Safe stable relationships are for parents as well
Dr. Saul talks about how his book aids parents
Short read
Step by step approach
From someone who is also learning
Raising a good citizen
Don’t become elderly, become an elder
Getting socially reconnected
Get involved and stay involved
Practice forgiveness personally and communally
Be part of the solution

[33:07 - 46:45] Closing Segment
A word for parents in hard living environments
3 levels of intervention
Active integration and support for these families
Advocacy can be part of the solution
Engaging the well-being of pediatricians
Seek out people who share your values
Don’t do it alone
Refuse to become discouraged
How Dr. Saul stays engaged
Dr. Saul talks about his book for children
Growing in wisdom
Final...

06. Listening to Parents: We don't always have to know everything!

Wed, 07 Oct 2020 14:00:00 +0000

https://swiy.co/WhatAreYourThoughts
Have you ever looked at your child or a patient and just thought, ‘oh my God, I don’t know how to fix this’? You’re not alone and we’ll talk about this today with our guest Sandy Fowler, host of the Mighty Parenting Podcast. Sandy is a stress relief and wellness coach, a wife, mom, and business owner whose passion is teaching people to make powerful choices that impact their lives in the best possible way and help them take back their life from the busyness and stress of modern-day living.
Let’s get right into the episode and learn from Sandy how we as pediatricians don’t always have to know everything, and what it looks like to partner with parents to learn together.
[00:01 - 08:13] Opening Segment
Introducing today's guest and my friend, Sandy Fowler, and what we will be talking about
Met on her podcast to talk about the topic of suicide prevention for parents
Listen to my guest appearance on her podcast here
Sandy gives us a bit of background on her story
Help parents learn emotional wellness tools
Why this age group
You don’t have to know the answer, just understand that you’re not alone

[08:14 - 13:01] Shhhh, Just Listen and Check Yourself
Sandy talks about common themes she finds on her show
Our teens still need us, but it needs to look different
Listening - a safe place to talk
Coaching
Modeling what it is we want them to do
Listening and coaching for kids
Parents need to be willing to check themselves
Pediatricians should help, not judge
Recognize and acknowledge things in yourself
Self-regulation
Try not to blow up

[13:02 - 24:56] We Don’t Always Have to Know
Sandy shares her experience with pediatricians
Expectation of partnership
Sometimes the doctor just doesn’t know what to do and end up doing the wrong thing
Be okay not knowing as a pediatrician
Be honest with the parents
Explore options as partners
Sandy talks about a positive story with her daughter and her doctor
Non-disclosure
Gave the option to speak directly
There is help
I talk about our training as a pediatrician
Acting on things you may not know
A parent wants to know they have help, not just an answer
Sometimes it’s a skills issue
“I don’t have a pill for a messy family”
Chaos impacts behavior
Sometimes we can’t just fix the kid
Sandy talks about what we can do to help the family
Non-judgmental
Partnership and options
Realize that the issues can connect to a still-developing brain

[24:57 - 30:07] Calmness is Key
Communication with the child is key
Don’t panic
Our calmness helps the child
Pause and let the silence sit until the child is ready
I give an example with a code lead manager

[30:08 - 39:34] Closing Segment
A word for parents
Your kids will be okay
Accept what you don’t know
We can be there for parents
The silence is...

05. Substance Use Disorders and Childhood Exposures: What you need to know with Dr. Allek Scheele

Wed, 30 Sep 2020 11:00:00 +0000

https://swiy.co/WhatAreYourThoughts
Welcome to Pediatric Meltdown, the podcast for busy pediatricians who want to better understand children's emotional health, behaviors, and gain the skills and knowledge to help them thrive. I am your host, Lia Gaggino. In this episode, I had the honor of speaking with Dr. Allek Scheele. Dr. Scheele is currently doing her pediatric hospitalist fellowship at the Helen DeVos Children’s Hospital in Grand Rapids. Her research focuses on pediatric and adolescent substance abuse and exposure.
Let’s dive into Dr. Scheele’s expertise so we can learn the hard truths behind child substance abuse and what we can do to arm ourselves, the children, and parents with tools and strategies to prevent problems in their lives.
[00:01 - 04:24] Opening Segment
Introducing today's guest, Dr. Scheele, and what we will be talking about
Dr. Scheele talks about how she got into her field
Opioid epidemic conference sparked her first interest
Led a project on marijuana exposure
Became addiction medicine certified
Reflected on her passion and decided to do a Pediatric hospitalist medicine fellowship in her second year of residency

[04:25 - 17:53] The Shocking Truth Behind Substance Use and What To Do
Dr. Scheele talks about the truths behind adolescent and adult addictions
The average age of addiction starts around 12
Preventative pediatrics can make a difference
I talk about my experience with a 9 year old patient
Monitoring the Future Study
“You can’t tell who’s a good kid”
Anyone can have a use disorder
Dr. Scheele breaks down how to deal with prescriptions
Talk with the family
Don’t over-prescribe
Not all pharmacies take back opioids
Promote putting out notices for when there is an event
Dr. Scheele talks a bit about vaping
The last two to three years has shown the largest substance increase we’ve ever had
These vaping products are obviously geared towards children
All Juul products have nicotine and most teens are being tricked into getting hooked
One pod equals a pack of cigarettes

[17:54 - 32:55] What We’re Seeing in the ER
Dr. Scheele talks about the dangers of marijuana vaping
Increase in accidental ingestion
Decreasing stigma
Marijuana ingestion is getting more creative causing kids to take in higher volumes
Kids coming in with altered mental status
What to screen for
Dr. Scheele talks about preventative pediatrics
Work asking about substances into your check with the adults
The Vapors in the house can cause an infant to test positive for THC
This can also be absorbed into their skin affecting long term brain development
ADHD
Schizophrenia
Substance Abuse Issues
I talk about promoting awareness
How to work with adolescents
Get to know who their friends are
Make it nonchalant
Be non-judgmental
Ask what it is they like about what substance they’re taking
Know stopping smoking weed will stop cyclical vomiting

[32:56 - 37:28] How to Deal With Alcohol Abuse
Dr. Scheele talks about the current state of AA
Know that it is part of the culture
Fortunately there is a decline in binge drinking
Gear...

04. Perinatal Mood and Anxiety Disorders: Asking Mom's if They're 'OK' with Kristina Ledlow

Wed, 23 Sep 2020 11:00:00 +0000

https://swiy.co/WhatAreYourThoughts
In today’s episode, I have the pleasure of speaking with my amazing friend and co-chair of the Kalamazoo Perinatal Mood Disorders Coalition, alongside myself, Kristina Ledlow ICCE, CD, CPD. After two very challenging pregnancies and postpartum periods, Kristina became especially passionate about educating families and other healthcare professionals about Perinatal Mood and Anxiety Disorders. Kristina holds certifications as a Childbirth Educator, Birth Doula and Postpartum Doula in Kalamazoo, Michigan. She also works for OB-GYN, P.C. as their Patient Educator, and teaches classes for Bronson Methodist Hospital.
Let’s dive into Kristina’s story and expertise so that, whether you are in pediatrics, a parent, or someone who knows a parent, you can be well equipped to help moms or even yourself get connected and be okay.
[00:01 - 07:50] Opening Segment
Introducing today's guest and my friend, Kristina Ledlow, and what we will be talking about
Certified in Postpartum Support International (PSI)
Doula
Patient educator
Kristina talks a bit of journey to expertise in PMAD and prevention
Severe depression and anxiety during two births
Several Risk factors going into both pregnancies
Manifested OCD tendencies
Connected with a therapist and put on medication
Went into childbirth education and perinatal mood disorders

[07:51 - 12:44] The Effects of PMAD
I talk about my shared experience with postpartum depression
Kristina talks about the impact on partners and babies
Mothers mood affects everyone
Losing function
1 in 5 moms affected, 1 in 10 dads affected
Dad’s can also break down from the stress and exhaustion
Each baby comes with their own personality and challenges

[12:45 - 25:30] Ask Mom’s if They’re Ok
Screening moms during pregnancy and postpartum
Worry of opening a pandora's box
Kristina talks about the importance of asking
Using the Edinburgh tool
Negative hormones in the mom affect the baby during pregnancy
Social workers and network to work with patients
Asking is therapeutic
You’re not crazy, this happens, let me get you connected
PMAD Virtual Care
Get them connected
Have a plan
We need to get moms connected to the right people
Use Postpartum Support International and get a coordinator involved
94% of moms have ‘scary thought’
1: OCD thoughts
2: Postpartum psychosis (rare but dangerous)
Believing the thoughts to be true and acting on it
It’s common to feel like this, it’s ok and there is help
Putting strategies in place
Getting good sleep by chunking

[25:31 - 34:46] Practical Advice and Actions to Face PMAD
These disorders can last up to two years
The strongest moms can feel like a failure
Postpartumstress Instagram
Don’t tie your self worth to social media
It’s ok to feel the way you do
Kristina shares self care tips
Reach out and ask for help
Support is key
Ask: how can I help?

03. Pediatric Hero: Building Safe Spaces for Kid's Emotions with Dr. Mark Sloane

Wed, 16 Sep 2020 11:00:00 +0000

https://swiy.co/WhatAreYourThoughts
Welcome to Pediatric Meltdown, the podcast for busy pediatricians who want to better understand children's emotional health, behaviors, and gain the skills and knowledge to help them thrive. I am your host, Lia Gaggino. In this episode, I brought in Dr. Mark Sloane. He is a board-certified pediatrician and an adolescent medicine specialist.
Let’s dive into Dr. Mark’s story of how important it is to build a safe space for kids with mental illnesses and how to get involved in your community to help with kids’ healing process. This is a movement that is not restricted to medical practitioners alone, everybody can make an impact on kids’ lives and we are all in this together.
[00:01 - 11:02] Opening Segment
Introducing today's guest, Dr. Mark Sloane
Dr. Mark talks about his career
He wasn't ready to practice because of limited training
He did ADHD-related work
Worked in a Trauma Center
Most moms were exposed to drugs, alcohol and domestic violence
How can we help kids with their functional outcomes?
Working across different systems
How do we achieve better outcomes and success?

[11:03 - 28:11] Building Safe Spaces for Kids’ Emotions
Dr. Mark talks about continuing to improve the medication process dealing with kid's mental illness
Looking for a holy grail pay off
How do we make things safe for kids with trauma?
Dr. Mark talks about using the same med-model on kids of different ages
Some families have no problems with their older kids but struggle on the younger ones
Kids being traumatized by the system
Getting compared to their siblings
Where do kids feel safe?
With school, teachers and their doctors
Helping them remember somebody they trusted
The Power of Adult's Resilience
If a kid has an adult that is crazy about them, this will help them big time with their healing process

[28:12 - 38:36] Collaborating with Other People
Medicine and Prescriptions are just not enough
Medicine only works to a certain extent
Anybody can make an impact on kids' recovery process
You don't have to be a psychiatrist
Dr. Mark talks about bringing in different people to help with primary care work for kids
Making connections
Schools need to work with doctors and vice versa
How do you get everybody on the table?
Having the right infrastructure buildings and personnel
We will all benefit from doing it. It's hard but worth it!

[38:37 - 44:40] Closing Segment
There are so many ways that we can help and support these programs
We are all in this together
Final words from me and Dr. Mark

Tweetable Quotes:
"If a kid has one adult that's irrationally crazy about them that can matter and that's enough." - Dr. Mark Sloane
"Primary care has been traumatized and the answer is relational change by reaching out to other people to help us mend our own trauma" - Dr. Lia Gaggino
Resources Mentioned:
Thinking Developmentally - Andrew Garner
Children's Trauma Assessment Center - WMU Kalamazoo
Bruce Perry, MD, PhD – www.bdperry.com
Ross Greene, PhD – www.drrossgreene.com

If you’d like to connect with me, you can find me at

02. Caring for Children in Foster and Kinship Care: Keeping a Trauma-Informed focus with Moira Szilagyi

Wed, 09 Sep 2020 11:00:00 +0000

https://swiy.co/WhatAreYourThoughts
Welcome to Pediatric Meltdown, the podcast for busy pediatricians who want to better understand children's emotional health, behaviors, and gain the skills and knowledge to help them thrive. I am your host, Lia Gaggino. In this episode, I had the honor of speaking with Dr. Moira Szilagyi. Dr. Szilagyi is regarded as one of the leading experts on the health of children in foster and kinship care and has served as chair of multiple AAP groups over the last 25 years leading the development of health care standards for children and teens in out of home care.
Let’s dive into Dr. Szilgayi's incredible story of how important it is to know the Three R’s and be a catalyst for change in the child welfare field, as well as to have trauma-informed focus as you learn, grow and impart skills to your fellow workers and the parents of your patients.
[00:01 - 11:08] Opening Segment
Introducing today's guest, Dr. Moira Szilagyi, and her achievements
Dr. Szilagyi talks about how she got into her career
Medical school at 28
Realized she wanted to work with high risk kids
Began working in Foster Care
“These kids deserve better”
Dr. Szilagyi tells a story of the one patient that inspired her to work in this field
She realized the foster kinship care needed higher standards and better systems. And that there wasn’t literature on the subject or training.
Begins to work on a task force
Charged with making different models of care
Centralized care
Opening 24/7
Run like a regular practice

[11:09 - 25:52] Trauma Informed Focus
Dr. Szilagyi tells a story of handling a child victim of fetal alcohol syndrome
Dr. Szilagyi now mentors many young people as an academic pediatrician
Remain open and find your passion
Children in Kinship Care became Dr. Szilagyi’s passion
Realizing these kids are coming in with so much grief and loss
Most return into family
Some disappear
Lifelong trauma
Dr. Szilagyi talks about their grant with AAP funding
Dr. Szilagyi talks about the kids in her foster care
You need the skill to actualize love
The kids can’t think they are going to be abandoned again even though the foster parent can’t promise a permanent home
They need to know they always have a home in the heart of the foster parent

[25:53 - 36:15] The System of Foster and Kinship Care
Dr. Szilagyi talks about her time in Rochester
Developmental path of psychology literature
Learning what children need to thrive
The Adverse Childhood Experience
Found problems leading to obesity back from childhood
Divided into 10 issues
The importance of healthy attachments from a young age
Early Brain Development: AQA GCSE
Harvard Developing Child
Children exposed to a chaotic environment adapt to living in such conditions
Knowing that you have to stay with the child THROUGH their trigger response

[36:16 - 46:53] Advice for the Busy Pediatrician and Parent
Dr. Szilagyi talks about the needed skills of the pediatrician
“What happened to you”
Give tools to the children and the...

Welcome to Pediatric Meltdown

Fri, 04 Sep 2020 11:00:00 +0000

https://cutt.ly/WhatAreYourThoughts
Hello and welcome to the Pediatric Meltdown Podcast, the podcast for busy pediatricians who want to better understand emotional health and behaviors and gain the skills and knowledge to help them thrive. I’m your hostess Dr. Lia Gaggino, and I’d like you to come on this journey with me to hear from leading experts in the field as well as other parents to become the best health care practitioners and parents/guardians we can be, in a way that feels less like a lecture and more like a conversation over dinner. We need all the help we can get to take care of our kids, and I believe that the more we learn the better this world will become.
[00:01 - 01:05] Opening Segment
Introduction for the podcast
Created with pediatricians in mind but hope parents and other professionals will listen in as well

[01:06 - 06:30] Why Pediatric Meltdown?
Imagine and put yourself in the place of children who can’t get through their struggles and their parents who don’t know how to help them
I’ve learned that these are unmet needs that are expected to be handled
The responsibility is on primary care
You will hear from professionals and parents alike
I want to share my passion and their voices
These won’t be lectures but conversations with friends
I will be linking resources form these conversations
The goal is inspiration
See one, Do one, Teach one
Let’s work together to help children thrive

[06:31 - 8:36] Closing Segment
I’d like to hear from you
I know how hard it can be
Thank you for joining me
Please give me your input and reach out to me
Links below
Closing

Tweetable Quotes:
“Imagine a conversation with a parent of a fifteen year old who doesn’t know what to do with their son who’s using drugs, or maybe it’s a six year old who’s throwing chairs at school, or a thirteen year old who overdosed after a bad argument with his dad, a foster child who can’t sleep at night, or one of your patients on the autism spectrum who wants to have friends but just can't figure out the social queues and so on. Imagine these kids’ meltdowns just dripping into puddles and the meltdowns parents have and, well, maybe even our own.” - Dr. Lia Gaggino
“We need hope, we need ideas, we need each other, to ensure that children thrive.” - Dr. Lia Gaggino
“When you listen I hope you will find a pearl, maybe a spark of excitement or creativity to help others out of dark places.” - Dr. Lia Gaggino

If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter or email me at gagginol@yahoo.com to let me know your thoughts and what you would like to hear in upcoming episodes. To learn more about me visit https://www.medicalbhs.com/

LOVE WHAT YOU HEARD? Leave us a 5-star review so we can continue to provide you with great content. Share this episode and help people know more about children’s health and well-being.

01. Words Matter- Talking about Weight and BMI

Thu, 27 Aug 2020 07:00:00 +0000

https://swiy.co/WhatAreYourThoughts
Welcome to Pediatric Meltdown, the podcast for busy pediatricians who want to better understand children's emotional health, behaviors, and gain the skills and knowledge to help them thrive. I am your host, Lia Gaggino. In this episode, I brought in my very own daughter, Julia Parzyck. She works in the eating disorder recovery space and has recovered from an eating disorder, herself.
Let’s dive into Julia’s story of how society impacts the mental health of patients suffering from eating disorders because of the BMI metric that tells them they are unhealthy or obese and how tough it is to have conversations and educating people more about food.
[00:01 - 04:52] Opening Segment
●     I introduce and welcome my guest and daughter, Julia, to the show
●     Julia talks about her eating disorder recovery journey
○     She grew up in a family with body image issues
○     She got bullied because of her weight
○     She went to a therapist to help her with her eating disorder recovery
[04:53 - 14:10] Children and Eating Disorders
●     Julia talks about the turning point of why she decided to recover from her eating disorder
●     Pediatricians goal with monitoring children's growth
○     How we try to prevent kids from having eating disorders
●     Julia shares her BMI issues
○     According to BMI, she was considered unhealthy and obese
○     Navigating her eating disorder in a healthier way
●     Julia weighs in on the mental aspect of patients with eating disorders
○     Eating healthy and exercising more is not very helpful advice
○     Living in a Fatphobic society
○     Having the right resources and education of what should their kids eat or not
○     Being compassionate in dealing with these patients
[14:11 - 22:48] Talking about weight and BMI
●     Julia weighs in on doctors dealing with kids' nutrition
○     BMI is not a measure of health
●     Having tough conversations with patients
○     Listening to patients
○     Dealing with families with a history of obesity
●     Feeding children the right information about food
○     Educate yourself so you can guide your kids
○     Children getting bad information online
●     Julia talks about intuitive eating
○     Emotional response to eating certain foods that are considered as "Good" or "Bad"
○     Society told us that being healthy means you have to be thin
[22:49 - 30:07] Taking The Right Approach
●     Having a team to have conversations and educate people about food
○     Adding on things instead of taking them out
■     The next time you eat a burger, have some salad with it.
●     Telling people they shouldn't have certain kinds of food in their homes
○     Do I have to be a certain weight in order to have these conversations?
[30:07 - 34:51] Closing Segment
●     Julia's...