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Dr. Peggy Greco shares practical tips for navigating challenging conversation with teens who have eating disorders and/or obesity including:

*  How to shift the conversation from WEIGHT to focus instead on HEALTH 
* How to focus on non-weight metrics of health such as:
·       mood

·       energy levels

·       activity levels

·       healthy eating habits

·       clarity of thinking
* How to understand why teens with eating disorders may be resistant to treatment

Dr. Peggy Greco, PhD is a pediatric psychologist with over 30 years of clinical experience. She serves as the Assistant Vice President, and Chief Patient Experience Officer for a large children’s healthcare system. One of her clinical areas of interest is in working with kids and families with eating disorders.

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Dr. Elise Fallucco interviews Dr. Sarah Garwood, a professor of pediatrics who specializes in eating disorders, about screening and managing eating disorders in primary care. They discuss screening tools, medical workup, and practical steps that pediatric clinicians can take to support children with eating disorders.

• Practical tools to  identify kids who are struggling with eating disorders including:
  • growth chart changes
  • SCOFF - 5 question eating disorder screening tool
  • NIAS - 9 item avoidance screener
• what pediatricians can do  to help patients with eating disorders 
  • medical work-up
  • comprehensive labs
  • establish regular eating patterns
• when to hospitalize a child/teen with eating disorders

 Dr. Garwood is a Professor of Pediatrics at Washington University School of Medicine who specializes in eating disorders.  Dr. Garwood’s work through the Adolescent Center in the Department of Pediatrics focuses on the unique health care needs of adolescents.  In August 2017, Dr. Garwood co-founded the Washington University Transgender Center at St Louis Children’s Hospital in order to support comprehensive medical and mental health services for transgender children and young adults.  Advocacy related to this role has included a TEDx Talk in 2019 

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How can we identify kids at risk for eating disorders  in pediatrics? How can we promote healthy relationships with food and with eating?  Our guest, Dr. Jennifer Leah Goetz, a double board-certified psychiatrist specializing in eating disorders, discusses:

·      the variety of eating disorders in kids, 

·      the prevalence, and risk factors for developing an eating disorder

·       how eating disorders come in bodies of all shapes and sizes 

·       questions that pediatric clinicians can ask to see if a child/teen is at risk of developing an eating disorder

·      Positive ways to talk about food with children to mitigate their risk of developing an eating disorder

Jennifer Leah Goetz, MD: is double board certified in general psychiatry and child and adolescent psychiatry. She completed her internship in pediatrics at Massachusetts General Hospital and her general psychiatry and child/adolescent psychiatry training at MGH and McLean. She previously served as medical director of the child and adolescent inpatient unit at Johns Hopkins Hospital and helped run the eating disorder clinical service. She is an attending psychiatrist at McLean hospital and an Instructor in Psychiatry at Harvard Medical School. She specializes in the care and treatment of those with eating disorders. 

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"Help! My preschooler has been kicked out of child-care and no one in our area can evaluate and treat young kids!" When and how should you prescribe medication for preschoolers with emotional and behavioral problems? Dr. Elise Fallucco shares her thoughts and suggestions on evaluating and treating these children. In cases where children have failed or are unable to access parent-child interaction therapy, she walks you through how to diagnose and understand these problems.  In cases of preschool ADHD, she discusses an evidence-based approach to judicial use of methylphenidate and amphetamine salts, and challenges the use of alpha-agonists in this age group. 

Dr. Elise Fallucco is a child psychiatrist, mom, and host of PsychEd4Peds.  She is a Professor of Pediatrics and Child and Adolescent Psychiatry with over 14 years experience in training pediatric clinicians to identify and treat mental health problems.

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 Parenting young children with behavioral outbursts can be very challenging. Dr. Joyce Harrison, early childhood psychiatrist from Kennedy Krieger / Johns Hopkins shares practical parenting tips and referral resources for families of young children.

**What parenting tips could pediatric clinicians share with parents of preschool-aged children?

o   Stay calm

o   Positive instructions; tell what they SHOULD be doing; + instead of “stop”

o   Catch them doing something good/right thing; PRAISE

o   Ignore negative behaviors

o   Consequences in the moment – be consistent, avoid idle threats

o   Child centered time, money in the bank ($) = TIME IN

o   Practice Effective Time outs 

o   Parents need time outs, too

** Any resources that you could recommend for pediatricians to help them take care of preschool-aged kids w/ behavioral problems?

1. Statewide child psychiatry access phone hotlines/ Pediatric mental health case access programs can help you find resources for young children in your area
2. Local AAP chapter may also know about local resources
3. The national AAP offers Early Childhood ECHOs for education
4. The AAP sells their Toolkit for managing BEP in kids younger than 5

About Dr. Joyce Harrison: 

·       Associate Professor of Child and Adolescent Psychiatry at Johns Hopkins University School of Medicine and Faculty at the Kennedy Krieger Institute

·       Previous and first Medical director of Maryland Behavioral Health Integration in Pediatric Primary Care program (CPAP)

·       Project director for Kennedy Krieger Institute’s Early Childhood ECHO programs

·       Co-chair of AACAPs Infant and Preschool Committee

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Temper tantrums can be so frustrating - for the child, the parent, the teacher, and everyone involved!  On episode 20 of PsychEd4Peds, Dr. Joyce Harrison, child and adolescent psychiatrist at Kennedy Krieger Institute/Johns Hopkins, shares with us an "8 S" framework for evaluating kids with temper tantrums. 

Q: What is on the differential diagnosis for a 4 year old with temper tantrums?

A: Thinking alphabetically, 

** A = ADHD, anxiety, and/or autism,

** C= communication difficulties, 

** D = developmental delay/intellectual disability, 

** T=trauma or adverse childhood experiences

Q:  What questions could the pediatrician ask the parent to sort through some of these possible issues?   

A:  It can be helpful to use the "Eight S framework"

§ 1 - Safety first

· Is this child safe?

· Are the people around this child safe? 

· Is this child safe to be treated in the setting that they're in? 

§ 2 - Specific behaviors 

· What is the child doing that makes the parent think something is wrong

· What is the most problematic thing? 

· What are you most concerned about?

§ 3 – Setting

· Where are the behaviors happening? (childcare/preschool, home, out w/ other people)

§ 4 - Scary/trauma 

· Has anything scary happened to this child/family? 

§ 5 - Services!!!!! 

· what kinds of services is the child getting now? (OT, PT, behavioral tx, meds)

§ 6 - Sleep

· How well are they sleeping? Any nightmares?

§ 7 - Social interactions

· Does your child have friends? 

· Does your child get invited to other things?

§ 8 - Speech problems

Dr. Joyce Harrison is an Associate Professor in the Division of Child and Adolescent Psychiatry at Johns Hopkins University School of Medicine. She is also on the Faculty at Kennedy Krieger Institute, a hospital serving children with developmental disabilities.  She is a nationally-recognized educator in early childhood mental health and its integration in primary care. She is the Project director for Kennedy Krieger Institute’s Early Childhood ECHO programs, and  Co-chair of AACAPs national Infant and Preschool Committee.  She served as the founding  Medical director of Maryland Behavioral Health Integration in Pediatric Primary Care program. She is President of the Association for Infant Mental Health, Maryland-DC chapter.

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Can we use information from our DNA to predict which medication will work for each of us? In this episode, Dr. Elise Fallucco talks about the latest information about pharmacogenetic testing and personalized medicine, and how they can (or cannot) be useful for treating ADHD, anxiety, and depressive disorders. She shares when and how pharmacogenetic testing can be useful.  In addition, she introduces Sequence2script, an online tool to help translate pharmacogenetic test results into clinical prescription recommendations. 

Dr. Elise Fallucco is a child psychiatrist, mom, and host of PsychEd4Peds.  She is a Professor of Pediatrics and Child and Adolescent Psychiatry with over 14 years experience in training pediatric clinicians to identify and treat mental health problems.

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How can we address family concerns about ADHD medications? What can we do to minimize and/or manage potential side effects? Join me as we discuss: 

1-  How to Address Common Parental concerns about meds for ADHD

o   Will his turn my kid into a Zombie? Mood changes? – stop if you notice these

o   Are they addictive? – No.

o   Potential for diversion of meds

 2 -    The risks of untreated ADHD

 3 - How to manage common ADHD medication side effects

·      Nausea, abdom pain, decreased appetite – take w/ a meal, calorie boost after med wears off

·      mild headaches

·      rebound hyperactivity, irritability – non-medication vs. medication approaches

·      sleep

·      cardiovascular effects

Dr. Elise Fallucco is a child psychiatrist, mom, and host of PsychEd4Peds.  She is a Professor of Pediatrics and Child and Adolescent Psychiatry with over 14 years experience in training pediatric clinicians to identify and treat mental health problems.

Check out our website PsychEd4Peds.com for more resources.
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Which med do you choose for ADHD? What do you do if the first med doesn't work? Join me as we review a step-wise approach for prescribing meds for ADHD.

Key points:
*Stimulants are first-line treatment for ADHD

Step 1: Choose which “class/type” of stimulant to start

Step 2: Decide whether short or long-acting

Three types of stimulants in my order of preference:

1.     MPH – my fave b/c fewer mood side effects

2.     Amphetamine salts – great also

3.     Focalin IR/XR – for those who don’t tolerate one of the other ones above

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Join me as I share some tips for how to evaluate kids for ADHD.  We will 

• review a clinical case of a 9 yo boy with behavior problems
• go through the differential diagnosis
•  share tools used in the evaluation
•  discuss how to talk to parents about a diagnosis of ADHD
• and how to explain to kids what it means to have ADHD

Dr. Elise Fallucco is a child psychiatrist, mom, and host of PsychEd4Peds.  She is a Professor of Pediatrics and Child and Adolescent Psychiatry with  over 14 years experience in training pediatric clinicians to identify and treat mental health problems.

Check out our website PsychEd4Peds.com for more resources.
Follow us on Instagram @psyched4peds