Pediatric Meltdown

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

Building Better Workflows Podcast

Building Better Workflows 

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 thank you. There's just not much interaction to begin with, and for some people, that's really hard."....Dr. Lia Gaggino on the reality of early parenthood

**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 [email protected]. 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

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 planning.

[46:20 - 54:50]  Closing segment Takeaways

Links to resources mentioned on the show

Postpartum Support International – PSI https://www.postpartum.net

PSI Perinatal Consultation Line:  https://www.postpartum.net/professionals/perinatal-psychiatric-consult-line/ 

PSI call or text support line – 800-944-4473, Spanish language line available for text 901-203-7773

National Network of Child Psychiatry Access Programs (many have perinatal support as well). www.nncpap.org

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

Building Better Workflows Podcast

Building Better Workflows 

Key quotes for Twitter:

“Knowing that I'm not alone is so helpful. And I think the extraordinary piece of it for me on a personal level is that I have also found a lot of healing in these groups."... Kristina Ledlow on unconditional acceptance and healing

"We were able to demonstrate that need in our community by first starting out with a community support group."...Kristina Ledlow on the power of community

**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 [email protected]. 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

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:  https://www.epilepsy.com/stories/truth-about-psychogenic-nonepileptic-seizures

Other episodes you may like:

https://pediatricmeltdown.com/episodes

199. PANDAS and PANS: Non-pharmacologic Treatment

198. PANS and PANDAS (pt 2 of 2

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

125 Tic Disorders: TikTok Tics

Building Better Workflows Podcast

Building Better Workflows 

Key quotes for Twitter:

“This is a true entity that exists on a neurobiologic chemical level, but we just aren't using these types of diagnostic tools in common practice to reach this diagnosis."...Dr. Sarah Dixon on the science behind FND diagnosis 

"Functional tremor is pretty easy to distinguish for us in the office from other causes of tremor that are more insidious and would warrant imaging."... Dr. Alex Gamber on understanding functional tremors

**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 [email protected]. 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

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 messaging options for wider reach.

[51:02 - 58:07]  Closing segment Takeaways

Links to resources mentioned on the show

International Association of Forensic Nursing

https://www.forensicnurses.org/

Academy of Forensic Nursing

https://www.goafn.org/

International Association of Forensic Nurses - Research.Educate.Lead 

RAINN: National Hotline 1-800-656-4673, RAINN | The nation's largest anti-sexual violence organization and online.rainn.org (chat)

National Sexual Violence Resource Center: www.nsvrc.org

National Children’s Alliance: Homepage - National Children's Alliance (nationalchildrensalliance.org)

National Children’s Advocacy Center: www.nationalcac.org

Darkness To Light: Resources - Darkness to Light (d2l.org)

The Mama Bear Effect: Home - The Mama Bear Effect

The National Center on the Sexual Behavior of Youth: www.ncsby.org

Office for Victims of Crime Training and Technical Assistance: www.ovcttac.gov

Michigan Resources:

SAS Business office (269) 245-3925

SAS 24/7 crisis-line: 1-888-383-2192 

State Sexual Assault Crisis Hotline: 855-864-2374, 855-VOICES4

Michigan Coalition Ending Domestic and Sexual Violence: https://mcedsv.org

 Michigan Victim Advocacy Network: https://mivan.org

Children’s Advocacy Centers of Michigan: https://cacmi.org

Other episodes you may like:

https://pediatricmeltdown.com/episodes

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

182. Social Media Dangers: Protecting and Educating Youth

181. Social Media: Guidance for Youth and Families

180. Social Media and Kids: The Big Picture

  27. Child Abuse and Neglect: Asking the Hard Questions

Building Better Workflows Podcast

Building Better Workflows 

Key quotes for Twitter:

"1 think that I really like about the RAINN's contact information is that they also have a chat option, and a text messaging option. So for people that are not comfortable speaking the words or calling a number, they can also just text or chat to get those resources or the support that they need."..  Sherri Killiah on Tech savvy support 

"Anytime a survivor or victim goes in to make a police report that they have the option to have that victim advocate present for them.".. Dannielle Kostrab-Boyd on supporting survivors every step of the way

**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 [email protected]. 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

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 [email protected]. 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

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:  https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Obsessive-Compulsive-Disorder-In-Children-And-Adolescents-060.aspx 

Other episodes with Dr. Cullinan you may like:

https://pediatricmeltdown.com/episodes

120 ADHD: Part 4 Executive Function  (pt4)

119 ADHD Part 3: Executive Function  (pt3)

109 ADHD Symptoms: Executive Functions Part II

088 ADHD: Strategies for Boosting Executive Function

Building Better Workflows Podcast

Building Better Workflows 

Key quotes for Twitter:

“Tics and Tourette's are very difficult. Of all of these disorders that we're talking about, which I think are all sort of habit-ish disorders, we're going to pick a label, which is not perfect, but it's the one I've selected at this moment."...Dr. Colleen Cullinan on the difficulty of treating these type of disorders

"A body focused; repetitive behavior can take up to 40 weeks to break. It requires a tremendous amount of practice, and I don't know if you've ever tried to teach a child anything. But if they're not motivated, they're not going to be into it.".. Dr. Colleen Cullinan on breaking long-term habits in children

**Transcript of Episode Available upon email request - [email protected] **

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 [email protected]. 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

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

https://docs.google.com/presentation/d/1Y_uVCLAjkTyZmPXnCSYCF5fg5eztefAH/edit?usp=sharing&ouid=116318706458170612793&rtpof=true&sd=true

Treatment of PANDAS and PANS: a systematic review

https://drive.google.com/file/d/1mpi3BSX2qQ-zHFpX9a5yNMUWDHkyC7hU/view?usp=sharing

Specialty knowledge and competency standards for pharmacotherapy for

adult obsessive-compulsive disorder

https://drive.google.com/file/d/1AExt8PTbVbwBYXgWqxwI_bcW8T04yA62/view?usp=sharing

JAP Treatment Guidelines

JCAP Treatment Guidelines -  Part I–Psychiatric and Behavioral Interventions  https://drive.google.com/file/d/15fgJGFDZ-tf8wmbgAihXoIU6OGR1oyB8/view?usp=sharing

JCAP Treatment Guidelines -  Part II–Use of Immunomodulatory Therapies

https://drive.google.com/file/d/1NT0RLn4xp1nT7h0_n5u4MyGcTDcaXW_2/view?usp=sharing

JCAP Treatment Guidelines -  Part III–Treatment and Prevention of Infections

https://drive.google.com/file/d/1DGUxCxkol8LFdKyzAYRNHIeVhO1RMqzp/view?usp=sharing

Quote from Christopher Pittenger, MD, Ph.D.

“The nature of this immune dysregulation, whether it exists in all patients or in a subset, whether it is causally associated with disease onset or progression, and whether it is a specific cause of disease, a nonspecific exacerbating factor, or an epiphenomenal, consequence of other pathophysiological events remain unclear”.

Other episodes you may like:

https://pediatricmeltdown.com/episodes

197.  Tics, Tourette’s and OCD

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

  88. ADHD: Strategies for Boosting Executive Function

Building Better Workflows Podcast

Building Better Workflows 

Key quotes for Twitter:

"If in the setting of a traumatic event, if one has an inflammatory response, we know that stress does that, and these kids may be more vulnerable to immune related dysfunction in the setting of stress responses."... Dr. Erica Greenberg on the link between trauma and OCD 

"And I think when you think that a child's disruptive behavior is because they're trying to manipulate you, you immediately stop being curious and you feel punitive.".... Dr. Erica Greenberg on Understanding PANDAS/PANS Diagnosis

**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 [email protected]. 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

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 hypersensitivity.

[55:38 - 01:02:21]  Closing segment Takeaways

Links to resources mentioned on the show

Tourette Association of America:  https://tourette.org

AACAP Resources Center: https://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/Obsessive_Compulsive_Disorder_Resource_Center/Home.aspx 

Other episodes you may like:

https://pediatricmeltdown.com/episodes

193. Understanding Challenging Kids: The Behavior Code

133 Tantrums, Difficult Behaviors, “Red Alerts”: Using the “Smart Brain” for Problem Solving

125 Tic Disorders: TikTok Tics

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Building Better Workflows 

Key quotes for Twitter:

 "The takeaway shouldn't be, like, the trauma leads, the trauma causes the OCD symptoms.".... Dr. Erica Greenberg on the relationship between trauma and OCD

"You don’t wanna push just for the sake of pushing to get to a high dose because OCD needs high doses. You wanna see something and then try to get to the lowest effective dose.".... Dr. Erica Greenberg on balancing medication for OCD

**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 [email protected]. 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

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                                                                                                                          LInkedIn: linkedin.com/in/jess-shatkin-9a854232

Check out his music on Spotify, iTunes, YouTube, Amazon, Pandora, etc.

Books:  

Child and Adolescent Mental Health

https://www.amazon.com/Child-Adolescent-Mental-Health-All/dp/1324031085/ref=monarch_sidesheet

Born To Be Wild - Why Teens Take Risks, and How We Can Help Keep Them Safe

https://www.amazon.com/Born-Be-Wild-Teens-Risks/dp/0143129805/ref=monarch_sidesheet

Other episodes you may like:

https://pediatricmeltdown.com/episodes

150 Integrating Behavioral Health: PCP Transformation!

  55. Trouble With a Child's Sleep? If They Snore, Do More! Dr. Hovig Artinian

  26. The 3 B's - Brain, Body, Behavior: Managing Anxiety

Building Better Workflows Podcast

Building Better Workflows 

Key quotes for Twitter:

"With CBTI, they have just as many or just as fewer awakenings in the middle of the night with CBTI as they do with sleeping medications, including the Z drugs and benzodiazepines."... Dr. Jess Shatkin on CBTI vs. sleeping medications: what's more effective?

"Aerobic exercise is as good for anxiety and depression, at diagnosable mild and moderate levels as is anything else we can do with therapy or medicine” … Dr. Jess Shatkin on the mental health benefits of exercise

**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 [email protected]. 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

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:

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