Pediatric Meltdown

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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...

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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 [email protected] or [email protected]. 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. 

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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

1. Thank you to Dr. Stacy...

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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

1. Huge Thanks to Natasha for honest and raw conversations about parenting who struggles to meet social...

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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:

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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

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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 [email protected] or [email protected]. 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. 

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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...

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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...

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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...