Pediatric Meltdown

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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 [email protected] to connect with Paresh and check out Michigan Medicine to learn more about his...

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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 [email protected] to connect with David and check out his website to learn more about his work. Listen to his podcast.

If

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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 [email protected] 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 [email protected]. To learn more about me visit

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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 [email protected] 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 [email protected]. To learn more about me visit

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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...

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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...

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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 [email protected] 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

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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 [email protected] 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

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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...

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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: [email protected] to connect with Dr....