Pediatric Meltdown

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Today, we are going to talk about genetics and behavioral health with Dr. Caleb Bupp, Division Chief of Medical Genetics and Genomics Spectrum Health at Helen DeVos Children's Hospital.

You might be wondering why we have invited a geneticist on a podcast about emotional and mental health in the pediatrics space. Well, our space intersects with genetics more frequently than you can imagine. Dr. Bupp will break these intersections down, explain genetics in a manner that you can also explain it to others, and highlight the importance of genetic testing with consent.   

Let’s listen to Dr. Bupp to learn more about genetics in behavioral health!  

[00:01 - 06:55] Opening Segment

• Welcoming today's guest, Dr. Caleb Bupp
• Why Dr. Bupp chose genetics

06:56 - 16:49] Genetic Issues 

• We talk about the 3 intersections of genetics and mental health
• Understand genetics better with this analogy from Dr. Bupp
• Dr. Bupp tells us why every health issue is genetic 

[16:50 - 27:49] Genetic Testing

• What is Dr. Bupp’s advice for children with autism 
• Genetics will be of no use under one certain scenario
• Dr. Bupp elaborates
• Genetic testing will be valuable in learning about behavioral health issues
• Dr. Bupp explains
• The worst part of being a geneticist for Dr. Bupp

[27:50 - 39:22] Genetic Data 

• We talk about the importance of consent in genetic testing
• The value of a person’s genetic data as explained by Dr. Bupp
• What is pharmacogenomics and why we should understand it 

[39:23 - 47:22] Closing Segment

• Listen to Dr. Bupp’s reminder for us 
• What’s his message for his resident self? 
• Finals takeaways
• Consent is a must in genetic testing
• Genetic testing has become mainstream 
• The different types of genetic testing
• Children with autism should be offered genetic testing or consultation about it
• A main barrier right now in genetic testing is cost

Tweetable Quotes:

“When you’re working underneath somebody who loves what they do, it’s just infectious.” - Dr. Caleb Bupp

“... every health issue is genetic. In some way, shape, or form, we just have to get granular enough to figure out what exactly the genetic cause for that [issue] is.” - Dr. Caleb Bupp

Resources Mentioned:

• Genetic Information Nondiscrimination Act of 2008
• What is informed consent?
• Locating a genetics clinic here
• Pharmacogenomics FAQ

Email [email protected] to connect with Dr. Bupp. Also, visit https://www.spectrumhealth.org/ to learn more about his space.

If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter or email me at [email protected].

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We always say that “prevention is better than the cure,” but prevention won’t happen if the necessary infrastructures, institutions, and support systems are not in place. Dr. Lee Beers, the new President of the American Academy of Pediatrics, recognizes this problem and aims to advocate for an integrated approach that can also address the issues that plague our children, particularly those relating to their mental health. 

Let’s listen to Dr. Beers to learn how to advocate for mental health services better!  

[00:01 - 06:01] Opening Segment

• Welcoming today's guest, Dr. Lee Beers
• Her story as a navy physician 

[06:02 - 17:23] Parenting Impacts

• Her memorable 18-month experience as a physician overseas
• Dr. Beers talks about the impact of parenting on infant development 
• The challenges of dealing with mental health among children

[17:24 - 29:04] Integrated Behavioral Health 

• Dr. Beers breaks down integrated behavioral health 
• She talks about the status of mental health in the United States
• Are there enough pediatric mental health providers?
• Is there enough access to quality health care? 
• How to advocate for an established mental health support system 

[29:05 - 40:27] Accessible Health Services 

• Why health services should be accessible in the long-term
• Here’s an old reminder from Dr. Beers that you should hear 
• The services that the American Academy of Pediatrics offers

[40:28 - 49:32] Closing Segment

• Dr. Beers’ message for her resident self you should also hear 
• Final Takeaways
• The parents’ wellbeing and health are crucial too
• The importance of family support 
• Integrated behavioral health 
• Delivery of health services 
• The place to make a change 
• Don’t be afraid to take risks 

Tweetable Quotes:

“It’s really important for us to make sure that access to [health] services is sustainable.” - Dr. Lee Beers

“Each and everyone of us has that power to make a change.” - Dr. Lee Beers

Resources Mentioned:

• American Academy of Pediatrics
• Through a Different Lens: Examining How We Care for Adolescent-Headed Families
• Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting
• Healthy Children website
• Pediatric Meltdown episode: Caring for Children in Foster and Kinship Care: Keeping a Trauma-Informed focus with Moira Szilagyi

Email [email protected] to connect with Dr. Beers. Also, visit https://childrensnational.org/ to learn more about her space.

If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter or...

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Sex and drugs remain taboo in society, and the reluctance to talk about these topics only leads to misinformed and misguided teenagers who feel unnecessary judgments for themselves. It’s now high time to raise the awareness of teenagers about these topics to let them know of the safe spaces where they can freely express themselves. Dr. Lisa Lowery, an Adolescent Medicine specialist at the Helen DeVos Children’s Hospital-Spectrum Health Medical Group, joins us today to give tips on how to normalize these topics that should have been normal already. We are sexual beings after all and we should not deny it. 

Let’s listen to Dr. Lowery to learn how to stay in the non-judgment zone! 

[00:01 - 05:40] Opening Segment

• Welcoming today's guest, Dr. Lisa Lowery
• Her path to adolescent medicine 

[05:41 - 17:42] Build a Safe Space 

• Dr. Lowery talks about the importance of mentors
• Hear Dr. Lowery’s interesting insights about teenagers
• Why they’re easier to work with than babies
• Honesty and consistency are keys
• Dr. Lowery shares a patient story that you should hear!
• Why we do what we do 

[17:43 - 32:18] Normalize Sex Talks 

• We talk about the responsibility that physicians carry
• A humbling experience
• Normalize sex and talking about it
• Dr. Lowery explains 
• The right questions to ask
• We discuss intimate partner violence 

[32:19 - 44:21] Take Care of Yourself Better

• The proper way to talk about sex trafficking with teenagers
• Behavioral health should be present in all practices
• Dr. Lowery tells us why
• Physicians should know social and mental health workers in their circles
• We talk about the benefits 
• Physicians should take care of themselves too

[44:22 - 50:04] Closing Segment

• Parting words from Dr. Lowery  
• Final Takeaways
• Providing a no-judgement zone 
• Strategies to ask teenagers about sex 
• Tips to discuss drugs and relationships with teenagers
• How to get into an adolescent’s head?
• Link below 

Tweetable Quotes:

“Your mentor doesn’t have to look like you.” - Dr. Lisa Lowery

“We [physicians] have to learn how to take better care of ourselves emotionally.” - Dr. Lisa Lowery

Resources Mentioned:

• Getting into adolescent heads: An essential update

Email [email protected] to connect with Dr. Lowery. Also, visit http://www.helendevoschildrens.org/AdolescentMedicine to learn more about her space.

If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter or email me at [email protected]. To learn more about me visit https://www.medicalbhs.com/

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We have a special episode for today because of two important guests. Dr. Sheila Marcus is the Section Chief of the Child and Adolescent Psychiatry of Michigan Medicine at the University of Michigan while Dr. Sarah Mohiuddin is the Director of the University’s Multidisciplinary Autism Program. They join us to discuss autism spectrum disorders and how we can detect them in as early as 4-12 months. We will learn that the symptoms of these disorders are often subtle and that early detection is critical

Let’s listen to Dr. Marcus and Dr. Mohiuddin to learn more about autism spectrum disorders.

[00:01 - 02:51] Opening Segment

• Welcoming today's guests, Dr. Sheila Marcus and Dr. Sarah Mohiuddin, 
• We introduce our topic for this episode

[02:52 - 13:24] Observe the Baby

• Dr. Marcus tells us what to look out for in a 4- to 12-month old baby
• A baby should learn how to love the parents by this time 
• Listen to Dr. Mohiuddin’s advice for pediatricians
• Encourage the patient’s parents to come back
• Use appropriate language that only subtly expresses your concern 
• Observe the baby with the parent without your presence

[13:25 - 23:31] Consider Virtual Evaluations

• They talk about the pros and cons of virtual evaluations 
• Hear the parents’ voice, see the baby
• The importance of early interventions for babies exhibiting signs of autism
• Dr. Marcus explains

[23:32 - 34:02] Explain the Spectrum 

• They explain why autism disorders are located in a spectrum
• Not a matter of “you have it” or “you don’t have it”
• Dr. Marcus talks about the common tests to detect autism spectrum disorders early
• What are the usual treatments for autism spectrum disorders? 

[34:03 - 47:43] Don’t Always Fill in the Gaps 

• Adults can let the conversation with a kid remain uncomfortable
• Dr. Mohiuddin explains 
• Why should adults “not fill in all the gaps?”
• We talk about how kids with autism build social relationships 
• Dr. Mohiuddin reminder on giving medications 

[47:44 - 57:53] Think About the Kid’s Future

• We share some useful resources to educate you more about autism
• Links below
• The challenging part of transitioning to adolescence and adulthood
• They talk about the importance of thinking about the kid’s future
• Independent living skills, work, and preferences, among others

[57:54 - 01:06:15] Closing Segment

• Parting words from Dr. Marcus and Dr. Mohiuddin 
• Final Takeaways
• Always listen to parent concerns and take them seriously
• Early identification and evaluation make all the difference
• Delivering the diagnosis can be hard and painful for patients 
• Early symptoms are sometimes too subtle 
• Applied Behavior Analysis and Early Start Denver Model
• Older language with strong language skills can be missed easily 
• Don’t always fill in the gaps
• Think early about the kid’s trajectory in the future 
• Medications should only be considered in extreme cases
• As adults, kids may do well regardless of their skills 

Tweetable Quotes:

“...if a parent who’s an astute observer and somebody whose opinions you’ve always trusted sensed [the possibility of autism], number one, believe them.” - Dr. Sheila Marcus 

“In doing an evaluation of an older kid who...

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In this episode, I invite Dr. Zakia Alavi, a child and adolescent psychiatrist and an assistant professor at Michigan State University who teaches medical students about the integration between basic and clinical sciences to the podcast. She has been providing psychiatric services to underprivileged children in Jackson, Michigan, and has published many peer-reviewed articles on psychopharmacology and polypharmacy.

Let’s listen to Dr. Alavi and learn more about building bridges between primary care and community mental health providers!

[00:01 - 06:02] Opening Segment

• Welcoming today's guest, Dr. Zakia Alavi
• Her path to child and adolescent psychiatry
• Touching one generation with one child

[06:03 - 16:12] Convincing Families 

• A supportive community mental health system
• How to convince “professional” families to treat mental health
• Building a two-way communication with children

[16:13 - 25:35] Building Networks and Relationships

• Primary care providers shouldn’t go beyond their comfort level
• Find out why
• How can physicians make a change within their systems? 
• The importance of network- and relationship-building 

[25:36 - 32:09] Creating a Safe Space for Children

• Trust and comfort among children as priorities 
• Mental health stigma during and after the COVID-19 pandemic

[32:10 - 41:53] Closing Segment

• Dr. Alavi’s parting words
• Trust the patients more
• Final Takeaways
• Connect with child psychiatrist
• The importance of humility among child psychiatrists
• Supportive systems in the community mental health world
• Building relationships and work on a team 
• Trust the system and the patient more
• Sometimes, it’s better to not do anything 

Tweetable Quotes:

“If I can touch one life, one child, that’s like a whole generation. You can affect so many people by just touching one child’s life” - Dr. Zakia Alavi

“Remember that you work in a community. You’re not in a silo.” - Dr. Zakia Alavi

Resources Mentioned:

• Michigan Child Care Collaborative
• Ep. 13: Psychiatric Consultation: The Doctor is In!
• National Network of Child Psychiatry Access Programs
• Understanding the Use of Psychotropic Medications in the Child Welfare System: Causes, Consequences, and Proposed Solutions
• When stimulants “fail” for children with attention-deficit/hyperactivity disorder

If you’d like to connect with Dr. Alavi, email [email protected]. Also, visit https://raind.msu.edu/ to learn more about his space.

If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter or email me at [email protected]. To learn...

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I have the pleasure of having Dr. Zakia Alavi for the second time (you will hear from her again in 2021!) to talk about a very relevant topic for pediatricians, mental health professionals, and parents – Covid and its effects on children’s mental health. Dr. Alavi is a child and adolescent psychiatrist and an assistant professor at Michigan State University. She teaches medical students how to integrate basic and clinical sciences and provides psychiatric services in Jackson, Michigan to those children who are in most need. Dr. Alavi offers age-specific coping strategies to mitigate the impact Covid on our children’s emotional well-being.

Join me and learn from Dr. Alavi about the ways pediatricians and parents can help children cope during the COVID-19 pandemic.  

[00:01 - 03:51] Opening Segment

• Welcoming today's guest, Dr. Zakia Alavi
• I introduce the topic for this episode

[03:52 - 18:43] Children’s Responses to COVID-19

• Dr. Alavi’s insights on the effects of COVID-19 to 5-year olds and younger
• Parents and caregivers should also be considered
• Her thoughts on the most affected age group of the COVID-19
• Teenage meltdowns to watch out for according to Dr. Alavi

[18:44 - 32:36] Parents’ Routines 

• What parents should realize about their routines or lack thereof
• Parents are the children’s personal clocks 
• The age group where verbal reassurance has the most impact 
• Dr. Alavi’s tips for teenagers that parents should know
• Her reminders for parents in coping with COVID-19

[32:37 - 37:01] The Right Questions to Ask Now

• Dr. Alavi’s insights about mental health issues during COVID-19
• What questions to ask for spouses and children 
• Other related issues that should be addressed

[37:02 - 47:49] Closing Segment

• Dr. Alavi’s parting words
• Silver linings in the pandemic
• Educating people about vaccines
• Final Takeaways
• COVID-19’s impact on children of different ages
• Sense of safety for kids under 5 years of age
• Parents’ response to COVID-19
• Children regressions and meltdowns
• Sleep should be addressed for all children 
• Routines will go a long way
• Mark the passage of time
• Verbal reassurance for middle schoolers
• Saving grace for teenagers
• Safety from lethal means

Tweetable Quotes:

“As long as the home environment remains safe and their attachment, as well as the figures that they are attached to, remains safe and accessible and available, these younger kids can actually do really well.” - Dr. Zakia Alavi

“Parents are in charge in many ways and now more than ever their self-regulation is how the kids are going to regulate.” - Dr. Zakia Alavi

Resources Mentioned:

• COVID-19 Parental Resources Kit – Early Childhood
• Helping Kids Cope with the Holidays During the Pandemic
• Resources for Helping Kids and Parents Cope Amidst COVID-19
• Parenting in a Pandemic: Tips to Keep the Calm at Home
• Body Keeps The Score

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Today, my gift to you is Dr. Michael Klein’s inspiring words that has carried me forward since the first time I heard them. Dr. Klein is a retired pediatric surgeon who served as chief of pediatric surgery at the Children’s Hospital of Michigan in Detroit for almost 40 years. His swan song in clinical surgery was a two-month service in Liberia with Doctors Without Borders. He joins us in this episode to share his unwavering commitment to invest in children, who he believes are the driving force that can move the world forward. In order for children to change the world they need guidance and care, and this is where pediatricians can help shape the future.

Let Dr. Klein’s words inspire you! 

[00:01 - 08:13] Opening Segment

• Welcoming today's guest, Dr. Michael Klein
• Dr. Klein’s road to pediatric surgery
• Overseas work
• Two greatest medical inventions for Dr. Klein

[08:14 - 24:44] Pediatricians are Awesome!

• Dr. Klein talks about the American Academy of Pediatrics
• Democracy at its best
• Dr. Klein tells us why pediatrics is wonderful
• Who are we serving?
• What’s the most important force for human progress?
• Vaccine education is a must

[24:45 - 37:08] Pediatricians are Crucial

• Dr. Klein talks about thriving under pressure
• He tells us why pediatricians are crucial in the community
• Why should pediatricians join chapters and national associations? 
• Issue-based politics benefitting children 

[37:09 - 42:26] Closing Segment

• Love your pediatricians
• Dr. Klein’s parting words
• Final Takeaways
• The American Academy of Pediatrics
• A pediatrician’s role in making the world better
• Children are the answer
• Return of Investment of children
• Toxic stress

Tweetable Quotes:

“It really takes a lot of courage to go into the office, see a patient, make a decision, and walk out and realize that you’re gonna be wrong.” - Dr. Michael Klein

“If we want to improve the economy, if we want better symphonies or better jazz, if we want better athletic teams or better social relationships, the way to get them is to invest in children.” - Dr. Michael Klein

Resources Mentioned:

• Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
• Thinking Developmentally
• Heckman Early Childhood Development ROI
• Doctors Without Borders

If you’d like to connect with Dr. Klein, email [email protected]. Also, visit https://www.miaap.org/ to learn more about his space.

If you’d like to connect with me, you can find me at LinkedIn, Facebook, and Twitter or email me at [email protected]. To learn more about me visit

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We have an important discussion today about LGBTQIA+ patients. Dr. Dan Shumer, Clinical Director of the Child and Adolescent Gender Clinic at Mott Children’s Hospital, will join us to share his story about caring for his transgender youth patients. His observations are promising as the youth are now becoming more and more vocal about their sexual orientation, gender identity, and gender expression (SOGIE). It is critical the healthcare providers understand the needs of this population. Creating a safe space in our practices supports not only the youth but also their families.

Let’s listen to Dr. Shumer and learn how pediatricians can care for transgender youth with compassion.

[00:01 - 05:59] Opening Segment

• Welcoming today's guest, Dr. Dan Shumer
• Dr. Klein’s talks about his clinic for transgender youth 
• Melting anxiety and shame 

[06:00 - 13:37] The Tasks of Adolescents 

• Dr. Shumer’s thoughts about transgender youth 
• The difference between gender identity and gender dysphoria
• The role of parents on their child’s growth

[13:38 - 23:48] Caring and Compassion

• Mental health of LGBTQIA+ patients
• Building a safe space for trans patients
• A difference in gender identity and biological sex is normal
• Find out why this is not a problem
• Educational materials about caring for transgender youth
• Links below

[23:49 - 32:21] Ethics of Care 

• Dr. Shumer’s treatment approach 
• “Pausing” puberty
• Ethical issues to consider 

[32:22 - 38:48] Closing Segment

• Dr. Shumer’s parting words
• Compassion is the first step to care for trans patients
• Final Takeaways
• Difference in gender identity and biological sex is normal 
• Parents’ dreams for their kids might differ from what the kids really want
• Parent education is a must 
• Relevant educational resources are available
• Timing and intervention are crucial in treatment 
• We need to look for mentors who can guide us
• Compassion can make a big difference

Tweetable Quotes:

“...there are some things that parents can do to show that they love and support their kid even if they’re having some internal conflict...” - Dr. Dan Shumer

“Gender identity is a normal human characteristic and having a difference in gender identity compared to biologic sex itself is not a medical problem or a mental health problem.” - Dr. Dan Shumer

Resources Mentioned:

• UCSF Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People
• World Professional Agency for Transgender Youth – Standards of Care

If you’d like to connect with Dr. Shumer, email [email protected]. Also, visit https://www.mottchildren.org/ to learn more about his space.

If you’d like to connect with me, you can find me at LinkedIn, Facebook, and

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The impact of racism on the health and wellbeing of children is significant and we must first examine our own implicit biases if we are to bring about change. We need to understand the differences between equity and equality and to advocate for our children, but in order to do so we have to educate ourselves and begin the change within. In this episode Dr. Lynn Smitherman, Vice Chair of pediatric education at Wayne State University School of Medicine walks us through definitions and constructs to better understand racism and antiracism.  Dr. Smitherman is the AAP District V champion for equity, diversity and inclusion and has long been advocating for children’s social wellbeing.

Let’s dive right in and hear Dr. Smitherman’s thoughts about the impact racism has on children and the need to change the narrative.   Dr. Smitherman offers strategies for change at the institutional, practice and individual level and provides multiple resources to drive change.

[00:01 - 08:39] Opening Segment

• Introducing today's guest, Dr. Lynn Smitherman
• Dr. Smitherman path to pediatrics
• Comfort in talking with children and parents

[08:40 - 26:09] Racism 

• Dr. Smitherman talks about restorative justice
• She talks about some terms related to racism
• Bias
• Explicit
• Implicit
• Discrimination
• Prejudice
• Racism
• Institutional/Structural
• Interpersonal
• Internalized  

[26:10 - 40:01] People of Color

• Dr. Smitherman talks about racism in the context of medicine 
• She talks about ways to handle racism
• For children
• For pediatricians
• Having allies from different backgrounds is crucial

[40:02 - 52:07] Education 

• We talk about addressing racism in the medical field
• Educate yourself
• Reflect on your current values
• Dr. Smitherman shares some relevant resources. Links below. 
• How to tackle racism in childhood and adolescence 
• Positive messaging
• The root of the problems

[52:08 - 58:00] Closing Segment

• Dr. Smitherman tells us why we should stand against racism 
• Children are vulnerable
• Final Takeaways
• Differences among bias, prejudice, and discrimination
• Racism’s impacts on children
• Equity, diversity, and inclusion
• Intentional effort to participate in change
• Trust as a bridge to people of color
• Personal change, practice change, and organizational change
• Representation in the medical field

Tweetable Quotes:

“We all have biases because we are all human beings and we all have ideas and thoughts of things we like and don’t like.” - Dr. Lynn Smitherman

“...for racism to exist, there has to be not only that prejudice but also a feeling of superiority that one group is superior over another group.” - Dr. Lynn Smitherman

Resources Mentioned:

For Kids:

• Your Kids Aren't Too Young to Talk About Race: Resource Roundup
• They’re Not Too Young to Talk About Race
• Embrace Race
• How...

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Today’s guest is Dr. Joanna Quigley, a clinical associate professor of psychiatry at the University of Michigan. She trained in pediatrics, general psychiatry, and child and adolescent psychiatry at the University of Kentucky and is part of the Michigan Child Collaborative Care (MC3) project at the University of Michigan, an outreach consultative program for primary care pediatrics, family medicine, and obstetrics.

Let’s dive right in and hear Dr. Quigley’s thoughts about common mental health concerns we see in primary care and how psychiatric child collaborative care programs can offer us support.

[00:01 - 08:47] Opening Segment

• Introducing today's guest, Dr. Joanna Quigley
• Dr. Quigley’s path to child psychiatry
• The differences between pediatrics and child psychiatry

[08:48 - 13:36] Collaborative Child Care

• We talk about the benefits of collaborative child care programs
• Learning from one another
• Leveraging one another’s resources
• Looking for collaborative care programs
• State health departments
• Keywords
• Telephone consultation programs
• Collaborative care consultation programs
• Psychiatric collaborative consultation 

[13:37 - 25:13] Psychiatric Consultation

• Dr. Quigley shares some tips to make consultations easier
• Current condition
• Trauma history 
• Symptoms 
• She talks about a few best practices on selecting medications
• Where to access these best practices? Links below

[25:14 - 40:27] Child Psychiatry 

• Managing screen time and media exposure of children 
• Setting limits is okay
• Practical tip: Turn off the WIFI
• Dr. Quigley talks about collaborations with primary care providers
• Be intentional in your collaborative efforts
• Be open to the fact that one visit won’t solve everything
• We talk about this game-changing service in child psychiatry

[40:28 - 46:24] Closing Segment

• Finding joys with patients and colleagues 
• Final Takeaways
• Collaborative child care
• Difficulties of primary care providers
• Psychiatric and pediatric trainings
• Trauma and anxiety 
• Symptom relief
• Resources of best practice guidelines
• Parent management of children’s social media use 
• “No question is too small, too stupid”

Tweetable Quotes:

“I do think that...it is okay [for parents] to set limits. Kids thrive on structure and consistency with expectations.” - Dr. Joanna Quigley

 “You don’t need to solve everything that’s going on in one visit.” - Dr. Joanna Quigley

Resources Mentioned:

• Michigan Child Collaborative Care
• HealthyChildren
• American Academy of Child and Adolescent Psychiatry
• National Network of Child Psychiatry Access Programs
• Stahl's Essential Psychopharmacology
• American Academy of Pediatrics

If you’d like to connect with Dr. Quigley, email [email protected]. Also, visit