Pediatric Meltdown

What happens when personal trauma intersects with professional purpose in the world of child psychiatry? 

Discover the compelling story of Dr. Nancy Rappaport, who turned the tragedy of losing her mother to suicide into a life-long commitment to prevent similar losses in others. This podcast episode explores the intricate links between personal history and professional practice with a focus on child and family psychiatry. It illuminates the often-overlooked nuances of family dynamics, the importance of understanding children's challenging behaviors, and the sensitive discourse surrounding suicide prevention. The conversation unearths how small moments of humanity in therapy can bridge profound professional gaps and reinforce the resilience required in dealing with complex familial issues. Listeners will leave with a renewed understanding of why appropriate conversation about suicide is a poignant necessity in both clinical practice and families. Listen now to uncover insights that might just redefine the approach to mental health support.

[03:43 -12:26]  Child Psychiatry & Personal History 

• September marks Suicide Prevention Awareness Month, underscoring the episode's thematic urgency.
• Discussion on how her experiences informed her choice to focus on child psychiatry.
• Importance of not using stigmatizing language like "committed suicide."
• Emphasis on reducing stigma and opening dialogues about suicide.

[12:27 - 22:00]  Trauma, Suicide, and Professional Development in Child Psychiatry 

• Personal experiences with trauma and loss can influence a therapist's approach to working with children and families
• The saying "when someone dies by suicide, they take their skeleton and put it in your closet" highlights the complex impact on survivors
• Shifting from individual therapy to family therapy can provide new insights into family dynamics and behaviors
• Balancing personal emotional experiences with professional rigor is crucial in the field of child psychiatry 

[22:01 -32:46] Childhood Behavior and Parenting Challenges

• Strategies for pediatric clinicians dealing with suicidal patients.
• The role of programs like the National Alliance on Mental Illness in aiding families with psychiatric issues.
• The importance of local resources, like those in Boston, for mental health support.
• Encouragement for clinicians to remind patients of their value, especially post-suicide attempts.

[32:47 - 41:46]  Childhood Behavior and Parenting Challenges

• The behavior code was written drawing on that was published in 2012. It's been on the bestseller of Harvard Ed Press for about 8 years.
• It was written about angry kids, oppositional kids, kids with sexualized behavior, and kids with withdrawn behavior.
• As parents, you're doing this dance, and then it's not perfect. Sometimes you step on each other's toes, but there is this room for repair.
• You have to have a lot of humility when working with parents because Yes. We all are doing the best we can.

[41:47 - 48:19]  Closing segment Takeaway

You can reach Dr. Nancy Rapaport

Email:  [email protected]                                                                                                             LinkedeIn:

Have you ever wondered what keeps pediatricians going despite the challenges of modern healthcare? In this episode of the Pediatric Meltdown podcast, host Dr. Lia Gaggino celebrates four years of insightful conversations while going into the heart of pediatric practice. She talks about the delicate balance between technology and human connection, emphasizing the importance of creating space for magical moments with patients. From the joys of a baby's laughter to the struggles with electronic health records, Lia paints a vivid picture of the pediatric landscape. As she reflects on the evolution of her podcast and the field itself, one question emerges: 

How can we preserve the magic of pediatrics in an increasingly technology driven world?

[00:33 - 03:02]   Celebrating Four Years of Pediatric Insights

• Reflection on the podcast's 4-year journey and growth
• Gratitude for amazing guests and their contributions
• Acknowledgment of initial challenges in podcast production
• Introduction of the concept "joy of pediatrics" and "magic in the room"

[03:06 - 08:12]  Balancing Technology and Patient Care  

• Importance of creating time for meaningful patient interactions
• Challenges of electronic health records vs. paper charts
• Encouragement to look away from screens during consultations
• Hope for future improvements through AI scribing technology

[08:11 -10:19]  Fostering Professional Growth and Community

• Upcoming national meeting in Orlando for pediatric professionals
• Invitation for listeners to connect with Lia at the event
• Encouragement to find and create magical moments in practice
• Teaser for interesting upcoming podcast guests

Links to resources mentioned on the show

Podcast Production

MouthyBroadMedia.com

Social Media Management

[email protected]

AAP

aap.org

2024 Practical Pediatrics CME Course - San Diego, CA | shopAAP

MIAAP

MIAAP

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Key quotes for Twitter:

"And I have to say, there was a lot of stuff I didn't know. Some of the episodes were pretty rough, but I have had just the most amazing guests."... Dr. Lia Gaggino reflecting on four years of the Pediatric Meltdown podcast.

"The AAP is the best because it is pediatricians. It's us. And there is just nothing better than being with other people who love children and love thinking about ways to make their world better and how to do a better job.".... Dr. Lia Gaggino reflecting on the importance of pediatricians connecting

FULL TRANSCRIPT WILL BE AVAILABLE UPON REQUEST

THANK YOU FOR...

What if the key to being a better doctor lies in not being a doctor all the time? 

Dr. Lia's solo episode of Pediatric Meltdown highlights the critical need for healthcare professionals to cultivate interests and experiences beyond their medical careers. She draws parallels to Mr. Rogers' iconic routine of changing into a cardigan, symbolizing the vital separation between work and personal life. From the joy of reading non-medical literature to the perspective-altering power of travel, Dr. Lia offers a blueprint for a more balanced, fulfilling life. She doesn't shy away from addressing the challenges of maintaining this balance but insists on its necessity. With practical advice and heartfelt wisdom, this episode is a wake-up call for healthcare professionals everywhere: Your life's story shouldn't be written solely in the pages of medical charts.

[01:21 -02:20]  Life outside medicine: Why it's important

• Set clear boundaries between work and personal life
• Maintain balance to prevent burnout in medical career
• Importance of having interests beyond healthcare

[02:21 - 08:10] Physician self-care: Reading and traveling experiences  

• Make time for non-medical reading, even in snippets
• Travel to gain new perspectives and experiences
• Don't postpone personal experiences for a "magical time"

[08:11 - 13:08]  Work-life balance for healthcare professionals: Relationships

• Nurture relationships outside the medical field
• Make time for people despite demanding work schedule
• Balance professional commitments with personal life

Resources mentioned on the show

aap.org

Other episodes mentioned on the show:

https://pediatricmeltdown.com/episodes

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Key quotes for Twitter:

"There is just so much more to talk about than medical cases."... Dr. Lia Gaggino on Imposter syndrome in the medical field”... Dr. Lia Gaggino on the importance on non-medical friendships

"I've had a book group for going on 30 years, and there are 4 of us that are still from the original group. I love it. It's mostly to just see my friends and have great food and some wine."..Dr. Lia Gaggino on interests outside of the medical books.

**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

Are you feeling overwhelmed by the constant need to prove your medical expertise?

In this week’s episode, Dr. Lia talks about the challenges and anxieties surrounding board certification for pediatricians, particularly focusing on the evolution of the MOCA peds program. She shares personal experiences with various certification methods, from proctored exams to open-book tests, highlighting the stress and self-doubt that often accompany these processes. The importance of continuous learning in the medical field is also mentioned, recommending resources like pediatric board review materials and various CME opportunities. You’ll hear Dr. Lia will also touch on the prevalence of imposter syndrome among medical professionals, reassuring listeners that it's normal to not know everything and encouraging them to ask for help when needed. Ultimately, she advocates for a balanced approach to professional development, acknowledging both the necessity of expertise and the reality of human limitations in medical practice.

[2:54 -05:07]  The Evolution of Board Certification Methods

• Proctored exams: Anxiety-inducing and challenging to concentrate
• Open-book tests: Time-consuming but aligned with real-world practice
• Return to proctored exams: Disliked by many professionals
• MOCA Peds: A modern, quarterly assessment approach

[5:08 - 07:14] Navigating MOCA peds and Continuous Learning 

• Utilize pediatric board review materials for preparation
• Approach questions as real-life cases, not trick questions
• Take advantage of the 5-minute time limit per question
• Embrace continuous learning through various CME opportunities

[07:15 - 12:30]  Expanding Mental Health Knowledge in Pediatrics

• Seek out mental health sessions at national conferences
• Attend specialized mental health conferences for pediatricians
• Consider long-term training programs like the REACH Institute
• Utilize resources from AAP and ACAP for ongoing education 

Resources mentioned on the show

MOCA-PBR  www.pediatricsboardreview.com 

Neuroscience Education Institute https://www.neiglobal.com/

REACH https://thereachinstitute.org/

nncpap.org

aap.org

aacap.org

AAP National Conference https://aapexperience.org/

Other episodes mentioned on the show:

https://pediatricmeltdown.com/episodes

116. Physician Wellness Coaching: Proven Benefit!

  98. Anxiety? Inattention? Depression?: Prescribe Nature! Dr. Stacy Beller Stryker

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Have you ever wondered what parents truly desire from their pediatricians? 

In this week's episode of Pediatric Meltdown, Dr. Lia goes into the heart of parental needs, drawing from her 34 years of experience and insights gleaned from her podcast interviews. She explores the universal desire for reassurance, the challenges of modern parenting in the age of social media, and the importance of fostering positive childhood experiences.

Dr. Lia emphasizes the critical role of relational health in supporting families, especially those facing adversity. She reminds us that the most powerful tool in a pediatrician's arsenal isn't fancy gadgets or cutting-edge treatments, but the ability to listen and validate parents' experiences. From navigating preschool expulsions to dealing with developmental milestones, this episode offers a compassionate perspective on the complexities of raising children. Whether you're a healthcare professional or a parent, this episode promises to leave you with valuable insights and a renewed appreciation for the power of human connection in pediatric care. Remember, in the journey of parenting, you're not alone – and sometimes, that's the most important message of all.

     [0:00 -01:46]  Observations from a Seasoned Pediatrician: Parental Needs

• Episode focuses on what parents want most from pediatricians
• Addresses the pressure parents face, especially from social media
• Emphasizes that fancy gadgets aren't necessary; however, relationship with the baby is key

[1:47 - 17:48]  Reassurance: The Foundation of Parent Support 

• Parents need reassurance that they're not failing
• Importance of praising parents for their efforts
• Reminder that the parent-child relationship is more important than material things

[17:48 - 18:29]  Navigating Challenges: A Collaborative Approach

• Addresses issues like preschool expulsions and daycare problems
• Encourages pediatricians to "ride the ride" with parents
• Suggests calling in reinforcements when needed (e.g., social work, community mental health)

[18:30 - 26:14] Building Relational Health and Positive Experiences

• Focuses on fostering positive childhood experiences
• Explains how supportive adults can help children overcome adversity
• Emphasizes teaching parenting skills, as they're not innate

Resources mentioned on the show

https://www.healthychildren.org

The Healthy Children Podcast:  Healthy Children (pod.link)

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115.  Chronic Pain Syndromes: Assessment and Management 

114.  Palliative and Hospice Care: A Conversation on Grief and Joy

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Key quotes for Twitter:

"Vaccines are the most important public health endeavor that...

What if you could revolutionize healthcare communication for diverse communities with just a 90-second video? 

That's exactly what Dr. Ripudaman Singh Minhas and his team are doing with their innovative approach to health education. Imagine a world where families can access vital health information in their native language, delivered by someone who looks like them and understands their cultural nuances. From TikTok-style snippets to in-depth Instagram lives, this initiative is breaking down barriers and building trust across various cultural and linguistic groups. With a focus on accessibility, hope, and cultural representation, they're transforming how health information is shared and received. By leveraging the power of "trusted messenger models" and collaborating with community advisory boards, they ensure that their content resonates deeply with their target audiences. From pediatricians to psychologists, a diverse team of over 60 clinicians volunteer their expertise to create content that's not just informative, but also engaging and culturally sensitive. This groundbreaking approach isn't just changing how we communicate health information – it's potentially saving lives, one short video at a time. 

[02:06 -09:46] Cultural Representation in Online Health Resources

• Created resources that were culturally responsive and adapted, translated where needed
• Aimed to build rapport and trust, answering questions families had
• Applied the trusted messenger model to an online space
• Each channel has healthcare providers on screen who are from the communities they serve, communicating in bilingual channels where appropriate

[09:47 - 17:07]  Social Media for Public Health: Innovative Content Strategies  

• Most videos are TikTok-style, 90 seconds long, offering quick bites of health content
• Longer content, up to 45 minutes, delves into specific topics like speech delay or summer safety
• Content is community-led, responding to questions and analytics from social media
• Videos feature practitioners from the community, speaking in their native language

[17:08 - 21:26]  Expanding Digital Health Education for Youth and Diverse Communities

• Goal to create more channels and content for families in over 40 countries
• Plans to develop content specifically for grandparents and fathers
•  Implementation of the Digital Health Youth Fellowship Program
• Training young content creators on video creation, self-care, and critical information appraisal 

[21:27 - 33:48] Social Media Impact on Pediatric Health Education

• The project has seen significant impact in terms of audience reach and engagement.
• Research is being conducted to evaluate how the project impacts parenting journeys.
• A study is examining how social media was used as a tool in the resettlement process for families displaced by the war in Ukraine.
• The project aims to do "microdoses of positive pediatric content" amidst other content families are scrolling through

[33:49 - 40:23]  Closing segment Takeaways

Links to resources mentioned on the show

Newsletter Sign Up: Our Kids Health

Website: Our Kids Health - Our Kids Health

LinkedIn:

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)

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Key quotes for Twitter:

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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...

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:

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...