Healing Magazine: Why did you start the podcast?
The name says it all. In pediatrics we often talk with parents about meltdowns, or tantrums on steroids, hence… Pediatric Meltdown was launched!
When I started my career, I had no idea how much of my practice would involve mental health care. Pediatric training is rigorous, but most of us do not get extensive training in mental health and much is learned on the job. I attended mental health conferences, read journals, did a rotation with a mental health expert and completed the REACH Institute course reviewing cases with child psychiatrists over a period of 6 months. In 2012 the University of Michigan launched MC3, the child psychiatry access program that provides same day consultations with child psychiatrists. MC3 was a game changer. The podcast evolved from those experiences. I wanted other pediatricians and trainees to learn all the things I wish I had known from the start.
HM: What were pediatric practitioner reactions to the podcast, at first?
The first episode was with my daughter Julia. We talked about eating disorders, including her own and her recovery, and why the BMI score we get at our doctor visits can be so painful, even triggering. The story moved listeners. I heard from my friends that the information was practical, that the guest stories resonated, and that they enjoyed the conversational tone of the interviews. Most listeners were from Michigan where I live; now episodes are downloaded around the world!
HM: Are there aspects of mental healthcare misunderstood by pediatricians?
The biggest myth is that only child psychiatrists should be assessing, diagnosing, and treating children’s mental health disorders. Most of what we see are behavioral issues that do NOT need medication at all, and pediatric clinicians are in a perfect position to monitor the trajectory of a child’s social and emotional development. We can coach parents, screen for trauma and help families navigate social determinants of health such as food and housing insecurity. A child may be irritable in the classroom, not because of depression or a bipolar disorder, but just because they are hungry, or had to sleep on a relative’s couch following an eviction.
HM: What is most misunderstood by families and parents?
Figuring out difficult behaviors takes time, and pediatricians can set parent expectations to make the process go more smoothly. Parents want their children to love learning, to have friends and to stay out of trouble, and when the opposite happens, meltdowns often follow.
Rarely is the solution a quick fix. Pediatricians need to consider the child’s temperament, the interaction with parents, genetic factors, their neighborhood environment, and family and social supports. This assessment takes time to tease apart — including more than one appointment, and feedback from other sources such as teachers, grandparents and coaches.
HM: What’s the most surprising thing a guest has told you on the podcast?
I was surprised over and over that what patients and families want from their pediatrician is simple: Just listen. Many problems cannot be “fixed” but can be managed. We can sit down and just be present. Author and psychologist Ross Greene’s phrase, “children do what they can” sets the stage even when things get hard.
HM: What changes have you seen in the way pediatrics and mental healthcare intersect?
For me, having social workers in my practice was a turning point. Families did not need to go elsewhere for mental health assessments or brief interventions. The behavioral health practitioner was part of my team, and this helped dispel the stigma of “going to therapy.”
The most important change, however, has been the focus on relational health and positive childhood experiences, in other words, helping parents fall in love with their children, to see what they see and to hear what they hear. I can help families build these skills.
HM: What do you hope practitioners in the pediatric field take away from your podcast, and how would you like them to use that information?
What I hope people take away is that addressing children’s behavioral issues does not require a pediatrician to also be a child psychiatrist. It’s not about medication. It’s about so much more. Pediatricians are highly skilled at relating to parents and patients; it’s what we do. I would encourage pediatricians to dig into their skills and just listen.
I guess the other thing I want pediatricians to take away is that although we are often heroes to families, we also need to take care of ourselves. Pediatrics is a demanding field. We are asked to meet the needs of families and our patients. They look up to us to take care of what they hold most precious. It can take a toll. We answer calls nights, weekends and holidays, often talking to scared parents in the middle of the night. This is difficult for us and our families. It’s OK to step back and take care of ourselves. That is an easy one to forget. It’s not in our training, but if we are if we are to take care of other people, we need to take care of ourselves.
To learn more about Dr. Gaggino and to hear episodes of her podcast, visit https://pediatricmeltdown.com/
