Pediatric Meltdown

• 245. When Sadness Looks Like Anger: Rethinking Pediatric Depression and Behavioral Activation

  Are you struggling to support young patients—and maybe even yourself—with the emotional aftermath of our “new normal”? In this compelling episode of Pediatric Meltdown, Dr. Colleen Cullinan returns to unpack the reality of pediatric depression in a world rocked by uncertainty. Discover why traditional approaches, like focusing solely on symptoms, may actually miss the bigger picture when kids are faced with unprecedented stress. Learn how changing the narrative, adopting techniques such as Acceptance and Commitment Therapy (ACT), and making small, values-driven changes can help children—and parents—find hope, function, and connection again. This episode isn’t just about treating depression; it’s about transforming how we relate to struggle and building resilience against the tide of ongoing adversity. Tune in for real stories, actionable tools, and a refreshing reminder: even the heaviest feelings can be given a name, a shape, and ultimately, a little less power.[00:00 - 08:40] The Impact: Symptom Overload, and Functional ImpairmentThe pandemic has significantly amplified youth mental health issues, leading to increased rates and severity of pediatric depression and anxiety.Symptom checklists like the PHQ-9 now reveal almost universal distress—so much so that a "normal" score is rare.Chronic uncertainty and prolonged stress (for both kids and adults) exacerbate feelings of hopelessness, helplessness, and irritability.The primary care challenge: shifting from symptom identification to understanding the real-life impact on activities, relationships, and overall well-being.[08:41 - 28:29] Rethinking Depression in Pediatrics: Connection, and Therapy ApproachesConnection—not just checking PHQ-9 scores—is a critical protective factor for youth mental health and should be the heart of clinical encounters.Traditional Cognitive Behavioral Therapy (CBT) and newer Acceptance and Commitment Therapy (ACT) are compared — with ACT focusing on accepting thoughts and changing relationships with them, not just “fixing” or disputing them.Dr. Cullinan explains how ACT techniques, including physicalizing and naming despair, help kids distance from and better manage their feelings.The “beach ball” metaphor illustrates how fighting negative thoughts can cause you to miss life’s joys—and how letting them coexist with living can restore function and hope.[28:30 -58:59] Strategies: Playful Experiments, Values-Based Goals, Motivational ToolsPractical examples include using humor, metaphor, and even quick physical challenges (like the “lemon” exercise) to help kids gain distance from distressing thoughts.Naming depressive feelings or thoughts (e.g., “pathetic,” “Bob”) can help externalize and reduce their influence, making them easier to talk about and manage.Motivational Interviewing is highlighted as a powerful tool—but only if it genuinely centers each child’s unique values and interests, not the provider’s agenda.Avoidance, not just the presence of sadness or fear, is flagged as the true engine of suffering; the focus shifts to acceptance and gentle behavioral activation.[59:00-1:06:47] Building Resilience: Safety, Nurture, New Frames, and Practical PearlsChildren’s beliefs and “frames” about themselves and the world are shaped by repeated messages—caregivers can help reframe these with new, nurturing narratives.Safe, stable, nurturing relationships offer the strongest protection and resilience against depression and trauma, as explored through frameworks like toxic stress and child transformation health.Providers can make meaningful impact in just minutes with new language, metaphors, and reframing exercises—even in a busy primary care setting.[1:06:48 -...

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• 244. Taming Pediatric Anxiety with Brain-Body-Behavior Strategies

  Have you ever wondered why anxiety in children can look and feel so physical—and what we as pediatricians, parents, or caregivers can do about it? We’re visiting a fan favorite from Episode #26 of Pediatric Meltdown, Dr. Lia Gaggino sits down with Dr. Colleen Cullinan, a leading pediatric psychologist, to dissect the powerful 3 B’s approach: Brain, Body, and Behavior. Together, they reveal eye-opening truths about integrated behavioral health, the ways anxiety manifests in kids, and practical, actionable strategies for managing emotional meltdowns in real-time. This is not just about recognizing anxiety—it's about transforming how we support kids inside and outside the exam room. If you want to empower families, level up your clinical skills, and make a tangible difference, don’t miss this conversation. This episode could change the way you think about pediatric care—forever.[00:00 - 11:35] Integrated Care Foundations: Building Partnerships in Pediatric PracticeIntegrated behavioral health bridges the gap between physical and mental health, creating seamless care experiences for families.Primary care is often the first—and sometimes only—entry point for children facing emotional or behavioral challenges.Partnerships between pediatricians and behavioral health providers increase accessibility, reduce stigma, and foster earlier intervention.The synergy and trust between pediatricians and psychology professionals leads to holistic, effective patient care.[11:36 - 15:49] The Role of Primary Care in Managing Anxiety and Emotional HealthPrimary care providers serve as trusted anchors, introducing mental health as an essential component of overall health.Familiarity with a child's history allows pediatricians to recognize subtle behavior changes and collaborate meaningfully with behavioral specialists.Normalizing physical symptoms of anxiety (like stomachaches and headaches) helps bridge conversations from medical to emotional concerns.Educating families on the inseparability of physical and emotional health empowers them to seek support without shame.[15:50 - 28:55] Anxiety Explained: The 3 B’s and Practical Strategies for KidsThe "3 B’s": Brain, Body, and Behavior, are interlinked—anxiety in the brain triggers body sensations, which guide behavior, often leading to avoidance.Psychoeducation is key: Emphasizing to families and youth that everyone experiences anxiety validates their feelings and reduces shame.Simple, actionable distress tolerance tools—breathing exercises, grounding techniques (like the “five senses” method), and focusing attention—can be taught in minutes during a regular visit.Providers can help children recognize “worry thoughts” and redirect their response before anxiety spirals into withdrawal or meltdown.[28:56 - 49:20] When to Escalate: Distress Tolerance, Prevention, and Team-Based SolutionsDistress tolerance techniques can bridge the gap until a child can access specialized behavioral care—or be sufficient for milder cases.Functional impairment is the marker for when anxiety moves from “manageable” to requiring traditional CBT or higher-level intervention.Exposure therapy explained: At its core, CBT for anxiety involves identifying fears and encouraging gradual, manageable exposure to them, with improvement through repetition.Advocacy for integrated behavioral health, resource sharing, and ongoing partnerships with community therapists are essential for sustainable, high-impact child mental health care.[49:21- 53:34] Dr. Lia’s...

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• 243. The Child Mental Health Podcast: Expert Insights from Child Psychiatry

  Are pediatricians prepared for the mental health crisis that’s impacting so many of our children today?In this episode of Pediatric Meltdown, host Dr. Lia Gaggino sits down with nationally recognized child psychiatrist and podcast host Dr. Elise Fallucco to uncover the urgent realities facing pediatric practice. From understanding why a simple podcast name change can transform the reach of critical mental health education, to exploring the real-world, stepwise journey pediatricians navigate when facing complex child anxiety and medication management, this episode is a masterclass in practical empowerment. Listeners will discover actionable strategies for burnout, the evolving landscape of pediatric mental health treatment, and authentic stories of resilience, support, and resourcefulness. The stakes have never been higher—and the need to equip pediatric clinicians with the right knowledge and mindset is more critical than ever. Don’t miss this invigorating roadmap for providing exceptional care in panicked times.[00:02 - 05:46] Branding, Access, and Reaching Pediatric CliniciansPediatric mental health education is increasingly being disseminated beyond in-person local trainings, leveraging digital platforms like podcasts to amplify access and reach.Clear, descriptive branding ensures the right clinicians can find mental health resources at the exact moment they need support in practice.The main driver in choosing content is what pediatricians most urgently seek: practical, actionable advice about managing medications for anxiety and ADHD.Making specialized knowledge accessible via on-demand, digestible podcast episodes empowers clinicians to feel less isolated and more competent.[05:47 - 13:30] The Ongoing Challenge of Anxiety, Burnout, and Self-CareAnxiety has emerged as the most common and burdensome mental health concern for children, exacerbated by societal stress and recent global events.Differentiating normal anxiety from clinical anxiety is crucial: functional impairment and life disruption are key markers for escalated intervention.Coping strategies for clinicians are vital; the “three pillars” are staying busy with purposeful activity, reaffirming personal/professional mission, and prioritizing self-care.Peer connection, exercise, and carving out time for meaningful relationships are highlighted as essential personal de-stressors.[13:31 - 25:00] Building Skill, Facing Complexity, and the Realities of CarePediatricians experience a four-stage progression from fear and avoidance to high-confidence care in managing pediatric mental health—each with unique challenges and rewards.Access limitations to child psychiatry have forced primary care clinicians to expand their skillsets and comfort zones, often out of necessity.Collaborative consultation programs, like psychiatric access hotlines, accelerate learning, build confidence, and foster an environment where sharing expertise is normalized.Developing fluency with diagnoses and medication management leads to more effective and streamlined care; “herd immunity” and practice culture shifts increase collective capacity.[25:01 - 36:05] Pain Points, Solutions, and Sustaining Progress in Pediatric Mental HealthBarriers to therapy—including logistics, family skepticism, and stigma—limit effective care, even as access improves; motivational interviewing is a partial solution but not a panacea.Integrated behavioral health models and school-based clinics offer promising solutions by reducing friction and meeting children and families where they are.Time constraints and misaligned incentives remain top frustrations; procedures are often reimbursed more than complex mental health care, despite the latter’s intensity and impact.Empathy,...

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• 242. Making Sense of a Mess: My Giant To-Do List

  Can one person truly make a difference in the complex world of pediatric healthcare?In this episode of Pediatric Meltdown, host Dr. Lia Gaggino explores how primary care pediatricians can step up amidst the chaos in Washington DC and stand as the trusted advocates children need. While Lia prepares for the pediatric academic society PAS in Honolulu, she is wrestling with the disastrous current health policy challenges and calls for local action. Lia pleads with her peers to organize and cause “good trouble”. This episode underscores that our most vulnerable population — children — deserves the unwavering dedication of empowered and informed advocates. In pursuit of crafting a brighter future for children's health, will you rise to meet the challenge?[00:00:04 - 00:01:21] Preparing for Change and ConnectionPediatric Meltdown is dedicated to children's mental health and emotional well-being.Dr. Lia Gaggino shares her passion for facilitating thoughtful conversations with experts.New and creative medical approaches are thriving and contributing to community upliftment.Enjoying family time and Hawaii's scenic beauty is part of Lia’s plan to recharge.[00:01:21 - 00:04:19] The Chaos in D.C. - A Call to ActionThe state of national politics is concerning, described as a "dumpster fire."Staying informed plays a crucial role despite the overwhelming current events.Balancing leisure with staying critically aware of policy changes affecting pediatrics.Connecting with pediatric colleagues to brainstorm actionable steps.[00:04:19 - 00:08:39] Advocacy for Children’s NeedsEmphasizing the trust placed in pediatricians and the responsibility that comes with it.Safe health practices are under threat from misinformation spreading rapidly.Vital programs and advisory committees crucial for child safety are being dismantled.Highlighting the unnecessary and detrimental effects of defunding health initiatives.[00:08:39 - 00:12:39] Empower Your Voice and CommunityHighlighting real stories as powerful tools for advocacy.Breaking down scientific data into relatable family narratives aids understanding.Demystifying Medicaid's role as crucial support for countless families.Urging listeners to take definitive action, whether through social media or community forums.Resources Mentioned:AAP Advocacy Guide Member log-in required to accessOn Tyranny Timothy SnyderAAP MMR Vaccine InformationAAP Medicaid State Fact SheetsHere are some more episodes you may likehttps://pediatricmeltdown.com/episodes231. Raising Good Citizens Through Conscious Parenting186. Immigrant Children and Families 158. Preventing Youth Suicide 100. The Art of Medicine Tweetable Quotes:"We've witnessed chaos, unprecedented and relentless. The landscape of Washington DC is reflective of a larger societal unrest, a crucible that now must forge strength and

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• 241. Fighting Untruths and Chaos: The Power of the Pen and A Little Therapy

  Are you feeling overwhelmed by the world's chaos and seeking hope amidst uncertainty? In this moving episode of Pediatric Meltdown, host Dr. Lia welcomes Dr. Robert Saul to discuss the powerful principles guiding his commitment to advocacy and change. Dr. Saul introduces the transformative 12 words that have anchored his life's work and how these principles can propel communities forward. Together, they examine the impact of truth, trust, and the little-known role of the communal aspect in tackling societal issues. As Dr. Saul passionately delves into historical and modern-day examples of lying within power structures and challenges us to confront uncomfortable truths. Discover where the true power of change lies and how understanding our roles can lead to actionable advocacy. This episode isn't just a conversation—it's a call to action for those yearning to make a difference.[00:00 - 05:09] The Art of Medicine and the Value of ListeningDiscussing the importance of comprehensive clinical encounters beyond quick checkupsStressing that empathy and genuine presence build deeper connections in healthcareHighlighting the responsibility to offer hope and guidance, not merely prescriptionsSuggesting that professionals and caregivers must pause to recalibrate when stress levels rise[05:10 - 12:31] Accepting Responsibility: “I Am the Problem, I Am the Solution”Exploring the idea that acknowledging our collective part in societal problems is the first stepUnderlining the distinction between culpability and willingness to engage in solutionsDiscussing how seeing oneself as part of the issue spurs commitment to meaningful actionReminding listeners that we are interconnected in every community concern[12:32 -31:06] Truth, Trust, and Social FabricDefining trust as the “currency” of relationships and community lifeArguing that telling the truth consistently is essential for building and preserving trustNoting that children thrive when caregivers, professionals, and policymakers work together with integritySuggesting that widespread misinformation undermines the health and wellbeing of communities[31:07 - 42:06] Looking Ahead: Ongoing Work and HopeEncouraging continued involvement in committees, local boards, and mentorship rolesHighlighting the drive to create community programs focused on healing and trauma-informed carePlanning future projects that address truth, trust, science, diversity, and civilityEnding with an affirmation that sustained efforts at all levels can foster a more promising future[42:07 - 55:46] Dr. G’s TakeAwaysAdditional Resources Mentionedhttps://mychildrenschildren.com/my-childrens-children-name/https://mychildrenschildren.com/better-is-good-incremental-steps-forward/Power S. The Education of an Idealist: A Memoir. Dey St. 2019; 580 pp. (p. 282)Snyder T. On Freedom. Crown, New York; 2024. 345 pp.https://mychildrenschildren.com/infant-mental-health-part-i/

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