In this collaborating series, our physicians at Pediatric Wellness Group will be talking with providers from Beyond Measure to destigmatize mental health services and help explain how primary care and mental health providers often work together to help your child through tough times. 

In today's episode, pediatricians, Dr. Eileen Chan and Dr. Roma Shah, speak with psychologists, Dr. Erika Jung and Dr. Salena Schapp, about how to know if your child might need therapy. 

Are these big feelings and worries normal for their age or is this something more?

We also dive into how therapy works, how long it lasts, and what concerns parents often have about therapy. 

This is just the first of many topics we would like to cover, so stay tuned for more to come! 

• Get an earthquake kit together, emergency pack, disaster plan 
  • Have a what-if bag? 
  • Get your photos onto digital hard drive 
  • Sort through old photos 
  • Make an inventory of your house  
• Don't try to take on the teacher role 
  • Things you can do which are educational but are not curriculum based 
• This is an amazing opportunity to reconnect with the "real" world if you look at it that way 
• Harness compassion for other people rather than feeling sorry for yourself 
• Meditate 
• Make playlists/share them, listen to something new, have an indoor dance party 
• Read a book, audiobooks, start a series (as a family): Harry Potter, Little House on the Prairie, Percy Jackson 
• Creative Writing: journaling or start writing a story or graphic novel 
• Socializing/ Reconnection: Facetiming 
• Organizing: maybe now is the time to finally get those photos organized, scanning files, getting tax info together 
• Let your inner child out: encourage your kids to pretend play and then join them in doing that! 
  • Make a tent inside with a blanket thrown over a table, tell spooky stories by lantern light (as long as this is age appropriate)  camp type dinner, S'Mores with your toaster oven/oven 
  • Picnic inside or in the yard, Candlelight dinner, Breakfast for Dinner 
  • Wear pajamas all day 
  • Make a fort with old delivery boxes or a fancy house for your cat 
  • Puzzles, real board games  
• Start to learn a new language. 
  • See if your kids pick it up faster than you do!  
• Teach yourself a new skill 
  • Practice on that piano, learn to play the guitar 
  • DIY projects at home 
  • Learn a new language 
  • Sewing, knitting [start a virtual knitting circle]  
• Hardware stores are open, think about a repair project, DIY paint project, some spring cleaning, TONS of ideas online.  
• Start an art project or craft: painting, homemade playdoh, beading, friendship bracelets. Be creative!  
• Now that we are making do with less, are there permanent changes you can make to help save our planet? 

• • Go over 7 stages of grief
  • Acknowledge fear and panic and grief
• This is an amazing opportunity to reconnect with the "real" world if you look at it that way 
  • Re-connect 
  • Re-define 
  • Re-imagine 
  • You can do that by 
    • Recognize
    • Resourceful
    • Reliance
• News blackout: 
  • Turn off TV/radio 
  • Sign up for alerts, set times to check information for critical updates 
  • Balance what you are watching 
  • See episode 1 notes for some trusted sources 
  • Harness compassion for other people rather than feeling sorry for yourself 
    • Be grateful 
      • Keep a journal [video, pictures, written] 
      • Offer to help someone that is less able/more vulnerable 
        • Needs a meal 
        • Needs meds or errands run that can't do that themselves 
  • Social distancing doesn't mean social isolation 
    • Check in with friends 
      • Call 
      • Write letters 
      • Video chats 
  • This is an amazing opportunity to reconnect with the "real" world if you look at it that way 
    • Re-connect with what is important
    • Re-define what "normal" looks like
    • Re-imagine the possibilities
  • You can do that by 
    • Recognize what is happening
    • be Resourceful
    • cultivate self-Reliance

• we will get through this
• Your health care community wants to be there for you, be thoughtful about how you use healthcare services right now
• Be kind to each other
• Model the behavior you want your kids to have

Sources we trust:

 CDC https://www.cdc.gov/coronavirus/2019-ncov/index.html

• American Academy of Pediatrics https://www.healthychildren.org
• WHO coronavirus information https://www.who.int/health-topics/coronavirus
• San Mateo County Health Department https://www.smchealth.org/coronavirus
• Santa Clara County Health Department https://www.sccgov.org/sites/phd/DiseaseInformation/novel-coronavirus/Pages/home.aspx
• San Francisco county health department https://www.sfdph.org/dph/alerts/coronavirus.asp
• Alameda County Health Department http://www.acphd.org/2019-ncov.aspx

This podcast is available for private, non-commercial use only. You may not edit, modify, or redistribute this podcast. PWG and the developers of this podcast assume no liability for any activities in connection with this podcast.

Here's an outline for episode 10:
note this is the longest episode of season 1 [about 50 minutes] so feel free to listen in small amounts.

• We need to address anxiety  
• Types of Anxiety:  
• Pathogenesis: unknown  
• What does this look like at different ages?  
• Different types of professionals: 
  • Psychiatrist
  •  psychologist
  • Licensed mental health counselor 
  • Licensed Clinical social worker [LCSW] 
  • Psychiatric or mental health nurse 
• Difference between counseling and psychotherapy  
• Anxiety vs. depression vs. mental illness [bipolar, schizophrenia]
• Is there something else going on? Learning difference? Substance use and abuse?
• Should I get some testing? What is commonly ordered?
• The role of electronics 

This podcast is available for private, non-commercial use only. You may not edit, modify, or redistribute this podcast. PWG and the developers of this podcast assume no liability for any activities in connection with this podcast.

Here's an outline for episode 9: 
“Between stimulus and response, there is a space. In that space lies our freedom and power to choose our response. In our response lies our growth and freedom” – Victor Frankl 

• Mind Body Medicine
• Non-pharmacological way to improve concentration, help decrease pain, control discomfort, or ease anxiety
• Includes biofeedback, yoga, hypnosis and guided imagery
• Meditation vs. mindfulness 

Mindfulness: Paying attention with moment-to-moment awareness, On purpose, In a particular way, Without judgment

• Noticing what is happening right now --> focus more deeply, pay attention to your senses
• Science behind it 
• Clinical benefits
• Psychosocial benefits
• Really about emotional health and well being 
• Mindfulness: How do I start? 
• How much do I have to do? 
• What if I hate it?
• What are the ways I can do this? 
• Apps 
• How to boost the effects of mindfulness 
• Resources
  • Kabat-Zinn J. Mindfulness for Beginners: Reclaiming the Present Moment—and Your Life. Boulder, CO: Sounds True, Inc.; 2016.
  • https://www.aap.org/en-us/professional-resources/Stress/Documents/private/Guided_mindfulness_handout_final.pdf
  • https://solutions.aap.org/DocumentLibrary/pcowebinars/Mind%20Body%20Therapies.pdf
  • https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Mindfulness-Training-in-Urban-Public-School-May-Help-Ease-Effects-of-Toxic-Stress.aspx
  • https://www.healthychildren.org/English/healthy-living/emotional-wellness/Pages/Just-Breathe-The-Importance-of-Meditation-Breaks-for-Kids.aspx
  • https://www.developgoodhabits.com/best-mindfulness-apps/
  • https://blissfulkids.com/what-is-mindfulness-and-how-to-explain-it-to-kids/

This podcast is available for private, non-commercial use only. You may not edit, modify, or redistribute this podcast. PWG and the developers of this podcast assume no liability for any activities in connection with this podcast.

Here is our outline for episode 8:

• What are the different types of Physical Activity?  
•  Exercise with Developmental Disabilities  
• Weight training guidelines 
  • Contraindications/Precautions
• Rest is important 
• How do I start a program? Take mine to the next level? 
• Benefits of organized sports  
• Do I need a trainer? Expensive equipment? 
• How to get around time challenges
• Specific exercise routines for different ages
• When can I run a 5K? 10K? Marathon?
• Pay attention to pain 
  • Patellofemoral syndrome
  • Sever's syndrome
  • Osgood Schlatters
  • Iliotibial band syndrome 
• Adequate Hydration/Young athletes guidelines 
• Consider Air Quality 
• Weight Management:  
• Some examples of Staying Active 
• What is the Key to getting Kids to Exercise? 

This podcast is available for private, non-commercial use only. You may not edit, modify, or redistribute this podcast. PWG and the developers of this podcast assume no liability for any activities in connection with this podcast.

Here's an outline of episode 7:

• Why is it important? 
  • Benefits for children .
  • Benefits in adults
• What are the different types of Physical Activity? 
  • Cardio/aerobic activity: 
  • Muscle Strengthening/Strength training: 
  • Bone Strengthening: 
    • (discussion in Episode 8)
• How much do you need? 
  • Guidelines for Preschool Age (3-5 y/o) 
  • Guidelines for School Age (6-18 y/o) 
•  Exercise with Developmental Disabilities 
• Weight training guidelines 
  • Contraindications/Precautions: 
    • (Discussion in Episode 8)

This podcast is available for private, non-commercial use only. You may not edit, modify, or redistribute this podcast. PWG and the developers of this podcast assume no liability for any activities in connection with this podcast.

Here's an outline of episode 6:

• Organic versus Non-organic: 
• Is Soy a Bad Thing? 
• How much water do I need? 
• Talking about Diet: negative emotions around the word "diet"

How to have a healthy relationship with food: Parents to show that you are eating a well balanced diet

Produce grown at home, getting kids involved with food, food prep, making fun shapes, dips

Food is culturally precious: someone put effort into growing our food

Food waste is a hot topic: food doesn't have to look perfect

Allow kids to have a choice about the treat that they want so they can begin to develop some self-moderation.

• Food Allergies: just briefly touching on... 
• Nutrition Help/Seek an RD opinion 
• Avoiding Breakfast: some kids just don't like to eat 1st thing in the morning 
• Probiotics: live bacteria and yeast that are good for you 
• Prebiotics are like fertilizers to help healthy bacteria grow in your gut 
• Take Home Points: Tying in Wellness to Sleep (the first pillar)  and now this discussion of Nutrition is the second pillar 
  • Quality of your food: organic versus nonorganic is important
  • How you model your relationship with food has a big impact on your children's relationship with food 
  • Food has a psychosocial element you shouldn't ignore
  • Teenagers trying out different options and Vegetarian/Vegan options are important to know about
  • Different eating styles can mean more work in making sure you get adequate nutrients
  • Gut microbiome is important 
  • Try to avoid making food a source of power struggles

This podcast is available for private, non-commercial use only. You may not edit, modify, or redistribute this podcast. PWG and the developers of this podcast assume no liability for any activities in connection with this podcast.

Here's an outline of episode 5:
Vitamins vs. minerals vs. herbals vs. probiotics vs. prebiotics

• What do vitamins do? 
• What do minerals do? 
• probiotics vs. prebiotics

How to shop for them

Do I have to take them?

Too much can be bad for you

Different eating plans: are they okay? Safety for children and adolescents? 

• Nutrient Risks in a Vegetarian/Vegan Diet

General principles

Resources

• https://michaelpollan.com/
• https://www.healthychildren.org/ 

 This podcast is available for private, non-commercial use only. You may not edit, modify, or redistribute this podcast. PWG and the developers of this podcast assume no liability for any activities in connection with this podcast.

Here's an outline of episode 4:

• Link with wellness  
• General principles 
  • Avoid battling about food: With toddlers you won't win this one 
  • Need to be intentional about good eating.   
• Parents take this opportunity to be more motivated to eat well because now it isn't just for you it is also for your child!
• Nutrition basics 
  • Limit sugar intake and discourage drinking sweetened beverages. 
    • No recommendation for sweetened beverages: drink milk and water 
      • AAP recommends: 
      • < 2 y/o avoid added sugars 
      • Or 2 y/o and up limit to 25 grams or 6 tsp/day 

Reassurance for parents:  Talking about nutrition from Day 1.  "normal kids will eat enough to grow normally"

Nutritionally Complete Diet:

• Recommendations can vary by age and even by gender in the teen years.
• Avoid battles with food
• ChooseMyPlate.gov  
• What to do for the picky eater?
• Whole Grains: 
• Proteins: 
• Fats/Cholesterol: 
• Snacking can be an essential component of the young child's diet

Resources

https://www.healthykids.nsw.gov.au/kids-teens/choose-water-as-a-drink-kids

https://www.choc.org/programs-services/urology/how-much-water-should-my-child-drink/

 http://depts.washington.edu/shsi/article/hydration-in-the-heat-for-young-athletes-medical/

 https://learn.truesport.org/how-much-water-should-youth-athletes-drink/

 https://familydoctor.org/athletes-the-importance-of-good-hydration/

This podcast is available for private, non-commercial use only. You may not edit, modify, or redistribute this podcast. PWG and the developers of this podcast assume no liability for any activities in connection with this podcast.

Here's an outline of episode 3:

• Medical evaluation can involve a sleep study, labs
• Tips for better sleep: 
  • Routines 
    • Same bedtime every day 
    • An hour before bedtime, dim the lights and turn off all screens. Blackout curtains are helpful.  
• Avoid caffeine after 1 p.m. and never go to bed tipsy. Alcohol is a sedative and sedation is not sleep. It also blocks your REM dream sleep, an important part of the sleep cycle
• Can use phrases or actions to cue your body for sleep 
  • Bath 
  • Herbal Tea 
  • Reading a story 
  • Audio cues: white noise, music 
  • Read a book 
  • Use essential oils to connect relaxation with sleep 
  • Heavy blanket or massage as tactile cue 
  • Snacks high in protein can help: warm milk, turkey, piece of fruit 
  • Gentle stretching 
  • Mindfulness 
  • Breathing exercises 
  • SNOO for infants 
• Exercising right before you go to bed may make it harder to fall asleep
• Avoid caffeine and nicotine late in the day and alcoholic drinks before bed
• Make room conducive to sleep: keep it dark, quiet, comfortable or slightly cooler temp [65 per Dr. Walker], no TV or computer
• Don't lie in bed awake, if you can't sleep get out of bed and do something like reading a book or listen to music until you feel tired.
• Herbals/supplements 
  • Melatonin 
  • 5-HTP 
• Gratitude [for the day, resets the mind chemistry, sets the tone for your rest, triggers a cascade of autonomic events that can help you get deeper sleep]
• Wearables--> do they work? Maybe, maybe not

Resources

https://www.sleepfoundation.org/articles/melatonin-and-sleep

 https://www.webmd.com/vitamins/ai/ingredientmono-940/melatonin

 https://www.healthline.com/nutrition/5-htp-benefits

 https://www.webmd.com/vitamins/ai/ingredientmono-794/5-htp

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415362/

• What does it do? 
• How much do you need? 
  • Varies according to age 
• Biology and science of sleep 
  • 2 basic stages: REM [rapid eye movement] and non-REM sleep [which has 3 different stages] and you cycle through these several times per night 
    • Non-REM Stage 3 is the deep sleep you need to feel refreshed in the morning, usually have longer periods of this during the first half of the night 
  • Circadian rhythm [or body clock] controls timing of sleep 
  • Chemical signals or neurotransmitters 
    • GABA is associated with sleep, muscle relaxation, sedation 
    • Norepinephrine and orexin keep brain active while we are awake 
    • Acetylcholine, histamine, adrenaline, cortisol and serotonin all impact sleep and wakefulness 
  • Genetics 
  • How can you tell you are getting good sleep? 
  • When should I worry about not getting enough sleep? 
• Resources
  •  Matthew Walker at UC Berkeley  Center for human sleep science 
    • Why We Sleep 
  • NIH 
  • WebMD
  • Mayo Clinic
  • https://www.sleep.org/articles/sleep-quantity-different-sleep-quality/ 

• Episode 1 --> setting the stage 
  • We are located in Redwood City, CA near Silicon Valley aka tech mecca 
    • correction: in the recording we mention that we are south of Silicon Valley, actually we are north of the valley
  • How we met 
    • PICU rotation story 
  • How we designed this practice 
    • Balthazar's in NYC with Tricia creating a vision for our ideal space and practice 
      • Warm, inviting 
      • Art, colors, flooring, etc. 
      • Not sterile, want to make a visit to doc less anxiety provoking because "no one likes to go to the doctor's" 
      • Snacks for kids --> apple, organic lollipops 
      • Coffee for parents "take a break" 
      • Books [for kids and adults], inspiring messages on screen, tactile toys, FISH TANK 
    • We knew we succeeded when a yelp review mentioned that their child is having a tantrum because she wanted to go to doctor's office! 
  • How we opened up the practice 
    • No one would lend us money we were 2 women doctors with no formal management training 
    • First Republic supported us, we love Greg Leando! 
    • Weren't sure how this would be received by people, really grateful that people followed us 
  • Why we are passionate about private practice 
    • Allows us to practice the way we feel is best for ourselves and our families 
    • Build relationships : 
      • People trust us and can open up to us, we can then have an impact esp with teens 
      • We *know* your child and can recognize when something is not right 
      • Important for you to be seen as a whole person, not just a number 
    • Integrate multiple tools for wellness 
      • Western medical tools such as vaccines 
      • Other healing traditions such as acupuncture, Chinese medicine, Ayurveda 
    • HPV vaccine story 
      • We are graded on this as a performance metric 
      • We have more latitude to craft an individual solution rather than strictly following algorithms 
  • Why a trifecta? 
    • Boston Cream Pie story 
    • Really at the heart of what we see every day 
    • What is wellness? We think it represents a healthy body, mind, and heart.
    • Need a healthy body, mind and heart to live a joyous and fulfilling life 
    • Foundation of wellness: sleep, nutrition, exercise -->  like the base of Maslow's triangle 
    • Trifecta for teens: balancing family with job/school and friendships/relationships 
    • Will come back to this idea of trifecta again and again 
  • How our episodes will work 
    • Set up some science, give you overview 
    • Deeper dives into specific areas 
  • Why are we talking about this?