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Melanie Cole: How do you talk to your kids during a time when so much of the news is disturbing, how can you help them navigate the ups and downs of everything we're seeing in the country and indeed the world today. Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Joining me is Dr. Neela Sethi. She's a pediatrician on staff at Henry Mayo Newhall hospital. Dr. Sethi, I always love to have you on as a guest and as a parent of two kids. And I know you are as well, a parent, this is unprecedented times. There's so much going on. It's just absolutely crazy what we're seeing. Have you seen an increase in anxiety, anxiety related disorders, eating disorders, this mental health crisis that we're seeing with our children.

Dr Neela Sethi: Absolutely. It's probably the worst I've seen in my career. I knew that it was coming, after COVID because you cannot have a giant life stressor and go through a global pandemic without having some mental health effects afterwards. But I will tell you what I've seen in this last year is unlike anything I've ever seen before, it's actually even pushed me to consider getting a secondary degree in, mental health services, because there are so many kids that are suffering and there is such a lack of, just providers available for these poor children. So it's just lose, lose for these young things. And it's, really, really sad to.

Melanie Cole: I thought about the same thing, Dr. Sethi, about getting some kind of a mental health certification, anything because there's such a need right now. How do you feel the impact of this news and media on our kids' wellbeing? I mean, certainly it has made our kids more worldly, more global than we ever were. And I'm older than you are, but more worldly, but it also adds to that level of tingliness, that level of stress, that we're all feeling, this worldwide stress. Right? I mean, what do you think about that?

Dr Neela Sethi: It's absolutely true. I think it's important to sort of note that kids react differently and, we often think, oh, well, kids feel stressed the way we feel stressed. And so if they're, looking fine and acting normal, then they're not stressed. And that is. Absolutely not true, especially When they're younger, they show stresses differently. You can see childhood anxiety present as sleep disturbances. You can see it present as eating disturbances. You can see them. Act out more than they normally would. So they're higher energy where they scream more, they yell more, they cry more.

Sometimes they become more quiet and they retract and they spend more time in their room. So it's really important to sort of deep dive into your child's behavior and really think, to yourself, is this change in behavior, something that could be caused from anxiety instead of just writing it off or saying, well, they don't tell me they're anxious, so they must not be anxious.

Melanie Cole: Well, then what are those red flags? You just mentioned retreating to their rooms, and we've seen a bit of an uptick in, substance abuse and abuse during the pandemic, for sure. But tell parents, listening some of those signs of anxiety, depression,things in our kids. I have a lot to talk to you about today.

Dr Neela Sethi: Yes for sure. when you're dealing with preteens, and toddlers up to kind of preteen, it's mostly. sleep, disturbances, eating disturbances, mood disturbances, and just overall not acting themselves. So we've talked about this before Melanie, where you have to trust your maternal or paternal instinct. Is your gut instinct as a parent saying, something's not right? My child used to love X, Y, and Z, and now they don't. They used to love going on play dates. Now they don't, they used to love reading their favorite book and now they don't.

They always watch TV at this time of day. And they're not so changes in their daily behaviors because as we all know, kids are creatures of habit can be a red flag. As they turn into teens and adolescents and young adults, they do tend to present similarly, to us. They report feelings of anxiety, feelings of anxiousness, nervous tummy. What you'll see is things that didn't used to bother them all of a sudden, do. They're scared to go places.

They talk about the fact that they're scared to go places. They tend not to want to be as social as they used to be things that didn't seem to affect them, seem to make them now nervous, retracting in their room for longer periods of time than they should, sleeping many more hours than they should or not sleeping. All of a sudden you're noticing that your child's up at 3:00 AM and they're up at 6:00 AM. And then eating disturbances.

Eating is one of my most favorite cues to use in kids, because I will tell you, it's very rare that kids don't want to eat, they usually will. Now do they wanna finish their plate every time? Not really, but most kids want to eat and are fairly good eats, especially if you offer them their favorite foods. So if you are noticing that you're making their favorite lasagna, and they're not touching it. Something is up and that's when you have to do the deep dive as to what's bothering them.

Melanie Cole: So then what, you and I discussed off the air, the lack of mental health professionals right now, the difficulty getting an appointment, even with the televisits, which I think televisits have really changed the landscape of the mental health services available, which I think is awesome. So much easier than dragging our kids around to some of these places. However, it still isn't easy to get. What do we do? Do we go first to our pediatrician? Do we talk to our kids and try and help them first? What do we do?

Dr Neela Sethi: First and foremost, you lean in as a parent. So you stop what you're doing. Put your phone down, close your computer, make your child the priority and sit them down and say, I am worried about you. I love you. I am here for you. I am noticing all these things and I wanna know how you're feeling. Open the discussion up to letting them talk about their feelings. And we've talked about this before. If it doesn't work the first time, well, you don't give up. You try again the next day and the next day and the next day.

And in the meantime, yes, you absolutely make an appointment to see their pediatrician, someone like me, or a general practitioner. Family medicine doctor and schedule an appointment, bring 'em in and say, these are the things that I'm noticing, but all really good therapy starts at home. So if your child explains to you that they're anxious about X, Y, and Z, you can give them some coping mechanisms for that. A lot of times them just being able to get it off their chest really helps for me. What I tell parents first and foremost, what's their screen time? That's my very first question.

How much Are they on their phone? If they have a phone, how much are they on their iPad? How much time are they on YouTube? Watching TV? How much time are they having just staring at a screen versus getting outside and moving around. So that's the first thing you have to move your body and have serotonin and vitamin D. Kids are so much more dependent on it than we are. They're naturally made to move their bodies. And a lot of times depression and anxiety can stem from just having a sedentary lifestyle. These poor kids, they went virtual.

They're on their computers all day. And then they're on their phone on TikTok and Instagram and Snapchat all night. And they're not moving outside. Guess what? Your body start deteriorate, your vitamin D level flow, your serotonin level flow, and that can lead to depression and anxiety. So, putting the phone down, putting the iPad down, turning the TV off and getting them outside. They will kick and scream and yell. But you are in charge. You are the parent trying to do things that are fun for them.

Swimming, hiking, biking, going for a walk, walking the dog, walking with a friend around the block. I don't care, but you get them up and moving. Get the blood flowing. Number two, deep dive into their diet. We often forget how important diet is in childhood. They need fruits. They need vegetables. They need foods that are not filled with preservatives and dyes. They need healthy diets. They need a certain amount of protein every day. You can do this as a parent by really helping them have breakfast, lunch, and dinner, and two snacks of good hearty food.

As we all know food and serotonin go hand in hand when you're not eating very well, you're not gonna feel happy. When you are eating a lot, but it's all junk. You're not gonna feel really happy. So really honing in on their diet makes a huge difference. Number three, sleep, sleep, sleep, sleep. How many of us as adults can state that when we're not getting enough? We don't feel good. That is true for kids as well. If they are not sleeping well. And I don't care if they're in their room for 12 straight hours, we don't know if they're actually sleeping all that time.

So having a bedtime routine, even for the older kids, turning off their screen time. For my teens, I tell them, get into a bath, listen to music that's soft. Get into your bed, make sure your bed is nice and comfy, and that your pillows are fluff and you have comfy pajamas and get a nice book. Or get, the Calm app learn how to just sort of wind down for your younger kids you do all those things, but bedtime stories, bedtime routine, making sure that they're cozy so that they can wind down at the end of the day and get sleep.

Sleep helps in so many more cases. I cannot tell you how many kids I have seen in my office that were just about to go on medication and if that's necessary, it's necessary. But once we help them out with sleep, decreasing their screen time and helping with their diet. They magically start feeling better a week or two in.

Melanie Cole: Wow. That was an awesome list. What a guest you are. And I agree with you as an exercise physiologist. I agree with you on every single solitary one of those points. And the sleep, I'm glad that you mentioned that that's so important diet exercise, just as you say. Now, with all of these. And we're all feeling this anxiety, Dr. Sethi, at this time, how can parents, I know you're a pediatrician, but at the medical home, you're working with families. How can parents manage our own emotional challenges so that we can best help our children?

I mean, I live Half a mile from Highland park grew up here all my life. And I think thank you. But it, I mean, it was one of the scariest days I've ever lived through. Military tanks were going past our house all day, telling us to stay in. And as a parent, my husband and I, at that day, we kept our kids close. We locked the doors, we shut the fence. We did all the things, but I was trying not to be so freaked out that my kids would then heighten their level of anxiety. Can you give us some advice for parents Is it the same advice you just gave us for our children?

Dr Neela Sethi: Absolutely. Absolutely. I think one of the things that we do as parents, that I'm actually learning later in my career is numb. That we tend to numb or block our pain or our feelings in order to protect our kids. And that actually is sort of natural selection, right? We're the mama bear and the Papa bear, and we wanna protect our Cubs. But what we're learning now is that there is an element of us being vulnerable with them that helps normalize their feelings and also helps destigmatize the idea that if you are struggling. It's okay.

Because what we did over the course of the last couple of decades is that we kind of made it seem like they should be happy if we are happy all the time. So if we are saying I'm fine, I'm great. I know there was just a shooting, but I'm gonna be okay. It's gonna be okay. We're gonna be okay. And they're not feeling okay. We are then giving them and telling them that their feelings are not validated. Now on the flip side, you don't wanna be absolutely hysterical either, but there's a middle ground in terms of saying to your child, I know that you're scared.

I know that you're anxious. I know how hard today was for you. I am feeling those same things, and I want you to be able to talk to me about your feelings, just as I'm able to talk to you about your feelings. Now, as much as we can talk about diet and exercise, and sleep. I don't want patients that are listening to this out there to think, well, that seems like such a simple response and there's more to it because let me tell you, especially post COVID and what we're dealing with in our nation, there are many of times that diet, exercise and sleep are just not gonna cut it.

And that's when you walk into your pediatrician's office and you say, I'm worried about my child. And I cannot explain to you how helpful seeking therapy is. We talked about it before with telehealth or in person, you advocate for your child. You call every single person on your insurance list to see if they're accepting new patients. I tell parents now advocate for your babies call outta state. I have plenty of patients that are seeing telehealth psychiatrists and psychologists in Wyoming, in Nevada in states that have more access.

Melanie Cole: Mine is in Arizona.

Dr Neela Sethi: Yeah, my, therapist is in Boulder.

Melanie Cole: Yeah. See, I mean, I'm in Illinois. My therapist is in Arizona. Just like you are in California and seeing someone in Colorado is easier today to do that. And I think that's excellent.

Dr Neela Sethi: It makes it so much easier. And then the last and final step is understanding that there are times that medication is necessary and really understanding that, that is not your fault as a parent, nor is it the fault of a child. It is no different than having a diagnosis of asthma or allergies or any other thing that your child does not have control over. Sometimes their serotonin levels. It causes severe anxiety, it causes a depressive episode and they need medication to boost those serotonin levels and help them feel better. What we do know is that therapy and medication together work.

That's the magic combo therapy on its own can be helpful in mild cases. But if you are having any major anxiety or major depression, both medication and therapy work together, and we really try and destigmatize that for parents, cuz they hear medication, they think, oh my child's quote, unquote crazy. Or I failed as a parent. None of those things are true. We are all just trying to hold on, especially everything that we've dealt with coming out of a global pandemic.

And now into this sort of, battle that we're in, at least to me, it feels like a battle. There's a lot on our plates. The world is heavy and we're just trying to do the best we can. And just as we're feeling stressed and overwhelmed, our kids are feeling that way as well.

Melanie Cole: You wanna make me cry? The world does feel heavy and things we've never felt before. Right. And whether our children are well adjusted, handling it all. I don't know how they can be. I don't know how anybody can be, but we have to, as you and I both said, it's all about protecting our children, keeping our children safe. That's what our pediatricians. Gosh, I love you guys. Pediatricians are the heroes of our children. Truly. You're helping us to raise our children, safe and healthy. And that's what it's all about. Give us one last piece of advice about anxiety and our kids and everything that we're seeing and how we can all kind of hang on to each other and look to our wonderful pediatricians and the experts and specialists at Henry Mayo Newhall Hospital for help. Should we need it?

Dr Neela Sethi: I think the best advice I received was from a mentor. And she said, lean in. Lean into every aspect of your life. Lean into your friends, lean into your colleagues, lean into your family, lean into your kids and let your kids lean in on you. Let your guard down, forget the vulnerabilities, forget society's stigmatizing of mental health. Forget what you think and go with what you feel. Go with what your gut instinct is and go with what's happening around you. If you feel a certain way, tell your kids. If you're worried about them, tell them. If you think that a friend could help them talk to your friend. If you feel like you need help from a colleague, lean in.

If you need help from your pediatrician. Go to your pediatrician. This is the time where we, not just as a nation, but as a world need to lean in on each other We're not meant to be an individualistic society. We're not we're homo sapiens. We were raised in tribes. The reason we evolved is because we had tribes of people and generations that helped us raise our kids and were forgetting that, and we're getting away from that. So my best advice is lean in, let your guard down. You will never know the advice that you get with a conversation from someone that you never thought you would have had you not brought it up.

Or If you had asked for help in a way that you never would've before. So that would be my best advice. That's, what's helped with me, with my kids and their own anxiety and my anxiety. And, I'm certainly available for anyone that needs kind of extra help and care, but lean in and just take extra care. Go easy on yourself and your kids right now, they're struggling and we're struggling too.

Melanie Cole: Wow. What an informative podcast. This was, we really got deep and discussed some important things for parents and their kids right now. And it's so important for all of us. We are stronger together, Dr. Sethi. I know we are. And thank you so much for your expertise, your passion and your compassion. What a lovely lady you are. I think your patients are quite lucky. And talk to your pediatrician if you have concerns about your child's mental health and for a list of youth mental health resources, please visit adolescenthealth.org and click on the resources link at the top of the page. And you can also visit the free health information library at library.Henrymayo.com.

That concludes today's episode of It's Your Health Radio with Henry Mayol Newhall Hospital. I hope you got as much out of it as I do. I'm Melanie Cole. Thanks for listening.