Josephine Elia, MD: You know being a parent myself i don't know that 
we want to even think about those things right so   it's the last thing that a parent wants to think 
about that their kid might be sick in any way   kids have a need to protect us and they have 
a need to make us happy and if they feel like   they're not being happy and or they're telling 
us things that may make us unhappy they won't   Joe McIntyre: Welcome to the Merck Manuals Medical Myths Podcast 
thanks for joining us I'm your host Joe Mcintyre   and today we're going to take a short break 
from myths to cover an extremely important topic   children's mental health i'm fortunate to welcome 
a very esteemed guest to talk about it with me and   Dr.

Josephine Elia. Dr. Elia is a psychiatrist with 
a specialty in child and adolescent psychiatry   at Nemours A.I Dupont Hospital for Children in 
Delaware. Dr. Elia thanks for coming on the podcast.   Thank you thank you for inviting me. now on this 
episode we'll talk about topics that help parents   to identify and address signs of mental health 
challenges in children and also offer actionable   advice for how to help children understand and 
process these challenges including when to see   a medical professional now dr elia let's start off 
with a fairly simple question perhaps children are   often said to be resilient or often more resilient 
than adults is that actually true when it comes to   their mental health well resilience i it's the 
ability to bounce back right so we can look at   brain development to help us answer this the 
brain isn't fully developed until the mid-20s   and it develops in sections the last part 
of the brain to mature is the frontal cortex   the part of the brain that is needed for 
planning organizing reasoning and impulse control   now adults are able to process 
and organize information   judge risky behaviors factor in consequences of 
their actions and all of these tasks are done   in the frontal cortex and it's one of the reasons 
the rates of car accidents are higher in teens   and don't actually come down to the adult rates 
until about age 25.

Now in addition to the fact   that the brain develops in different stages 
the brain cells are also developing connections   and they form large networks of 
connections so that each of the brain cells   can communicate with one another and talk to one 
another these connections however are not static   but are constantly adapting and changing new 
connections are formed other ones are broken   and then this allows for a healthy brain 
function to happen and it's what gives   the brain you know some of this resilience being 
able to adapt to one circumstance versus another   these connections are in constant change and 
don't fully form until you know adolescents are   late adolescence and when they're not working 
well then it's very difficult to adapt to new   situations or to be resilient when there's 
some event that has caused some regression   then the other thing that plays a big factor 
is life experiences a child who's living in a   home where there's adequate food heat where 
the home is in a neighborhood that is safe   and parents are healthy and can provide 
warmth and care these children are able to   manage and bounce back from stressful events 
much easier and quicker than children living   in adverse situations without an adult 
that can model and can help them process   whatever might be going on therefore to 
answer your question in a long about way   both from a brain perspective from the maturation 
from the connections between the different brain   cells as well as from an environmental perspective 
children do not have the capacity of an adult   brain to have that level of resiliency that an 
adult may have now do you often feel dr elia that   signs of mental health struggles are more often 
ignored in children because it's often easy to   dismiss it as a sign as a kid being a kid or a 
kid being difficult or fussy or whatever it may be   so that that's a really really important point 
i don't know that these signs that we may   label as difficult or fussy or one of my least 
favorite description uncooperative i don't know   that they're ignored necessarily because these 
things cause a lot of external trouble in a sense   however what i would say that we're often 
seeing is that they're often misinterpreted   or misdiagnosed i'll give you an example of the 
kids that we've been treating obviously we're not   going to give any identifying information but they 
reflect many cases that we see it was an 11 year   old boy admitted to our hospital and the reason he 
was admitted was because he needed to continuously   go to the bathroom to pee to urinate the reason 
we were called our counsel team was called   was because staff was having a difficult time 
managing him and you know he became the difficult   kid on the unit because he was running constantly 
from his room running to the bathroom and if staff   tried to stop him he would get very aggressive it 
was very clear when we saw him that he really did   not need to void and to pee because he had just 
voided so when we saw him and and and saw him   compulsively trying to run in to the bathroom we 
obtained a thorough history from the the parents   and discovered that around thanksgiving about 
about three weeks three to four weeks earlier this   eleven-year-old who had been functioning optimally 
and going to regular school had developed a fever   a cough and an ear infection a week later 
his behavior acutely changed abruptly changed   he began having periods where he had difficulty 
talking he was having staring episodes   had become this difficult oppositional fussy 
child and oddly was curling up with a blanket   and wanting to sleep on the on the dog cushion 
rather than going to sleep in his own bed   anyway these behaviors again this this looked like 
an oppositional kid and even an aggressive kid   but clearly that was not the case we 
checked some blood work and i identified   some antibodies that were very high 
that were related to a strep infection   we also got a brain scan where there was some 
swelling in some of the midbrain regions and   we know that there's some infections that can 
cause can cause some brain changes that can   bring out these behaviors so we started treatment 
quickly the treatment that was really effective   was plasmapheresis where we basically you know 
cleared the blood from all of these antibodies   and within two weeks the brain swelling 
had stopped the boy's behavior returned   to normal and he was discharged to home at his 
baseline behavior and went to school the next day whether you're a parent or a seasoned 
professional a medical student or a   caregiver the merck manuals has the right 
medical information in the best format   and it's always free easy to access 
and readily available for you now what questions should parents ask either 
of you a psychiatrist or their pediatrician   to gain a better understanding 
of their child's mental health   you know being a parent myself i don't know that 
we want to even think about those things right so   it's the last thing that a parent wants to think 
about that their kid might be sick in any way   and i think things are a little bit better now 
than they may have been in the past with you know   all the information that's out there but in 
general during the routine pediatric visits   it's kind of critical for there 
to be a give-and-take conversation   with a parent and the pediatrician or whatever 
clinician is working with the family so that   if there's issues they can be discussed and i 
think as as physicians you know as clinicians   we have learned that we need to do a better 
job in even asking the questions ourselves   so an example i can give you is that one of 
the things that are being implemented across   all like health care institutions at this point 
is that we have to screen for kids if they're   if they're having any thoughts of 
wanting to hurt hurt themselves   and in the past never even you 
know imagine doing such a thing   and some parents can get upset about that when 
we do that screening and understand the blue cell   but the reason these are done is because often if 
you don't ask the question if you don't bring it   to the table then it's something that they may not 
be able to talk about or bring it out themselves   likewise in our primary care offices our 
pediatricians are doing screens for depression   for anxiety i think we're doing a little bit 
of a better job in helping parents with earlier   identification and also putting things on the 
table with regards to depression parents often are   not the first ones to to notice these symptoms not 
because they're not the the symptoms aren't there   but we do not and again as a parent we do not want 
to think that our kids not happy and i think in   part we need to not see it so clearly so even 
when we do studies you know to look for either   epidemiological studies or treatment studies we 
know that the parents are not the best reporters and then here in the hospital when we have 
a kid who does come in and they you know   they've hurt themselves uh parents are always 
devastated and we try to to to comfort them by   letting them know that this is typical often 
the parent is not the first one to be aware   kids have a need to protect us and they have 
a need to make us happy and if they feel like   they're not being happy and or they're telling us 
things that may make us unhappy they they won't   so our institutions are beginning to do a little 
bit of a better job and at least trying to screen   for some of these now you do mention anxiety 
and depression and how difficult it is for   parents often to identify that what are some 
of the signs and symptoms that children may   display when they're suffering from a mental 
illness like anxiety or depression some symptoms   of anxiety or depression they can differ 
during the different developmental stages   so for anxiety when kids are little the main 
thing that you see is separation anxiety   and separation anxiety at certain developmental 
stages it's totally normal right so when a kid   around 18 months of age doesn't want to leave 
your side and screams their head off when you're   leaving them even if it's to go to the downstairs 
or whatever that's very normal likewise when the   first day of kindergarten i think teachers have 
a lot of experience with those parents trying   to drop the kids off and sometimes the anxiety is 
not on the part of the kid it's on the part of us because we can't separate from 
the child but in a healthy kid   once they're you know you 
dropped them off at the school   and teachers will tell us the minute they walk 
in the class they have forgotten about you and they don't think about 
you for the rest of the day   so when does it become more problematic 
so it becomes more problematic when a kid   cannot adapt and when they're experiencing 
you know the severe anxiety after they've   walked in the classroom after they've seen the 
teacher and their classmates and then in the   really severe cases is where kids avoid school 
and can't even get to school and then as kids get   older some of the other anxieties disorders can 
come out you can get more of the social anxiety   where you know the kid is a chatterbox at home 
and talks you know all the time but the minute   they come out of the comfort zone of home they 
can't talk anymore they become mute essentially   uh in the classroom they cannot raise their hand 
even you know when they know the answers in groups   they can't talk at the lunch table they're 
fearful of eating in front of the other kids   and then you know they get into the avoidance of 
participating in activities with others now you   know there's some things that can get confusing 
so we'll have a kid that is not able to talk   you know in the classroom but they have the 
lead in the school play so that in in situations   where they may be in large groups but there's no 
personal really you know connection they can do   quite well and i think of you know what i should 
say all of us have a certain level of anxiety   so anxiety itself is not bad it's actually 
you know a quality that helps us it helps us   to prepare for for events right it helps us to 
prepare for exams it helps us to um you know to   relate to each other in in in positive ways so 
it's really when we get to some of the extreme   ranges that it can cause difficulties and then as 
as kids get older we don't see as much separation   anxiety but we see more of the generalized anxiety 
where some kids become fearful of everything   and everything is a catastrophic event 
even things that they can't control   and again all of us have some degree of that 
but it's when it becomes extreme when it gets   into avoidance behaviors when it interferes 
with doing all the things that are necessary   you know to to get through the day and the good 
news is that there's treatments for anxiety   there's all the the cognitive behavioral therapy 
treatments there's the breathing exercises there's   all sorts of of activities that can that one 
can do to help to decrease these and then when   these are not enough we have medicines that 
can be very helpful and that are very safe   so if the symptoms are severe treatment can make a 
big difference dr elia i have a few more questions   that i want to throw your way so if we can i'm 
going to ask that we stop here and we'll take   an even deeper look into the topic of children's 
mental health on a second episode in the meantime   i want to thank our listeners for tuning in to 
the merck manuals medical myths podcast be sure   to subscribe to this podcast on apple podcast 
google podcast spotify or wherever you listen in   of course be sure to check out part two of our 
discussion with dr elia until then i'll leave our   listeners with the message we always do with merck 
manuals medical knowledge is power pass it on



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