Find out how your child’s pediatrician can become an invaluable resource for YOU in your parenting journey. 🩺 👶🏼 👩⚕️
Here to discuss the nuances of what is normal when it comes to childhood milestones, reassuring parents that the journey isn’t one-size-fits-all, is board certified pediatrician Dr. Jessica Hochman.
Whether it’s a late walker or a picky eater, we’ll provide practical guidance on when and how to trust your gut as we explore the intersection of parental anxiety and child well-being.
If you’ve ever found yourself on the edge of a Google search rabbit hole, wondering if your child’s development is on track, this episode is your go-to for navigating those uncertainties with more information and confidence.
Dr. Jessica (00:00):
Every kid out there I believe has a gift. If you’re a parent listening and you really think about your kid, there is a gift there. And so making your child feel good about their gift, giving them that they deserve to have about their gifts and letting them hone in on it so they can flourish.
Dr. Sarah (00:23):
Have you ever wondered what are the most common questions pediatricians get asked from concerns about delayed milestones to picky eating and how to handle those early fevers and coughs? There are a lot of things, the key parents up at night. Joining me today to help quell some of the fears and worries from parents just like you is board certified pediatrician and the host of the Ask Dr. Jessica podcast, Dr. Jessica Hochman. Together Jessica and I explore the pressure parents often feel for their child to hit every milestone and check off all the boxes. We talk about the value of self-esteem in child development, and most importantly, in my opinion, how critical it is to focus on a child’s strengths rather than their deficits. I can’t wait for you to hear this episode.
Hi, I am Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I’ve taken all of my clinical experience, current research on brain science and child psychology, and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights so you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is Securely Attached.
Hello. So today we are joined by Dr. Jessica Hochman. She’s a pediatrician, so, so glad you’re here. I love talking with pediatricians because I feel like our work is so, it’s like walks down the path side by side so often and I just picking brains of pediatricians. So thank you so much for coming on.
Dr. Jessica (02:12):
Thank you so much for having me here. I love talking with you too. I love the way your brain thinks and I so enjoyed having you on my podcast. So thank you for all the work you do.
Dr. Sarah (02:20):
Yeah, yeah, we should put a link in the show notes to that episode because it was a really good talk.
Dr. Jessica (02:27):
It was a big hit. It was definitely appreciated by my audience and you are so good at what you do. You’re such a natural and I love talking about attachment and you have a gift, so thank you.
Dr. Sarah (02:38):
Aw, thank you. Yeah, attachment. And we’re going to try to figure out a way to weave into attachment, well kind of to everything we talk about, but especially this because I think parents, they know that their pediatrician is a resource. They know that their pediatrician is someone who can answer a lot of questions about development and health and wellness. I think that sometimes, and to be fair, I think this isn’t true of all pediatricians because I don’t think that all pediatricians, and I’m curious your take on this in terms of training, get a lot of training in the more psychological and relational and personality development stuff, but I do find that there’s a lot of pediatricians that I encounter that really, really know how to support that relational and sort of mental health development in a way that parents might not know is a resource for them. And so what I was hoping today was to talk to you about when parents are feeling anxious about their child’s development when parents are, there’s kind of two types of anxiety really, I think that happens in relationship to the pediatric side of things is parents feeling really anxious about their child’s development and helping manage that anxiety, but then also helping the family manage other types of mental wellness stuff as it comes up with the child or within the family system.
Dr. Jessica (04:15):
Yes. No, I agree. I think that I like parents to know that I am a resource for them, especially in this day and age where a lot of parents honestly will start off by going to the internet. They’ll google a milestone and they’re nervous and I want to know what they’re nervous about so that we can work together. And I like that they have the ability to Google. A lot of parents will say to me, I’m so sorry I Googled, I couldn’t help it. But I’m actually glad that they do because to be quite honest, parents are my first screener. They’re the ones that pick up on something that might not be right, but we can work together where they have the ability to tell me what’s going on with their child, what their concerns are, and then I can provide the context with what I see as normal or what’s typical for kids. Because a lot of most things with kids aren’t so cookie cutter.
So for example, parents may tell me, oh my goodness, I’m really nervous because I Googled and my child is one year old and they’re not walking yet. And I read that most kids are walking at one. And the truth is something like walking, there’s a huge range of what’s considered normal. So yes, there are kids that are walking at one. Probably the bulk of the kids that I see are walking really more like 14, 15 months, and some kids may not even be walking at a year and a half, and that’s still normal. And so I’m glad they bring it up to me so I can check their body and evaluate within the context of what’s happening within all of their developmental milestones and skills. But I like that. But things aren’t always the same for every kid. And so it’s important that parents bring up those anxieties to me so that I can hopefully reassure them and then also hopefully identify a problem if there is one.
Dr. Sarah (06:08):
And I think that’s the beauty of anxiety, right? Anxiety in of itself isn’t a bad thing. It’s a little alarm bell if you have it. It’s okay to listen to it. It’s okay to go and say, I’m feeling nervous about this. What do you think? Right. But obviously when I say, what do you think? I’m hoping you’re asking that question to a vetted, trusted resource who actually knows how to answer it, but it’s not a problem in and of itself to feel worried about something related to your child’s development. I think the threshold for me is always when you are collecting information over and over and over and over for the same question, chances are we’re not talking about information gathering anymore. We’re talking about soothing and anxiety response. And is it serving the actual global decrease of your anxiety or is it just hitting your anxiety snooze button? I got to check, check, check again, check again, and actually maintaining the anxiety.
Dr. Jessica (07:22):
Yes, yes. No, it’s true. And I have to tell you that as because anxiety is normal and it’s okay to have some anxiety, as you mentioned, it can be an alarm bell that can be helpful and can serve us, but if it gets too much, if it gets out of proportion to what can be, there is a point where it can be unhelpful. And so I love my role as a pediatrician because to be quite honest, so often when I hear what the concerns are, I can be a reassuring figure or I can be a guide in a lot of ways. So it’s such a cool part of my job because a lot of the things I hear about will my child ever get their teeth? Will my two-year-old stop biting their friends? Will my child ever sleep through the night? Will they ever poop on the toilet?
There’s so many things that I can confidently tell them, most likely this is all going to get better and this is going to resolve. So it’s a great job for me. I love being that role. But also there are times when there are things that are brought to my attention where we can be helpful for parents, where I can guide them in the right direction, where I can tell them what specialists to see or I can tell them what to look for. So I do agree wholeheartedly that parents please feel comfortable talking with your, take your concerns and bring them to your pediatrician because everybody can feel good afterwards. You’re going to make your pediatrician feel helpful and you will feel less anxious hopefully on the other end of the conversation.
Dr. Sarah (08:47):
Yeah, and I think that’s so helpful because, and this is why I think the source of the reassurance is the critical piece to this puzzle. You can go on Google, it’s okay to go on Google and search something, but you want to understand how much weight I’m going to give that result, right? Because that’s I think where we start to see that repeated checking behavior that really actually maintains anxiety. Whereas if I look at Google, it gives me a result. It makes me a little bit like, this isn’t matching up with my experience with my kid, and then I take it to my pediatrician and they validate that fear. They say, I understand that that might be something that would concern you. Let’s take a look. Let’s get some data, let’s check it out. And then you use your expertise and your experience with not just obviously with medical education, but with seeing so many children. I think there’s something we forget. Parents generally have a very, very small case study to go off of. Maybe they know a handful of kids and they know their kids and it’s hard to compare big generalized data because the small sample size, but you probably see how many kids do you think you see a year?
Dr. Jessica (10:13):
Oh, thousands. And I often see new things. So even with seeing thousands of kids, I still am learning something new and seeing a new normal milestone or a new characteristic all the time. And I think you said something really important that it’s so easy to compare within a small cohort. So what I see all the time is people compare to their siblings or they’ll compare one child to the other. So for example, this comes up all the time. My child’s a year and a half and they only have 15 words, but their brother had a hundred words. And so when in reality both of these children end up they’re normal developmentally, it can be stressful for parents to compare and see differences. So I think again, those are all good reasons to talk to your pediatrician because they’re real comparisons, but all within the realm of normal, quite often they say a lot comparison is the thief of joy. Have you heard that expression? That’s something I really like. So when you compare one kid to a sibling or a kid to a friend, sometimes it can cause stress. So bring that stress and talk to your pediatrician because likely there’s a very good chance they’ll make you feel better or they’ll help you get your child the services that they need.
Dr. Sarah (11:34):
I definitely don’t want to underplay the importance of early intervention. So again, this is where anxiety is important and like you said, your parents are this really valuable first screener because we know our kids so intimately and when something doesn’t feel like it’s going the way you would’ve expected, it’s important to trust that gut. So there’s two sides to this that really both need to be given space and balanced in an appropriate way. You should trust your gut if you think something isn’t going according to what you were expecting in your child’s development, listen to that, right? Don’t dismiss it, but at the same time, get your information, collect all the data, use good sources like licensed medical professionals, and then reassess is this anxiety is this, I’m comparing this to something that’s not necessarily an appropriate comparison, or maybe there is something and now I have a path. I have a path to follow. Early intervention is fantastic for a lot of developmental delays, and it doesn’t necessarily mean that it will always be off the normal curve. We can get it back on track very, very easily often.
Dr. Jessica (12:59):
Absolutely. And something I think that is really important to emphasize to families is that there’s not one decision that works for every family. So for example, I really like hearing what parents are worried about and then I can have a conversation with them and talk about the options. Some parents would rather wait, and some parents, their style is more to intervene early. And I think there’s not one right answer for every family, and it’s not really my decision to make for that family. My job is to present the options, give them the information that I know and help them come to the best decision for their family, if that makes sense.
Dr. Sarah (13:39):
Totally. What do you see? Can you give us an example or two of a common challenge that might be happening in development and how maybe one of multiple paths someone could take to address it?
Dr. Jessica (13:56):
Absolutely. So there’s so many examples. I’ll start with, I’ll start picky eating. Picky eating is something that I hear about every day. It’s something like over 50% of toddlers parents will tell me when a parent brings their toddler in to see me over 50% of the time. When I ask them, what are your concerns? I will hear that they’re worried because their toddlers are so picky. And we know big picture. If you think about the United States big picture context, we have an obesity issue with children. I don’t ever see kids that are, rarely do I see kids that end up not gaining weight sufficiently. Yes, we have a spectrum of weight, but it tends to be more an issue on the other end. And so I’ll have a parent that talks to me about their child that’s a picky eater, and we’ll talk about different avenues.
We can take one if they’re really struggling, I can go through with them. I can be their first line of help where we can talk about ways to present food in a way that might be more palatable to their child. I can be a source for the parents where I’m reassuring to them that this will, my mantra always for parents is, for example, in this context, our job as parents is to provide the quality of the food and then let children pick the quantity of the food. So if parents are stressed that their kids are always having fast food and french fries, I say, well, our job as the parents is to give the better quality. Let them pick how much. If it’s more stressful than that, I can refer parents to an occupational therapist that’s a feeding specialist. We can always talk about family therapy. There’s lots of avenues we can take. And I do try to hopefully reassure parents within the visit that things are going to be okay and make them feel most likely going to be okay. And hopefully that’s enough. And if not, we can talk about other paths as I mentioned.
Dr. Sarah (15:56):
Yeah, I love that. I think that’s so important. I think it’s funny, I get a lot of questions about picky eating too. And I think just the fact that it’s such a common question really also sheds light on how common it is common. And I think that’s a thing. We have this perception in our minds as parents, something is supposed to look a certain way and if it’s not, we define it as picky. But the implication there is that that’s an outlier of what’s normal. Whereas what I’m hearing from you and what matches up with my experience is actually if you’re going to look at a bell curve of typical child’s eating behaviors that most kids in the middle of that bell curve actually would probably be described as picky. And it’s the kids on the end of the extreme of the tails of that bell curve that we actually would be looking at maybe worried about the one tail end of we’re so restrict the pickiness is causing such restriction and such limited nutritional intake that they’re really falling off their growth curve. That’s probably a really small percentage actually, and that most kids probably fall somewhere in the middle of that picky range. And then there’s probably just a little bit of PIs on the tail end that are eating very adventurously. So it’s kind of important to reframe what do we want to use as a definition as developmentally typical or atypical.
Dr. Jessica (17:23):
And you’re right, I think that unfortunately the children that are on the end of the bell curve where they’re eating a variety of fruits and vegetables and quinoa and Brussels sprouts, those are the kids that get their picture taken and put on Instagram or on social media and all the parents think, oh my, wow, my kid is different. My kid is not eating broccoli and Brussels sprouts and quinoa. There must be something wrong with my child or the way that they’re eating must be a problem. And the truth is that if you think about, I’m sure most of your listeners, when they think back to their childhoods, most of us weren’t that keen on vegetables. Most of us liked and preferred carbohydrates and sweets and desserts. It’s just a very normal, it’s normal for kids. So I think that while as parents, we should always try to introduce nutrient rich foods for our kids and be a role model for them and be a guide for them. I also hope to impart upon parents that the stress around the eating I hope to lessen because it shouldn’t be. We eat all the time and we want to enjoy our children and we want to enjoy eating. And the stress that comes with it often is out of proportion to what I hope for families.
So that’s something that I think conversations about what’s normal, what we typically see for kids, I hope can lessen anxieties of families.
Dr. Sarah (18:51):
And I’ll even add to one thing you said, which is the stress. Yeah, it makes it less enjoyable, but if you think about it hyper stressing and hyper-focusing on your child’s food and eating may actually be a factor that contributes to the picky eating. And so we can create this unintentional self-fulfilling prophecy. I’m anxious about my child being picky. I hyper-focus on their eating. My child feels that pressure and then retreats or gets more rigid around their interactions with food. And I see the end result is the picky eating. And so it’s like sometimes, not all the times, there’s lots of explanations for picky eating. Like you said, we have to kind of be detectives and kind of look at it and figure it out for each kid. But I frequently do see a pattern of at least in part parental anxiety around the pickiness of the eating, amplifying the problem. And so instead of just child intervention around getting them to shift the way they eat food, I think it’s very useful to take a step back and look at family system work around how do we change the feeling in the relationship when we’re eating? And that’s a lot of actually parent work.
Dr. Jessica (20:21):
It’s so true. It’s so true and I understand it. I understand that feeling anxious is a normal phenomenon. A lot of us go through it. We all feel anxious at some point in the day every day. But it’s true, there is a real relationship between parental anxiety and what kids are feeling. And so I do think that there’s a feeding therapist in the area, and she doesn’t with kids anymore. She works with parents only because she found that really the crux of the issue is the parent’s anxiety around their children’s feeding. And so if you can help parents manage their anxiety and give them tips and tools that makes things a lot better. Not to say that parents’ anxiety isn’t appropriate or it’s not, not to lessen those feelings, but I do think if we can help parents encourage parents to understand that these behaviors are normal in the context of childhood, hopefully everything feels better. Because something that you and I agree on, I think with our messaging is we want to have, our goal is to make parents and the family unit as enjoyable and loving and as connected as possible. And if something like eating is getting in the way when it doesn’t have to be so stressful, I’d love to help that process be easier.
Dr. Sarah (21:47):
And I would even say, I completely agree with you. I think all of the stuff that you do that we’re talking about right now is in the service of making everybody feel more ease and more pleasure in this life of the family. But I will add too, I want to be clear that even if your child, so there’s situations where I feel like we as parents can project anxiety onto a situation that actually isn’t a problem and then inadvertently kind of make it a bigger problem or is a small problem, but it gets amplified or kids dig in. I also find that when kids legitimately have ARFID, avoidant, restrictive food intake disorder, whatever, I forget the acronym means, but there’s a legitimate problem that the child is facing around their ability to tolerate food intake.
Dr. Jessica (22:44):
Dr. Sarah (22:45):
The treatment that I find works the best for this, and there’s a lot of research coming out on this, is parent intervention, not parent intervening on the child, but intervention that directly supports the parents shifting their behaviors nonetheless. So even if we are treating a legitimate feeding disorder in a child space, which is a treatment program that came out of the Yale Child Study Center, and it stands for Supportive Parenting for Anxious Childhood Emotions, they have a specific protocol just for treating ARFID. And so it specifically looks at parental accommodations to these restrictive eating behaviors of the child. And in modifying only the parental accommodations, it can treat the ARFID. And they’ve been able to show studies that have shown good efficacy with this. So it’s like I don’t want to say, Hey, parents, your anxiety is the problem, and so let’s just be less anxious and let’s just hover less. Sure that will help. And no parents not going to feel anxious if they feel like their kid isn’t eating enough because we are so profoundly motivated to support our children’s nourishment, right? And we have identified that deeply as part of our job and a signal that we’re a good parent. And so I just want to be clear, this is actually how we treat it when there is a legitimate challenge with child is facing with food. And so just the power of the parent-child relationship in supporting mental wellness in the whole family.
Dr. Jessica (24:32):
It’s true. I mean, I even relate myself as a parent. I get this odd satisfaction and feeling of victory when I see my kids eat vegetables.
Dr. Sarah (24:41):
Dr. Jessica (24:44):
So I totally understand the stress around feeding myself, and I remind this to myself that you have to take, it helps to take a big picture perspective. I also think something that I try to remind parents about is how beautiful it is that kids are different. Because I think a lot of parents will look at one kid who’s good in math and one kid who excels in athletics, and they’ll compare what the other child can’t do. And I think it’s so helpful to focus on what your child’s strengths are that really, I think, makes everybody feel better rather than focusing on what they are lacking, if that makes sense.
Dr. Sarah (25:26):
Yeah. I think that’s so profound. And I think especially with kids who genuinely are struggling in certain areas, maybe they have a learning disability or maybe there was a developmental delay or a speech issue or whatever it might be, they’re constantly getting reinforcement from their environment that people are paying attention to, that they’re constantly having a spotlight shown on those deficits. And I think parents sometimes underestimate how much a child doesn’t actually get a spotlight on their strengths. Just as a society, we tend to focus on the things that aren’t working very well because that’s kind of the way our brains are wired. We look for problems and threats and dangers, and there’s an evolutionary benefit to that. It keeps us safe. So we have to kind of remember, we have to kind of counterbalance that intentionally. We have to really remind ourselves consciously to be aware of and pointing out and reflecting back to our kids, all of our kids, but especially kids with certain challenges, the things that are their strengths, no kid anywhere that doesn’t have strengths, and we have to highlight them. They’re so important.
Dr. Jessica (26:50):
I totally agree with you. I talked to a family last week for example, where the mom was upset because the child didn’t test well on reading for their grade level, and she was really stressed about it. What should I do? Is my child ever going to, as we talked more about it, there was a lot of deep seated anxieties about her child’s future, and we were talking more about her kid. And it turns out her kid has this brilliant entrepreneurial mind sold lemonades, record breaking lemonade with a lemonade stand, and did all sorts of really neat creative things to raise money and work in sales. And you can see that there’s this side of the child’s brain that’s so beautiful and going to help serve their child as they grow. And so I touched them, mom, yes, we can work on helping your child read.
We can get a reading specialist or a tutor, and let’s focus on what your child is thriving at because this is pretty cool. And this is really a gift and shifting, not ignoring the anxiety about the child’s reading, helping the child, but also focusing on the positive that the child’s offering and will bring to the world. And every kid out there I believe has a gift. If you’re a parent listening and you really think about your kid, there is a gift there. And so making your child feel good about their gift, giving them that they deserve to have about their gifts and letting them hone in on it so they can flourish.
Dr. Sarah (28:25):
And I think that’s the building block of self-esteem, right? And we have to remember that if we want our kids to persevere in the face of a challenge, maybe they do struggle with reading. If we want them to look at that as a solvable problem that they are capable of and willing to put energy and effort into addressing, well, they better have gas in the tank. You have to make sure that they think and feel that they are capable and that they have so many other strengths that buoy their self-esteem. That is what will be needed to draw upon to fuel balancing out challenges. So I think the problem with looking at a deficit, looking from a deficit lens and an anxiety around, oh no, there’s a problem. Let’s really hyperfocus on fixing this problem. I’m not saying we don’t want to look at problems and fix them, but if that’s the lens through which we’re reviewing our child, they will internalize that. And instead, if we can look at the lens, look at our child through a lens of you have so many strengths, and the more that you can connect with your strengths and see yourself as capable and smart and interested in solving problems. Now when we talk about reading or whatever, fill in the blank that kid’s sense of self is going to fuel them. That’s so important.
Dr. Jessica (30:03):
It’s so important. And I also like to remind everybody that you want kids to be different. That’s what makes the world flourish. If everybody was good at math, who would be writing the screenplays and who would be the psychologists and who would be the teachers? And would be, you don’t only want mathematicians in this world, you want some people to have different talents because that’s what makes the world go round.
Dr. Sarah (30:33):
And I think it’s so much easier for us to appreciate that in adults. And for some reason I think we have so much pressure for our kids to be good at everything or at least on the curve with everything. And I think that goes back even to our point earlier of that’s I think ingrained in parents from day one in terms of milestones, every milestone should be within the bell curve. Everybody should be able to always meet all the developmental milestones at the same range. And that gets kind of projected out onto later development. And it’s like no one develops evenly across the board in all of their capacities. That’s just not how human development works.
Dr. Jessica (31:19):
Right. There’s no such thing. So I am a pediatrician. I work with my dad, which has been really fun. We’ve been working together for the last 12 years, and he has this really interesting perspective on raising kids. And his line is always, or the line he often says is There’s regression to the mean. So maybe you are the parent that has the great sleeper from the beginning. Your kid is just a few months old and they sleep to the night. Well then that other parent who’s has the difficult sleeper, maybe they’ll get lucky with an easy teenager. We all don’t have it easy all the time for everything for our kids. So you may get lucky on some milestones and some may be a little bit trickier, but eventually we all get there. And enjoying the journey along the way I think is really the battle.
Dr. Sarah (32:13):
And I think a huge piece, a huge skill in attaining that perspective is the ability to zoom out. And there’s nothing like a delayed milestone that forces a parent to zoom in really, really, really tight. And then they get stuck there and they get sort of stuck looking at that tiny piece of the puzzle. And so a lot of my work with parents is helping them, whether it’s a behavioral issue or a developmental milestone or something sticky. So just zoom out and try to remember to look at the whole picture because like you said, if you’re remembering, hey, there’s always some regression to the mean, which basically is stats talk for everything kind of evens out at the end. You’ve got to zoom out to be able to see all of the things that are counterbalancing that one issue. Or maybe there’s more than one issue. Sometimes these issues are clustered together. If you have a feeding issue, you might have a weight issue, which might lead to, I don’t know, some gross motor issues. It’s not unconnected, but you got to zoom out to be able to remember the bigger picture and then be able to have enough distance from things so you could be objective and kind of figure out, how do I want to approach this?
Dr. Jessica (33:34):
I think that’s such a beautiful important point, just the ability to zoom out. Because if you think about so many of the things that we stress out about with our kids when they’re younger, whether it be when they’re going to learn how to walk, when they’re going to learn how to talk, when they’re going to learn how to toilet train, when they’re going to be eating their vegetables, all these things that parents have stress around with their kids. If you think about most adults, eventually adults that can talk in full sentences and have conversations, we can walk really well. We’re all using the toilet. We don’t need to have sandwiches with the crust cutoff on the sides, we become less picky overall. So if you can zoom out, I agree, it can lessen anxiety, which can be a beautiful thing. I see it a lot with parents where they have multiple children, they’re able to say, oh yeah, this is a normal thing.
Kids don’t sleep in the beginning or they’re all different to the beginning. And eventually these issues tend to resolve and when they don’t. Something that I think is so important for myself as a pediatrician is listening to parents, letting them trust their gut and when something doesn’t feel right to them, making sure that they know they can talk to me. So just again, I’ll tell parents something I feel really strongly about is there’s no such thing as a silly question. There really isn’t any question you’re having any anxiety, you’re feeling, anything tugging at your gut that something isn’t right, please bring it up to your pediatrician. So again, hopefully we can either reassure you or guide you in the right direction.
Dr. Sarah (35:10):
And I think that’s so important that people know that’s a resource. And I think it’s getting more understood. And I’m hearing of pediatricians that have these types of access to them through parent portals or what are you seeing in the pediatric world as far as people having more access to their, because there’s this other issue, which is the insurance and the medical industry and the healthcare industry, and it’s sometimes I think people are moving out of that system so that they can create more access to their patients. And then I think some places there’s a desert where they don’t have access to that kind of pediatric resource because they have to work inside of a system that doesn’t allow for pediatricians to have the time or the space to really answer their questions.
Dr. Jessica (36:11):
I mean, that’s a really good question that I think as a pediatrician I struggle with because on one hand, I love being a resource for families. There’s nothing that I like better than feeling like I’m serving someone else and I’m helping somebody else. I think about that all the time, how blessed I feel at my job that I can be that role for somebody. And at the same time, I have to be able to turn it off because I have a family.
I have kids, I have three kids at home, I have a husband, nieces and nephews. I have a life outside of work. So if I’m fully accessible, then this is sort of a different topic, but I worry that I’ll burn out. And so I think, and that’s not good for my patients if I burn out. So I really, really try to create a boundary where, yes, I’m accessible. I post a lot of things on Instagram that I hope are helpful for families. I have a podcast that I hope I can put out good quality information for families. But I also think there’s a realistic limit that we all can offer for our families that hopefully the way I view it is it’s better for families because if I’m fully accessible all the time, I’m not going to serve anybody if I burn out.
Dr. Sarah (37:25):
And if you’re all the time, well, I’m thinking too, if you’re fully accessible all the time, it can start to play that same role of like I check, I check, I check, I check. It’s just a anxiety management snooze button problem.
Dr. Jessica (37:41):
True. No, it’s true. Sometimes parents call about, they’re worried about their kids. There’s an issue like a fever or a cough, and if you give it a little bit of time, the issues tend to resolve. And so it’s empowering for families. I think we serve a better role if I can teach parents what to do when their kids have a fever or a cough, what to look for, which I think ultimately is better for families to feel empowered. I don’t want them to feel like they have to call me with every cold, every fever. Then I feel like I’m not doing my job as an educator and as their pediatrician if I haven’t given them the skills to feel somewhat comfortable on their own and to know what to look for, if that makes sense.
Dr. Sarah (38:24):
And to tolerate the anxiety, right, to validate, hey, it’s hard when your kid is sick. It can definitely make you feel anxious. And here are the resources that I know you can use. You can internalize these resources and make them your own, that you can lean on those from now on. I’ll teach you some things and then I trust that you’re going to be able to do this on your own.
Dr. Jessica (38:47):
Yes. Yep. No, it’s very true. And finding that balance where parents feel comfortable that they can reach out to you but also feel like they can entrust their gut feelings. I’m just curious, did you ever feel like you wanted to access your pediatrician? You couldn’t get ahold of them and it was frustrating?
Dr. Sarah (39:05):
No, I haven’t, fortunately, and I don’t even have a concierge pediatric thing that I have access to 24 7 either. But I think, and I have an amazing pediatrician. She’s actually been on the podcast before.
Dr. Jessica (39:24):
I’ll have to listen.
Dr. Sarah (39:25):
Yeah, she’s awesome. And my favorite thing about her, I will say, and I’m going to go ahead and guess you do this too. Every time I bring my kids into their wellness visit or there’s a sick visit, she talks to them, not necessarily just to me. And I was like from the beginning, even when they were infants were always, my children were involved in the conversation, not just doctor parent conversation. And that was so profoundly impactful to me as a new mom, to have a pediatrician who saw my kids as there and part of the conversation and the patient receiving the treatment.
Dr. Jessica (40:11):
I have to tell you I do that. But because I love talking to kids, they’re so much more fun than adults in the sense that they’re silly, they’re fun. A lot of times they’re really brutally honest with me, are we done yet? Can I go home? Or they’ll say things like, they’re just wonderful kids. They’re silly. I am up to date on all the princesses, all the Disney shows, all the latest trends. And I find that adults can often be really serious and we lose that side of ourselves. That can be silly and fun. So kids are such a good influence on me, honestly. So I feel really lucky that I get to talk to kids and ask them all sorts of questions. I feel really, honestly lucky for my job. And they’re also cute. I mean, I’ve yet to meet an un-adorable 2-year-old.
Dr. Sarah (41:06):
I know it’s so funny. But I do think another, we’re talking about anxiety and we’re talking about how to use a pediatrician as a resource for managing anxiety. And we’ve been talking a lot about in the context of parental anxiety, about their child’s development and their child’s wellness. But I think also at the beginning I was saying there’s this other element which is how do we help kids who are feeling anxious and how do we help families navigate anxiety or other challenges, whether they’re behavioral or sort of relational in the work with the pediatrician? And I feel like this is, some of it is just my kids’ temperament and some of it’s just who they are, but my kids are not anxious at the doctor and that they get shots and they get their blood drawn and they don’t like it. But from the very beginning of my exposing them to pediatric medicine, them from the very beginning, I really felt it was super important that they were sort of a player in the room.
And my pediatrician has facilitated that so beautifully, but I really want them to know what’s going to happen. I want them to be aware. I don’t try to distract them from things and then surprise them with them getting a shot. Every time my kids would get a shot from the beginning, I would tell them it was happening. I would hold them, not hold them down, but hold them in my arms, give them be a sort of a support. I’d tell them that it was going to happen. I’d tell them it was going to hurt. I’d tell them that I would be there. And I don’t know, there was some way in which they just developed this trust around this experience. It wasn’t pleasant, but they always were able to kind of get through it. And again, I’m not saying that this is a magic trick that will make all kids not anxious about the doctor because some kids just have, they’re more sensitive to that kind of anxiety. But I do find that there’s a lot of distracting kids and then hitting them with a shot. And I think that that can help in the moment to avoid a lot of anticipatory anxiety for the child. But I think it ends up making a larger issue for anxiety in the long run because they start to associate a lack of predictability, a lack of safety, a lack of security around doctor’s visits. And I think it can backfire.
Dr. Jessica (43:44):
Right. No, I agree with you. I’ve seen all sorts of approaches. Some parents give their kids a warning and they have a plan ahead of time. And some parents prefer to surprise their kids. Obviously parents should do what they wish with their children. But if you were to ask me, I like your approach. I think just in terms of fostering a trust with your child and keeping the line of communication open so that you can prepare them the best. I think that’s my preferred way. So I totally agree with you. I liked kids to know ahead of time when they’re getting their vaccine so they’re not surprised so that they trust the doctor’s office. And then you can do things with your kids, as you mentioned, beautiful, to hold them. You can try to distract them. You can come up with a plan for, the kids tend to be anxious around vaccinations. So I think your result is the best result that your kids now have a favorable experience when they go to the doctor, they understand what’s happening, they’re not surprised. So a plus to you, I think that’s a great, of course, I’ll never tell a parent what to do. I trust their judgment, but if I were to pick, I would be open with kids so that they trust coming to the doctor and they trust the parent, which helps with attachment.
Dr. Sarah (45:03):
Yeah, it does. And I think it helps with attachment because I think knowing that a parent can see my fear and stay with me in my fear and not need to protect me from my fear, protect me from being afraid they can protect me from, they can be with me while I’m afraid, right? Yes. But as parents, we want to sort of gatekeep fear because we don’t want our kids to experience it. It does have kind of a backfire outcome because it is scary to receive a shot or to be in pain, and it’s an appropriate fear response. And so we don’t want to, I think it’s like how do we give our kids permission to be scared and also communicate and demonstrate and model to them that that’s an appropriate fear. It’s safe to be scared of that, and it’s safe to get shots.
It’s safe to have that kind of pain afterwards. The pain goes away eventually, and you are still whole, you’re okay. We kind of made it through this scary thing together and we can reflect back on it, make sense of it. But just this welcoming of fear and pain and discomfort and being able to say, this is part of, sometimes when we go to the doctor’s office, we do have to get a shot and it doesn’t feel good and it hurts a little bit. And eventually that pain stops and I’m here with you the whole time. You can handle this. That’s a gift that we’ll keep on giving because that same approach to our children’s feelings can be replicated in all kinds of tricky places.
Dr. Jessica (46:54):
Yes, yes. No, and I say this coming from the place of a mother who does have a child who’s anxious about vaccines, my oldest in particular gets very nervous. But what’s interesting is they’ve shown that the number one reason why kids are anxious or the number one link to an anxious child around vaccines are anxious parents around vaccines. So I do think there’s something to say for kids pick up on their parents’ energy. They can tell if you’re nervous about the vaccines. And again, I have a child who’s anxious about vaccines, so I dunno what that says about me. Hopefully I’m not that. Hopefully I provide comfort for her. But it is true that I think parents can play a bigger role than we expect. And being honest and being clear and transparent, as you mentioned, yes, it will hurt, but afterwards it’ll be better.
And I’m there with you through the whole ride and explaining to the older kids why they benefit from vaccinations, why it’s a good idea. I think kids are smarter than we give them the benefit for a lot of the times they’ll understand. So talking to kids in language that they understand, it does make things better. I’ll give a plug for, there’s a great website for people listening that do have kids that are anxious around vaccinations. Meg’s Poke Plan is a great website, and she’s listed a plan for kids that tend to get nervous so that they can have a better experience. And one of the things she mentions is the way that parent holds the child can make a big difference in lessening their anxiety.
Dr. Sarah (48:26):
How does she recommend parents hold them?
Dr. Jessica (48:29):
She has them. There’s pictures where they’re sitting in their lap and they’re hugging them for babies. She recommends holding them in a nice position, even breastfeeding while getting the vaccines. She offers all kinds of ways to make a child. She acknowledges that it’s uncomfortable and that there are also things we can do to make it better for kids. So I think having a conversation ahead of time, coming up with a plan can be better for everyone in the long run.
Dr. Sarah (48:54):
Yeah. Yeah. No, that all tracks. I think that’s so helpful. And I think some parents, even going back to infants, I think that some parents have heard, I can totally understand feeling that they wouldn’t want to breastfeed their infant while their infant was getting a shot because they’d be afraid that the infant would associate that pain with breastfeeding. And actually, I think that very understandable fear. But actually I would definitely, I would bust that myth because what we actually might make a child associate that is our body language. So if we can, for example, if you have an infant, and this is true for older kids too, if you’re not breastfeeding, you’re just holding them. But if you are holding them tightly and with your own kind of tense energy, anticipating a big reaction, and that’s going to be actually more the thing that’s likely to amplify their fear in that moment. This is that co-regulation, that attachment relationship benefits. So if I can regulate my nervous system and I have to do some inner work to do that, I might have to do that to say, they might have a hard time with this. They will be, okay, this is safe. I can handle this. How do I calm my body down? How do I hold them with soft arms? How do I hold them with a body, sort of a bodily energy that is relaxed, but how do I let them know what’s going to happen?
So if I’m breastfeeding my infant, I might still talk to my infant who does not understand my words, but again, they understand tone and they understand facial expressions. And so to say, here we go. It’s going to be a pinch and I’m holding you. And so I’m acknowledging that it’s happening, right? I’m acknowledging that something is happening and it hurts. I’m acknowledging that hurt. Oh, it’s almost done. You’re doing great. I got you. Almost done. You are safe. The whole time. I’m using that positure of calmness and safety, you are far more likely to prevent an association of fear with breastfeeding if you’re breastfeeding or them sitting in your lap, because what you’re doing is you’re pairing something scary with your safe presence, and that actually can reduce the association a child. It just makes that memory less sticky, period.
Dr. Jessica (51:29):
To your point, I learned the same thing when I was in my pediatric training that we should not have parents or we should not have mothers breastfeed while they’re getting the vaccines for fear of associating pain while breastfeeding. And I agree with you since then, I’ve learned that is totally not the case. And it makes sense. It makes logical sense. How could something as beautiful as breastfeeding is something so desirable to a child as breastfeeding become less fun because of a one second vaccine? It just doesn’t make logical sense. So my view is, yes, if there’s anything we can do to make things less uncomfortable in the process of getting a vaccine, we should encourage it, whatever that may be. The way you hold them, the way you feed them, the way you talk to them, the way you’re there for them, and in the big picture, it will lessen the intensity of fear and anxiety for that child.
Dr. Sarah (52:26):
Right? And the important thing too that I think is also just a little piece I’d add is this strategy doesn’t mean your child won’t be upset necessarily in the moment when they’re in pain. So we want to differentiate and distinguish distress in the moment when something is scary or painful with, I have a fear now of this experience that’s a cognitive association. It might be an unconscious one or a conscious one, but that is a cognitive association. I’m pairing these things together and now I’m going to have a fear response just by thinking about it or anticipating it. Again, that’s not the same thing. So I think parents might mistakenly think, if I’m doing all these things and my child should be calm and when the shot happens, and if they’re not, I’ve messed up, and that’s not at all the case. It would be bizarre for your child not to have a reaction to the shot, even if you’re comforting them totally appropriately.
That’s not what we’re mitigating here. What we’re mitigating is a learned fear response that this isn’t safe. It’s okay to be in distress when something is distressing. It’s okay to be in pain and have a response to that when something is painful, that’s not the problem. What we’re wanting to do in that moment is wrap that moment in a blanket of this is real, this is happening, this hurts, and you’re safe. So that we prevent the learned experience of that shot this doctor’s office that’s not safe. I don’t want to go there. And now I have anxiety every time I think about it or we go there. So you’re not failing if your kid gets upset when they get the shot or the vaccine or the blood draw or whatever. That’s appropriate and that’s fine. And again, we want to name that it’s happening for our kid and say, this is hard. You’re doing great. It will be over in a little while. I’m here so that they can have both pain and sense of safety. That’s the thing that’s critical.
Dr. Jessica (54:32):
Yes, you’re being honest. Shots aren’t fun. We wouldn’t want to do them if we didn’t have to. There is some discomfort. You’re being honest with your kid. They will feel that. But also how beautiful of a role to be as a parent, to be there for your child. I think that’s such a gift we can have as a parent, is that when our kids are feeling or facing discomfort facing their anxieties, we can be a trusted source. We can be there for them. We can make things feel a lot better.
Dr. Sarah (55:02):
Yeah. What an empowering role. I love that. I love that you empower parents to do that. I think your podcast is awesome for that.
Dr. Jessica (55:10):
Oh, thank you. I do feel like for me, what’s so important is there’s so much noise out there. There’s so much information out there, so much anxiety, so much to feel anxious about, and I do feel like if you give families quality information, good real information, while you can’t take anxiety away, you can lessen it. You can really dramatically lessen it, make it more palatable. Make it more livable, which I think really makes life better for everybody, which is what we want, right? At the end of the day, we want to have a good experience raising our kids, raising our family, going through this journey of life.
Dr. Sarah (55:48):
I love that. I love that. I love that you said that. It’s so true, and it’s definitely accessible. It’s there. We can tap into that. So thank you.
Dr. Jessica (55:59):
Yes, I agree. Yeah. Then apart from the anxiety, we want to find time to have joy, be silly, have fun, which is why hanging out with kids is a good idea. Yeah,
Dr. Sarah (56:08):
Totally. Thank you so much for coming on. If people want to know more about your work, where you practice pediatrics, your podcast, where can they find you?
Dr. Jessica (56:21):
So I practice in a small suburban town in Oak Park, California, but most people can find me on Instagram. I try to be pretty active and present on Instagram. It’s @askdrjessica. I put out a weekly podcast every Monday on various pediatric topics, all with the goal to give quality information on common pediatric concerns, to lessen anxiety. So there’s all sorts of topics. I’ve been doing it for over two years now. It’s been a lot of fun. And my favorite part about podcasting is meeting really quality people like yourself. So thank you for doing the work that you’re doing.
Dr. Sarah (56:55):
Oh, thank you so much. I feel the same way. My absolute favorite thing about this podcast is getting to meet such amazing and interesting people, and it’s been so fun getting to know you. I’m so glad we connected.
Dr. Jessica (57:08):
Thank you so much.
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