Traci Manis, BSN, RN (Host): Hi, I'm Traci Manis. And thank you for joining us today for another empowering conversation. Today, we're with Dr. Appeah with NKC Health Pediatrics.

Harriet Appeah, MD: Hi.

Host: Hi, Dr. Appeah.

Harriet Appeah, MD: Thanks for having me.

Host: You bet. It's so nice to meet you.

Harriet Appeah, MD: Nice meeting you too.

Host: All right. Tell me a little bit about you. Tell me how you chose pediatrics.

Harriet Appeah, MD: Yeah. So, I grew up in the Kansas City area. I grew up in Lee's Summit, and I did my pediatrics training in Cincinnati, Ohio. The reason I picked pediatrics is because I just love taking care of kids ever since medical school. There's so many different stages of life that are so, like, wonderful to watch a child grow up. And I love being that resource for families, because there's so many things out there that are scary, and I'm just happy to be, like, a guide for them. So, that's the place that I find, like, the most joy.

Host: Yeah, I love that. I think about that with my own kids. Every stage has been my favorite stage. And so, it's fun to move from one to the next and enjoy all of that. So, you get to do it all day long, every day. That's awesome.

Harriet Appeah, MD: All day. And I love it.

Host: What's the most rewarding part of your job?

Harriet Appeah, MD: I think the small victories, the small wins that parents have. For example, you know, if they were worried about a milestone their kid wasn't hitting, and then the next visit they're like, "Oh my gosh, Dr. Appeah, they're now rolling." Or even just, like, you know, with teenagers, like, we've decreased screen time by even, like, a little amount, like 30 minutes. Just those small victories have been so wonderful to be a part of. Even though, like, I see, you know, your kid ever so often, I still am so proud of just those small accomplishments for both the parent and the child.

Host: Speaking of milestones, what are some of the milestones that parents might get stressed out about that you wish that they would not stress so much about?

Harriet Appeah, MD: Yeah. I think that a lot of the stress about milestones comes from comparing your child to another child, even if it's your own family members. And I think that one thing that families and parents should remember is that milestones, it's a spectrum, and it's a certain timeframe. So, your kid is not going to hit this specific milestone right when they turn six months. A lot of those are skills that a child has to build, and those skills take time to build.

And so, my job as a pediatrician is to let you know if something is abnormal or if this is something that we can just watch. And I think that parents would be surprised at how much kids can develop in such a short amount of time. So for example, like, let's say at their six-month visit, there was something that you were worried about that they weren't able to hit. And then, at nine months, they're soaring.

So, a lot of it, it just takes time. And I think that when you see your pediatrician, definitely raise those concerns so that we can make sure that we address those properly. Because as a parent, you know them best. And so, if you think that something is abnormal, please let us know and we will, you know, figure out if this is something that we can wait and watch, or is this something that needs a little bit more intervention?

Host: Yeah. So, how would you recommend that a new parent choose a pediatrician?

Harriet Appeah, MD: Yeah. Well, I'm obviously biased, so I'd say, like, my practice.

Host: Of course.

Harriet Appeah, MD: But I think that parents should pick pediatricians who are as close as possible, because I know it's hard with just the, like geography-wise, because if you have a sick child, you don't want to travel, like, very far away.

But also, making sure that you, you know, feel comfortable with your pediatrician, that you feel like you can ask them questions, that you trust that they will understand your questions, but also understand, like, where you're coming from, too. When you raise a child, it's not just about those specific things like are they growing and all that. It's about, like, your environment from a socioeconomic standpoint, and you want to have a pediatrician who understands all those different factors when it comes to raising a child. And so, you know, you want to pick somebody that you feel like will listen and that you're comfortable with, because you'll be seeing us for a very long time.

Host: Yeah.

Harriet Appeah, MD: Yeah. And you'll see us a lot, especially in their babyhood. You see us, like, every two months. Like, you want to make sure you actually vibe with the person.

Host: Absolutely. So, do people interview doctors? Do they interview different doctors to go with kind of who they vibe with?

Harriet Appeah, MD: It can be. Like, you can call a practice and kind of see what their pediatricians are like. Our website has, you know, what we emphasize with. So for example, for me, I am also a certified lactation consultant. So, I also really love to empower women for breastfeeding and answer a lot of breastfeeding questions.

We have pediatricians in our practice who are really specialized in things female health and mental health and, like, ADHD, those kind of things. And so, looking at, like, specifically what people's niches are is also helpful. And then, you meet us in the hospital. Like, you'll see us if you give birth here at NKC Health, you'll see us, and, um, you can see if you're like, "I like this person," or you're like, "Hmm-

Traci Manis, BSN, RN (Host): Yeah ...

Harriet Appeah, MD: maybe not."

Traci Manis, BSN, RN (Host): Yeah.

Harriet Appeah, MD: So- Right ... yeah, there's ways. And you can always change. I think that's the other important part, is you don't have to get it right the first time. If you... There's somebody, if it's in your gut, you're like, "This person isn't for me," that's okay to find somebody else, because you want to feel comfortable with your pediatrician.

Host: Right. Yeah. You do spend a lot of time with the pediatrician, those first couple of years. I remember that very much. Okay. So as you're starting to talk with families about the growth of their children, nutrition's obviously very important with that. What are some things that, as far as nutrition goes, are bad habits maybe that might quietly cause problems later?

Harriet Appeah, MD: I think having set mealtimes is really important, and helping develop that is getting rid of distractions. So, like eating in front of screens, having toys at the table. Kids are easily distracted, especially in the toddlers when they want to just have fun, and sitting down and eating is, like, not their priority, right? And so, making, mealtime that's very set and specific, and it's like, "Okay, we'll eat. We have to eat here at the table," or "We can't have our toy now, we can have it after," can really help with, like, them focusing on eating. Because that is one of the biggest concerns and questions that parents have is, like, "My kid's not eating, and I don't know what to do." And so, I think one of the ways is making a structure around mealtime, and that can be really helpful.

Host: Yeah. Okay. So if your child isn't eating well or not eating the things that you think that they should be eating, but they'll only eat certain things. What's your advice to a parent in a situation like that? That's hard.

Harriet Appeah, MD: Yes, yes, yes, yes, especially as somebody who was a former picky eater myself. And I know I caused my parents a lot of stress. EXposure and repeated exposure to those foods is really helpful. And again, with having structured mealtimes, I think about it as, like, positive peer pressure. If they're like, "Well, if mom and dad are eating this or if my big brother's eating it, then maybe let's see if I can try." And then, offering those new foods with safe foods. So if you know that they like, I don't know, like, chicken nuggets, having the chicken nuggets and offering that food that you want them to try. And, you know, it just takes repeated times, too.

Also, something that's good to remember is when they're toddlers, they don't need as many calories as they did when they were babies because parents are so used to eating, feeding every three hours. Toddlers, there's not as much growth as there is in that first year of life. And so, they might be more of, like, a grazer, and that can be developmentally appropriate. And our job as a pediatrician to make sure that your kid's growing well.

Host: Perfect. All right. So along with all of those things, kids get sick, right? And sometimes as a parent you're like, "Okay, this is no big deal." What are the symptoms that are a big deal that would require a parent to call the pediatrician rather than just riding it out?

Harriet Appeah, MD: Yeah. I think that that's such a hard thing for parents to kind of determine, because they don't want to, you know, they don't want to feel like they're wasting our time or it's hard to like take off work, so those kind of things. You know your child best. So if they're ever not acting like themself, they're sleepier, they're fussier, they're, you know, very irritable. Those are signs that something is going on. And you know, feeling out like do you feel comfortable? Or if there's anything in your gut that's saying, "This is not right," always come to us. There's a nursing line that we have, one of our nurses, she's really great at triaging. So, letting you know, "Is this something? Hey, just come to our clinic and we can see you." Or is this something like you need to go to the emergency room because this is a little bit more serious? And that can help when we're in that gray with kids when they're sick.

Host: Yeah, especially with the breathing, and these things, fevers.

Harriet Appeah, MD: Yes.

Host: Yes. Okay. So, speaking of fevers, is it appropriate to let the fever burn? Or do you suggest that people automatically go to Tylenol or ibuprofen to bring a fever down?

Harriet Appeah, MD: Yeah, that's a great question. I think when you think about when you're sick yourself and you're having a fever, you don't want to just suffer through it. If your kid is having a fever and they're like running around and playing and like acting like themself, it's okay to let it ride out. But if your kid is like miserable, give them that Tylenol, give them that ibuprofen. They do not need to suffer through it. And also, you don't need to suffer through it.

Host: Well, and you can kind of see it in their little eyeballs, right?

Harriet Appeah, MD: You can tell. You can tell. You can tell they're not feeling it. Like, it's okay. There's not a level where a fever is too high that's super like concerning. It's more about how your baby is behaving. If your baby has a fever of 100.4 and they're really lethargic, that you can't wake them up, take them straight to the emergency room. If their fever's 103 and they're playing and you're able to manage it with Tylenol, it's okay to watch at home. I think the biggest thing is just seeing how your child behaves. If your child is not acting like themself, always call us.

Host: Absolutely. Okay. So as kids get a little bit older, some symptoms like a stomach ache or avoidance or whatever, sometimes that's anxiety, right? So, what are some early signs of anxiety in kids that parents might not notice or that they might overlook?

Harriet Appeah, MD: Yeah. I think some early signs or things to pay attention to is if your kid is being a little bit more withdrawn, if they're on their phone more than they usually are, if they're not wanting to do things that they typically did, if they're a very active kid who's in sports and all these activities and then they don't want to anymore. If there's ever a time where they're kind of trying to like avoid something, I think that's a great time for parents to check in and see if there's something that's going that's causing them to feel that way. Especially in the age of social media and that kind of thing, there's a lot of outside pressures that kids have to endure that a lot of us didn't have to when we were growing up. And so, being really attentive to just those changes in behavior are really important.

Host: And it's not always outside behavior too, right? Sometimes it's internal behavior to strive or succeed or do well that kids put on themselves. And so, knowing that I think helps a lot too.

Harriet Appeah, MD: Yeah.

Host: Okay. Very good. Okay. What is a realistic healthy approach to screen time? You mentioned that earlier as far as setting boundaries. Appropriate age levels as they move up, obviously, it changes. What are appropriate times?

Harriet Appeah, MD: I think one is remembering now that screens are such a huge part in education. Kids have iPads or tablets or just like those laptops that they need for schoolwork. And so, I wouldn't include screen time like limits with like schoolwork, because that's just the way the world works now. Everybody has to be on some type of computer. So, I would try to set realistic amounts of times. The American Academy of Pediatrics recommends less than an hour of screen time for kids who are two and around that toddler age. And then, for teenagers, around two hours. And I think the best way to kind of decrease screen time is to make smaller incremental changes. Like you're not going to just stop being on your phone cold turkey.

And the other thing that's also helpful is leading by example as a parent. And as somebody who also has like a hard time with screens, if you're always on your phone, it's going to be hard to tell your kid for sure you're to get off their phone. So, I think also just making that a family experience. You know, if you're having family time everyone's off their phone. So, even just like small things like that can make a big difference.

Host: Yeah. Setting examples as a parent, for everything, everything we do, the habits we do, the screen time we have, all of those things.

Harriet Appeah, MD: And it's hard because kids watch, you know. It's hard to, you know, live in the do as I say, not as I do.

Host: Sure.

Harriet Appeah, MD: Yeah. And I mean, and even for me, like I say, "Kids, cut your screen time," and I look at my own screen time and I'm like, "Oh, my goodness."

Host: Yeah. Well, okay. So, what is one moment in your career that reminded you, "This is why I do it"?

Harriet Appeah, MD: Yeah, that's a great question. I feel like I have a lot of those little moments, especially when I was training as a resident, where you're working so much and you're like, "Oh my gosh, like, when do I get to, like, do this by myself?"

Host: Is this going to be worth it?

Harriet Appeah, MD: Exactly. Yeah. Exactly. I think just those moments of whenever I see, like, a baby who's super happy, or if I see a patient and they're wanting to tell me all about the things that they did, or they're talking about their favorite thing at school or hobbies, or just seeing them light up, I'm like, "I get to be just a part of that moment, even if it's so small." Like, those things really do make it feel worthwhile, and I feel like I'm a part of, you know, them growing up. And so, it's really nice to just even those little small moments to be a part of.

Host: Yeah. Well, and in a community, like we have here that NKC Health serves, you see so many families, and you have such a big part in growing our community of healthy people. And so, that has to be really satisfying.

Harriet Appeah, MD: Yeah. No, it is. I love it.

Host: Yay. All right. So if you could give parents a piece of advice that would make their lives easier, what would it be?

Harriet Appeah, MD: Ooh, that's a really good question.

Host: It's loaded. That's a loaded question.

Harriet Appeah, MD: I think the thing that I usually say to families is to give yourself grace. This process, parenting, raising a child, being responsible for a person, is a lot. There's a lot of pressure that you put on yourself, that the world puts on you, that you hear from family members. And I think that giving yourself grace, and allowing yourself to make mistakes, and seeking help, and understanding, too, that your mental health and the way you feel about yourself does affect your child.

And so, being able to forgive yourself if you've made mistakes or, you know, if you feel like you're not being an amazing parent, just think about the impact that you have on your child on a day-to-day basis. And it's hard, because, you know, like I said, there's just so much stress, and you have such an important role. But I think that it's okay to, you know, pat yourself on the back for those small wins.

Host: For sure. Yeah. Yeah, for sure. And the thing about it is it's such an important job, but we've never done it before.

Harriet Appeah, MD: Exactly.

Host: We're all rookies when you start, right? I don't how we're expected to be perfect as parents. So, I love that. Giving grace, admitting when you're wrong. Sometimes telling your kid you're sorry.

Harriet Appeah, MD: Yeah.

Host: Right? That's a big one. That's pretty empowering. It's been empowering for me to admit to my child, "Hey, I'm wrong. You know, I'm sorry."

Harriet Appeah, MD: So, I think that, at the end of the day, just giving yourself grace is really important in this journey of parenthood.

Host: Yes. I agree completely. We could all use a little more grace, for sure.

Harriet Appeah, MD: For sure.

Host: All right. Thank you. This has been great advice.

Harriet Appeah, MD: Thank you for having me.

Host: You bet. Thank you for joining us today for our Care Empowered conversation.