Neil Thornbury, DSc (Host): Welcome to Pulse & Perspectives, where we explore the people, ideas, and health topics shaping care right here in our community. I'm Neil Thornbury. And today's conversation is for every parent who ever wondered, "Am I doing this right?"

Parenting is one of the most meaningful things that we do, but it can also be overwhelming. From newborn feeding questions to toddlers to school-age focus concerns to the mental health challenges facing teens, parents are constantly trying to make the right decisions, often while feeling tired, uncertain, and even judged.

Today, we want to take off some of that pressure. I'm going to welcome Dr. Ryan, who attended Western Kentucky University for his premedical studies, earned his medical degree from Avalon University School of Medicine, and completed his pediatric residency at Charleston Area Medical Center. So, Dr. Ryan, welcome to Pulse & Perspectives.

Luke Ryan, MD: Thank you. Thank you so much for having me.

Host: Absolutely. Let's just jump into the right question. But before we get into specific parenting questions, just tell us a little about yourself and what drew you to pediatrics?

Luke Ryan, MD: Well, I have to be honest, probably what drew me to pediatrics was my nephews. I didn't even really know I liked kids until they came along. I was an EMT before I went into medical school, and I found that I enjoyed the runs that I got a chance to take care of the kids the most. And I thought, "You know, I would really like to just take care of the kids." They're the best. I think that's generally what drew me to medicine. So now, I'm here.

Host: It's great. Fantastic. And I'll add some context to this, and you have to correct me if I'm wrong. I feel like you've got about a one-year-old now as well. Am I correct with that, you and your wife?

Luke Ryan, MD: He's two now. Yeah.

Host: Two now? Two. Wow. So, I share that as to tell people, not only are you getting great physician perspective, but you're also getting the real-life perspective of being a parent. And I think those are exceptionally important. I think it's real important when you're listening from a parent's perspective.

Luke Ryan, MD: Yeah. It drastically changed the way I counseled and the way I provided patient care, so it changed everything for the good.

Host: it's an interesting perspective for everyone. It's the hardest job and the most rewarding I've ever done, I can tell you.

So, you shared with me one of the biggest messages you want parents to hear is that parenting is tough, and not being a perfect parent does not mean you aren't a great parent. So, why is that so important for parents to understand?

Luke Ryan, MD: The biggest thing that parents struggle is parent guilt. You know, you've never cared so much for somethings in your life. At the same time, if they're anything like me, it's like you can't wait to be around them, and then sometimes you're like, "I just need a break for a minute." And then, it's a constant battle between, "Am I doing enough? I'm feeling exhausted. I'm feeling guilty. I'm feeling, you know, embarrassed that I'm not doing this perfectly or I don't know this already." I have a number of parents that I've had come to me and say, "This is my, you know, third child, but I had a huge gap, and I don't know what I'm doing with a newborn anymore."

I want to normalize all that because we're all human. I'm a parent too. Sometimes I have questions and I'm like, "You know, I've never thought about that. No one's ever, you know, asked me that before. I've not looked at it, read it, anything." So, normalizing being a human, and navigating parenthood is very important.

Host: I completely agree. And I've got two children now. My boys are older. They're 20 and 22 now. But I can tell you everything you just described is exactly what the parenting is. Am I spending enough time? And it's a lot of guilt that you can live in and focus on as opposed to trying to really focus on being present and being a parent when you can be a good parent and being there.

And again, just showing up is a lot of times the most important thing for the child, at least was for my children. But I think another thing you mentioned to me was, you know, having questions, parents having questions that they may feel embarrassed to ask. What would you say to a parent who thinks, you know, "I should probably already know this?" Or what do you see and what would you recommend as far as the space to be able to come to you and have those questions and not feeling embarrassed?

Luke Ryan, MD: The biggest thing is I do my best to tell them, to reassure them, "Please do not feel embarrassed because, if you've thought it before, chances are somebody's already asked me before. I've already asked myself before. You're not alone." I know oftentimes we feel isolated. We feel this sense of, "I better not tell anybody because they're going to find out how little I know." And so, we keep it in secret, but really the person next to them is thinking the same thing. And so, I try to reassure them that I'd rather you ask me and me spend five minutes of my time telling you why that's normal, why that's okay or whatever else than you not tell me, and it be something of concern, and even if it's part of my job to make you feel reassured, equip you, and let you know that you are capable of caring for this child and raising them. So very important.

Host: Yeah. I don't think we can emphasize that enough with patients. I think they have a lot of worries that they come in, parents, and all those. But one thing that I always share is the only thing that the physician really is going to struggle with are the things that you just don't disclose to them. That they are the person that if the more you tell them, the better they can help you solve your problem and/or come up with options or opportunities. And that is the most important thing. Just come in and share whether you think it's trivial or not, just share it if it's on your mind.

Luke Ryan, MD: Absolutely.

Host: And it's a great message out there. The next question is a bit of a broad question because it goes across many, many groups of kind of the life cycle of children as they grow. But what are some of the most common worries that you hear from new parents?

Luke Ryan, MD: From new parents, some of the most common worries, I think probably from the newborn—I think probably if we go across all categories of all different ages—it's always like, "Is my kid eating enough? Are they eating the right things?" Things like that from if you start very little at age, like when they're a newborn, parents wonder like—if mom is asking me and mom's like, "If I breastfeed, how do I know how much baby's getting?" Like, "How do I know? Are they getting enough? Are they getting what they need?" To toddlers when they hit the terrible twos and they love the autonomy, and they keep saying no to everything that you offer them, you know, "Is my baby getting enough?" And I think that's kind of like not just feeding, that's everything in life, right? Are they getting enough of everything?

But in feeding generally, the way that, you know, I usually navigate that is, first, we review their diet, we see if they are eating well. And this applies to teenagers too. Sometimes we send them off to school, and we think, "Oh, they're eating school lunch or whatever else. I check it every time because you never know. Sometimes it could even be an emotional thing to where like they feel bad about themselves, so they're not eating. So, it's a broad category. I look at their weight, see how they're growing. I talk to them about their eating habits, and I try to foster that environment of we develop healthy relationships with eating. We recognize food for what it is and that kind of thing. So, one of the biggest questions has got to be eating. Yeah.

Host: Completely agree. It's another worry that's in there, right? It's another box that parents just worry about, and I fell into the same category with both of my children. I'm going to serve a pretty challenging question here that I'm sure you get. My oldest child is what I describe as indomitable. He was a very strong-willed child who, on occasion, as you said, those terrible twos started with some tantrums. And I know what happens, and I know if you're in ground zero with your child, you know, what are some practical ways for parents to be able to respond when that child has that meltdown or when that child acts out in certain ways?

Luke Ryan, MD: The unfair thing to say is the first way to treat it is to prevent it, right? So first, we set clear expectations, say, "Hey, we're going out in public. This is how I expect you to behave. If you don't do it, this is what's going to happen," and we stick to it. We have to be so predictable as parents that it's boring.

So, if we say it, we do it, and we don't lose our cool. The minute we lose our cool, they think, "Oh, there's a chance I can negotiate this. I'm starting to get under their skin," whether they think it subconsciously or not. But some of the best ways that we can deal with it, the analogy I like to give is if you had two plants in front of you, you have a good behavior plant, a bad behavior plant. Which one do you want to shower with attention so it grows? So, you want to shower the good attention plant. And if we can safely do so, ignore the bad behavior. If they're throwing that temper tantrum and you can safely walk away while still keeping an eye on them, that's acceptable. Or if you have to put them in, you know, their own safe space and say, "You know what? I can see that you're really upset right now," so you're acknowledging their feelings. "I know you really wanted to do this, but this is how it has to be, and you can hang out in your room until you calm down for a little bit." And sometimes that works, sometimes it doesn't, but the biggest thing is consistency there. Unfortunately, I wish there was a quick fix, but it's a time and consistency thing.

Host: It's great counsel. I think those that are in the home that are helping raise the child, as adults, have that conversation of, "Here's the plan, and here's the plan that we're going to commit to together. Although we may have been raised differently from different paradigms, we're going to agree on this paradigm with our child."

And I think that's an important conversation to have to accomplish what you just said, which is being consistent with that child and reinforcing when they're doing great things and, again, just trying to put that in check when the behavior is not exactly optimal. It's great counsel.

I've got another tougher—these are all tough. Listen, children can be challenging. These are tough questions, because they just happen. So as children start to get a little bit older, and again, now I'm talking about children that are getting to preschool age or school age, again, some children may still be bedwetting. Like you said, healthy, healthy eating habits or, just in general, healthy habits. When is it still normal? When should parents bring that up to you? As parents, how should we listen and think and work through that type of worry that we have about that particular age range?

Luke Ryan, MD: So, everybody knows there's a lot of nuances to it. You know, the details are very important. So like, were they ever daytime dry? Were they ever daytime, nighttime dry? How long? And then, it even matters like when were parents daytime, nighttime dry? Has there been major stressors in life? Things like that. It can be normal for a kid to not develop full nighttime dryness until much later in life. But it's always worth mentioning to your pediatrician so they can help source that out and figure out, you know, are there other warning signs that we need to be concerned about, or is this normal? And most of the time, pediatricians, we're pretty good at that. That's a common question we can filter out, what was important information, what is okay, what isn't.

Host: Again, I know we're moving rather quickly through this. But again, I just want to make sure that we give a good touch on each of these areas. But now, let's move on to, say, preteens and teens, which brings on a whole different set of challenges. Talk a little bit about—I know because this was important for us, is, you know, what are the mental health signs that parents should be watching for? Or what are some of the biggest risks that's facing that age range?

Luke Ryan, MD: So, I say that mental health signs would probably be like—there's a difference between a teen that is withdrawn or a teen that wants to hang out in their room all the time and talk on the phone, versus a teen who wants to withdraw to their room and not go out with friends, may not have any friends, and doesn't talk on the phone, doesn't really do the things that they once enjoyed.

Oftentimes, depression, anxiety, if we think about it, it comes out pretty similarly to the way that it does in adults. We get irritable, we get frustrated easily, we may snip easy, and it can become difficult to kind of tease out, is this an issue? Is it not? I think the biggest thing is checking in with your teen and making sure, seeing how they're doing, even at the risk of them maybe getting snippy with you. You know, we have to put up with that. That hurts us. But, you know, that's part of the sacrifices we make as parents. You know, we have to say that my feelings matter less. I want to make sure you're okay. That's part of it.

I think some of the other health challenges, mental health included in this, adjacent is lifestyle. So, teens that don't sleep very well, that are over-caffeinating, that are not drinking enough water. I mean, I think that's probably one of the most common things is just a kid that can come in for anxiety, symptoms of anxiety, and I just work my way slowly through everything, and then I ask them, "How much caffeine are you drinking?" Or I just say, "What are you drinking in a day?" They'll say like, "Well, a couple cans of soda a day," and then, you know, maybe an energy drink here or there. And I'm like, "Well, I think I know why our chest is hurting. I think I know why we're not sleeping at night. You're drinking close to five hundred milligrams of caffeine a day. I think we need to, you know, knock that back". You know, I'm not saying that a soda here or there is terrible, but I think that plays a big role. And I mean, us as adults, if we don't take care of ourselves, we can fall into the same trap. We got to do more work. So, we stay up later, we drink caffeine, we do all this stuff. I'm no exception. It's happened to me before. I went through residency. And I think that part of that is it can be challenging. We got to model that behavior and it's tough. But I think that's probably some of the biggest challenges that teens face along with, you know, social media is a big one too. They start comparing themselves to somebody else's ideal life. So, it's very challenging waters to navigate.

Host: Yeah, there's a whole host of information you just shared right there that probably could be talked about for hours.

Luke Ryan, MD: Yeah.

Host: Yeah, I mean, agreed. I think that the healthy habits, healthy eating habits, healthy drinking habits and limiting caffeine is something that—again, having a Coke on a Saturday was a big deal. we tried not to do it during the week. But again, I think one of the bigger pieces for that age range is really trying to—and it's so hard just to monitor that social media, but it has such an impression on a very impressionable age. And it takes a lot of coaching, I think, from the parenting of saying put it into context.

And again, go out there. If you're going to research and you're going to say things, go out there and research it for yourself and find facts. Not just take somebody's word for this, and then draw an impression upon yourself about that. So yeah, that's such an important piece.

And then, again, I just want to touch on the safety piece of all these ages, which I think, again, is sometimes undervalued. But let's just talk about medication safety in the home, prescriptions in the home. Tell me a little bit about your thoughts and what parents—how how soon do I need to be, being mindful of where my prescriptions are in my home and that topic. I think it's a very important topic

Luke Ryan, MD: Absolutely. I think if I could encourage parents to do it before baby is even born, I would. Because if anything, much as anything in life, you're setting up a habit for success, right? So, we say that our medication always goes up here. It's a higher shelf that can keep under lock and key, so that way we make it a habit. So, you know, sure, the toddler can't get up to the second shelf, but the teenager can. And, you know, going back to the mental health issue from the teenagers, you know, we want to make sure that that's kept under lock if possible. And that practice starts early on.

And as far as what medications, I would say all. Unfortunately, if we talk about like accidental ingestions, overingestions, intoxications, things like that, the most common medications that occurs with is actually over-the-counter medications, antihistamines or Tylenol, ibuprofen, things like that. So, all medications locked up, regardless of the age, from a baby that can crawl and accidentally get it in their mouth, or a teenager who is struggling with mental health issues. It's a priority for safety.

Host: Completely agree. Kids are so—you know, again, they're just exploring, inquisitive, and all the things. And that's something that in the hospital world we certainly see and it's very preventable. And if it's one message you could listen to, I'd say that's a great message. Even over-the-counter medications, just make it not accessible because they're going to come across it, and you don't want them to make mistakes in a situation that could have been prevented.

Again, I know we talked about so many things. I want to leave you with kind of an open-ended question here. What else would you like to share? What else is out there? Again, I'm a parent. I've got newborn children. I've got young children. Tell me a little bit about anything else you want to make sure that you can share with me

Luke Ryan, MD: So, I would think the biggest thing is taking time out to care for yourself. That is so important, I think to steal a line from Mr. Rogers, everything boils down to love or the absence thereof. So, we got to take time to love ourselves, care for ourselves as parents. Take that time out to go to the gym and exercise, or get outside and walk. Eat right. Take that time to get up from our desks and walk to the water fountain and get a bottle of water. I'm talking to myself too. I'm no exception. So if you see me out in public and I'm not doing the right thing, tell me, "Hey," say, "Get a bottle of water." Whatever, you know. "Put down the soda."

But, you know, take time out for ourselves. So that way we can model that behavior for our kids, set them up for success for the rest of their life. So that way, they become the adults that we want them to be. And take it easy on ourselves, you know. We're not going to get it perfect. We're not going to do it right every time.

Sometimes we are going to have that extra cup of coffee. Sometimes we are going to not get optimum eight hours sleep. You know, life is all about consistency and not perfection. Progress, not perfection. That's what I tell, every parent every time. And it's very easy, like we talked about in the beginning, to shame ourselves. Staying away from that and making sure that we just, like you said, show up for them every day. Be consistent.

Host: It's a great message. Progress, not perfection. Great message, truly. Dr. Ryan, thank you for joining us today.

Luke Ryan, MD: Thank you so much.

Host: What stands out to me from this conversation is that parenting does not require perfection, as we just said. It requires love, attention, patience, humility, and a willingness to ask questions when you're unsure.

And I hope parents listening today hear this clearly. Your pediatrician is not there to judge you. They are there to support you, educate you, and to partner with you as your child grows. Dr. Ryan brings not only excellent training and pediatric expertise to our team. But also, as you could tell, a genuine heart for families.

As a father himself and as someone with deep ties to this region, he understands the privilege of walking alongside parents and children through every stage, from newborn to adolescent, all the way up. Dr. Ryan is now seeing patients, in Primary Care Pod C at the TJ Health Pavilion, again, caring for children from newborns all the way up through age eighteen.

I want to thank you for listening to Pulse and Perspectives today. If today's conversation helped you, please share it with a parent, grandparent, or caregiver, whoever needs a little encouragement. I'm Neil Thornbury urging you to keep your pulse on the future, your perspectives wide open. Until next time, stay informed, stay proactive, and stay well. Thank you.