Transcription:
Early Childhood Mental Health Awareness

Melanie Cole: There's no handbook for your child's health, but we do have a podcast featuring world class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids HealthCast by Weill Cornell Medicine. I'm Melanie Cole. Today we're talking with Dr. Daniel Bigman. He's a child and adolescent psychiatrist and an assistant professor of clinical psychiatry at Weill Cornell Medicine, and he's here to highlight early childhood mental health awareness for us. Dr. Bigman, thank you so much for being with us today.

As so many parents are going through the same thing, we're all worried about our children, how much anxiety they're under. There is really a mental health epidemic for our children going on in the country today with a lack of healthcare providers. Can you tell us about some of the disorders that our littler kids can have as we're talking about early childhood Dr. Bigman, what do you see happening today with our littler kids?

Dr. Daniel Bigman: First of all, thank you for having me and it certainly has been concerning regarding children and mental health issues that have arisen from the pandemic. But nonetheless, what we know for sure is that anxiety disorders are clearly the number one cause or the most common cause of children's mental health or children's psychiatric disorders.

Melanie Cole: So speak about some of the aspects of mental health and childhood. Are we looking for emotional and psychosocial? Developmental and emotional milestones? I mean, we know and we've learned over the years, Especially from these podcasts, that milestones, often the goalposts kind of move around a bit, right? I mean, a kid doesn't, every kid doesn't walk at the same time, talk at the same time. But when we're talking about psychosocial, emotional anger management, ability to self soothe, those kinds of things, can you tell us where we stand on that sort of timeline of those milestones?

Dr. Daniel Bigman: Absolutely. What we know for sure from an evidence based sense is that the emotional processing and the environmental setting of how children how when children are developing start at infancy. And some even argue that it starts in utero or when mom is pregnant. Interventions or these issues can start so early on. So the environment of an infant, the care that a child receives, the stressors that they're living in socially, these are all very impactful in terms of predisposing children to develop psychiatric disorders like anxiety or depression, bipolar disorder, or even schizophrenic.

Melanie Cole: Are there some red flags as we're looking at those psychosocial developmental milestones? Are there signs of mental distress? Because with our teenagers, of course, we've learned over the years, drugs, the friends they hang out with retreating to their rooms and their phones, that sort of thing. But with littler kids sometimes, They act out. I mean, my daughter was a tantrum thrower. She's 20 year old. Awesome. Now, are there some red flags for our two year olds, Our three year olds, our five year olds, our seven year olds, that will let us know that we say, you know, we need to get them some intervention?

Dr. Daniel Bigman: Absolutely. Some of the difficulties that children or that parents will report that would raise flags or that would be appropriate to speak to the pediatrician, primary care provider or a mental healthcare professional about would be based on age but frequent tantrums, being irritable all the time. Excessive talk about worries or fears, a lot of what we call somatic complaints, which are stomach aches, headaches, feeling nauseous. And in a way that's kind of recurrent, that even though they get checked out, there's really no identifiable cause, but it constantly keeps happening.

Children who can't keep still that are restless, who are very hyper or children who sleep too little or too much or are sluggish during the day, or even children that are not paying attention to other kids or pay too much attention to other kids. And if it's age appropriate in the academic sense, children who are starting school, who are not really thriving academically. Or who are preoccupied, which means just really focused on areas other than academics or areas that maybe are not of great importance. I think that these are all signs that would warrant, or that's very reasonable to have an evaluation done, which could be underlying presentations for psychiatric disorders.

Melanie Cole: So then who do we call if we notice this or they're preschool or caregivers or daycare, somebody says, this child is acting out and this is not normally what we see. First our medical home, right, our pediatrician. Then what happens, because there is early intervention programs in certain states that can help with these evaluations, speech therapy, whatever. But for psychiatric issues, for mental issues, are there those kinds of interventions?

Dr. Daniel Bigman: As you mentioned earlier, there certainly is a shortage of psychiatrists in our country, mental health professionals, nonetheless, child and adolescent psychiatrists. We are a bit of a rare breed, but what we generally recommend is the first line of defense are primary care providers, pediatricians, and even the school. The school guidance counselor, the school district should have somebody appointed to be evaluating and screening for any type of emotional dysregulation or anything that may not be anything that could be of concern.

So these are all, I would say the first line of defense, or the first screening point, or the first checkpoint. And from here we can then further assess and we can then further evaluate if the need for a specialist is needed. Like, do we need to refer a child to early intervention? Do we need to refer this child to the community mental health center? Does this child need to be seen by a child psychiatrist? And by doing this, the idea is that we can provide improved access to the community.

Melanie Cole: What do you do for children that are having these kinds of issues when they're little like that, I mean, we think of our teens that are, using antidepressants and they're on medications and there's all kind of anti-anxiety for our teens and young adults. But for littler kids, are these medications considered safe? Do we do cognitive, behavioral therapy. Are there things, Dr. Bigman, that have been shown to work for our little kiddos?

Dr. Daniel Bigman: Absolutely. We know that early intervention is really what helps the prognosis, meaning it really helps improve the outcome of overall health, including mental health. So yes, we do know that there are evidence based appropriate treatments for all different types of severities. And the treatments are tailored, whether it's a child who is struggling with ADHD, whether it's a child who needs parental reinforcement or parental training, whether it's a child who struggled through trauma, there are very specific tailored types of treatments. For example, there's a type of psychotherapy called parent child interaction therapy, which is specific to certain types of psychiatric disorders.

There's a specific type of therapy called CPP, which is child parent psychotherapy. And I know they sound kind of similar, but they're all very individualized in particular, and that is more for children who have struggled with types of trauma to help reestablish bonding with a parent. So we do know that there are evidence-based tools that we have to help improve outcomes. There are medications that can be used depending on what the presentation is or what the diagnosis is, and there are risks and benefits to everything, just as like there are for adults.

Melanie Cole: This is such an informative and important episode that we're recording here, Dr. Bigman, and before we wrap up, I'd really like for you to speak about some things that parents can try with their kids when they start to notice some things, because some of this doesn't always necessarily say your child is bipolar, or as you mentioned. So some of it is anxiety disorders and there are things we as parents can do. What would you like us to try as far as sleep you, You mentioned that you're a sleep medicine specialist. Getting our kids into routines, their phones, white noise, yoga, meditation, exercise, nutrition. Speak to some of these things that we might try with our little kids.

Dr. Daniel Bigman: And it's a great point because what we know for sure is that young children thrive with structure and keeping busy. And some of the earlier theories of maternal bonding and having parents, whether it's maternal or paternal or just general parental bonding are so crucial. So it's important for parents to make sure that their parenting is consistent, that there isn't any kind of differences between the parents in terms of how they parent. These are things that really can prevent confusion in little ones, that can really cause or set them up for other types of disorders.

It's really important to maintain good lifestyle choices, having meals, different meals a day, keeping diversity. Definitely benefiting from exercise, keeping busy and maintaining a routine sleep schedule, sleeping consistently at the same time, and waking up consistently and making sure that you have enough hours of sleep.

Melanie Cole: Dr. Bigman, and again, before we wrap up, because this is, there's just so many things to ask, but I'd like you to summarize what we've discussed here. I'd like you to tell parents and guardians what to know about child and youth mental health, how to provide. How to provide youth and family peer support. But I'd also like you to give us a piece of advice here for parents listening. I want a real usable piece of advice on working with our kids, teaching them healthy social skills and how to cope when there are problems.

If you were working with a family and there is a five year old that just isn't getting along at kindergarten. Especially since Covid, and it was all weird for the kids and masks and things. And I'd like you to give us a real usable piece of advice while you summarize this podcast today about how to work with our kids. I'm getting along with other kids and how to work with them if things don't always go their way.

Dr. Daniel Bigman: It is so important for parents to be supportive of children in this time, especially around the pandemic where mental health surges continue to occur, where we see increasing amounts of anxiety and depression and other types of mental illness. It's really important that parents should reinforce and validate children and to not dismiss children. And to take their concerns seriously. Parents often will disregard or ignore or not be consistent, and these are all areas that while may not be wrong, but we know that predisposed children to being nervous or to be an additional stressor of not knowing.

So I would say that one of the most important things that parents could do for young ones is definitely look out for those warning symptoms or warning signs that potentially could be contributing to an issue and that parents should continue maintaining good boundaries. As well as being supportive, listening and showing their kids that it's okay to talk about mental health. It's okay to talk to mom and dad or family about what it is to feel, how it is to feel.

Melanie Cole: That's great information. Thank you so much Dr. Bigman, for joining us today and sharing so much information for parents. As we're all going through this kind of feeling of anxiety lately. Anything we can do to help our kids is really the most important thing right now. So thank you so, so much. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Kids HealthCast. We'd like to invite our audience to download, subscribe, rate, and review Kids HealthCast on Apple Podcast, Spotify, and Google Podcast. And for more health tips, please visit wei cornell.org and search podcasts. And don't forget to check out our Back to Health. I'm Melanie Cole.

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