May 27, 2022
Since the onset of the COVID-19 pandemic, those of us caring for children and adolescents have seen a dramatic rise in stress and anxiety among the pediatric population, and a need to support kids and their mental health. In this episode, Children’s Minnesota’s own Kid Expert, Dr. Sara Gonzalez Rodriguez, licensed psychologist, joins us to discuss the impact of anxiety and stress on kids and their families, and ways clinicians can offer support during this critical time.
Dr. Angela Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, home to the kid experts where the complex is our every day. Each week, we bring you intriguing stories and relevant pediatric health care information. As we partner with you in the care of your patients, our guests, data, ideas and practical tips will surprise challenge and perhaps, change how you care for kids. Welcome to Talking Pediatrics, I’m your host, Dr. Angela Kade Goepferd. Since the onset of the COVID 19 pandemic, those of us caring for kids and adolescents have seen a dramatic rise in stress and anxiety among our pediatric populations and a need to support kids and their mental health. If we weren’t already doing a lot of mental healthcare before the pandemic, we certainly are now.
Luckily there are folks out there with the expertise to help us as we support kids and families through this current mental health crisis. Joining us today to discuss the impact of anxiety and stress on kids and families is Children’s Minnesota’s mental health kid expert, Dr. Sara Gonzalez. Dr. Gonzalez is a licensed psychologist working with children and adolescents and children’s psychological services department. She has been with children since 2019 and works in both inpatient and outpatient settings including part of our own team and gender health. Sara, thank you so much for joining us today.
Dr. Sara Gonzalez Rodriguez: Absolutely. It’s a pleasure to be here.
Dr. Angela Kade Goepferd: All right. Well, let’s start with some basics. We were talking before the podcast started about really differentiating stress and anxiety and how are those two things different? And why is it so important that we make that distinction?
Dr. Sara Gonzalez Rodriguez: It is absolutely, important to think about it and how to distinguish it because stress and anxiety share so many of the same emotional and physical responses. It’s important to note that stress is linked almost always to a specific stressor that is identifiable and symptoms decrease once that stressor goes away. But anxiety it’s internal, it’s a persistent and excessive experience of worry and fear that doesn’t go away even in the midst of no known stressor or threat.
Dr. Angela Kade Goepferd: So how common is that type of anxiety, the anxiety that doesn’t go away? How common is that among children and adolescents?
Dr. Sara Gonzalez Rodriguez: Anxiety is actually, the most common childhood psychiatric disorder. And according to the CDC about 10% of kids before the pandemic after 2019, the first data said that kids between three and 17 years of age were diagnosed with anxiety. And now, recent data showing that has risen to about 30% more than that.
Dr. Angela Kade Goepferd: Wow.
Dr. Sara Gonzalez Rodriguez: So that’s definitely, a significant increase that we’ve seen with the COVID 19 pandemic to an already high number of kids experiencing anxiety disorders.
Dr. Angela Kade Goepferd: We all know that kids will worry from time to time and some kids are a little more prone to worrying than others. One question that I often get in the primary care office is, is this just worrying or is this anxiety? And how can we help make that distinction between normal worrying and anxiety that needs some attention?
Dr. Sara Gonzalez Rodriguez: I think the most important piece to highlight is functioning. Something becomes a disorder when it’s impacting functioning whether that be sleeping, eating, attending school, leaving home, making friends, all those things that can make our day to day enjoyable and happy. If it’s getting in the way of that, we really need to be talking about it in a different way and accessing resources and support.
Dr. Angela Kade Goepferd: So if a child appears to be able to cope with their worrying even if it’s maybe more intrinsically part of their personality or maybe a family trait perhaps, as maybe in my own family between me and my children as long as they’re successfully coping, it’s probably, manageable. If the child or even maybe the parent doesn’t know how to cope with the worrying then that might be a good time to get some extra attention.
Dr. Sara Gonzalez Rodriguez: If someone is able to use coping strategies, all the skill they have been building in their toolbox to manage the worry and the different stressors that life can throw at them then fantastic. The minute that becomes a challenge and even when the kid is trying to use the skills and that’s not sufficient then yes, we should definitely, be linking that family with more supports.
Dr. Angela Kade Goepferd: So one of the reasons that we wanted to talk with you particularly now on the podcast is not just because of the rising anxiety rates but we’re in mental health awareness month and the awareness month exists because a lot of people still don’t talk about mental health. So for the families who aren’t coming in saying, “I want to talk about the mental health of my child,” what other presentations or signs might we look for that a kid is experiencing anxiety?
Dr. Sara Gonzalez Rodriguez: When we’re talking about the stigma that still impacts mental health within the community, we may not get the typical presentation but we really, again, I’m leaning into that word functioning because when kids are presenting to our office even if they’re not pointing out the worry or the fear, if they’re eating patterns are off, if they’re withdrawn and not interacting with others, if they’re not sleeping well through the night, multiple night wakings, experience of nightmares or just trouble falling asleep, those are good intervention points to call out that there is a giant link between the mind and the body. And if as providers and clinicians out there, we can start linking that mind, body connection we’re going to have a lot more success at talking about mental health.
Dr. Angela Kade Goepferd: For families or cultures that really are adverse to talking about mental health and really prefer to talk about physical ailments and are often looking for us to search for a medical cause for why their child might not be eating or sleeping or having stomach pain or any of those things. Do you have any recommendations or tips for us about how we could broach those conversations with families to really help them understand that we are treating something real even if it’s not something that’s wrong with the physical stomach or the physical body in some way,
Dr. Sara Gonzalez Rodriguez: I think explaining to families that the way that we talk about wellbeing includes both emotional and physical components and that mental health is health. Just as part as physical health is health. If we can equate that as providers then families have a little less resistance when it’s coming from a provider that they’re already going to and trusting. So clinicians out there listening to us today, really, I want for them to feel agency over bridging that gap of talking about mental health and health. But even when we talk about, yep, these stomach aches are a real thing they’re happening in real ways.
Dr. Sara Gonzalez Rodriguez: In the same way that we would give medicine, if it were a physical diagnosis or with a biological etiology, we can then link into some relaxation strategies or different coping tools even within our office to normalize that’s a common experience and this is a way to regulate our full emotional wellbeing. And the child is definitely, not doing this on purpose. I think that’s part of the dialogue as well, to disrupt the stigma against mental health, is to know that the child isn’t faking their experience. It’s a common place and it is a symptom of the disorder. So we need to treat it as such.
Dr. Angela Kade Goepferd: Speaking of that myth that kids are making it up or they’re pretending, what are some other common myths that we have or that we hold as a society or even in pediatrics about kids and anxiety?
Dr. Sara Gonzalez Rodriguez: Yeah. I think the biggest one actually, is that talking about anxiety may make the child more anxious and that’s 100% a myth. If we can give word and meaning to what the child is experiencing then we can have them have a better understanding of what’s going on with them. It can reduce the shame of why is it that I’m feeling this way. So actually, providing accurate information about what anxiety is and how it’s manifesting in their body is actually, a fantastic thing to do.
Dr. Angela Kade Goepferd: I have three kids, two of them are eight and one of them is six. And one of my eight year olds struggles, I would say, with stress and managing feelings of anxiety. And one thing that we have found really helpful is including him in figuring out how to make himself feel better so he’s really struggles around transitions. If we say we’re going to do something and he doesn’t have a lot of advanced warning it really bothers him. So we’ve sat down with him and said how can we avoid this meltdown? What is it that’s going to help you feel less anxious or feel less nervous? And my experience with my own child is that he can help participate in the problem solving if we invite him in.
Dr. Sara Gonzalez Rodriguez: That is so fantastic, bridging that to the conversations that should be happening within the primary care office. Oftentimes as adults, we talk about the patient as if they’re not in the room because they’re too little or they might not understand but actually, in conversations of mental health especially, also with physical health but especially, with mental health, bringing them into the conversation, acknowledging that their experience is true to them but that we can definitely, link them to resources and strategies to feel better will have better outcomes that way.
Dr. Angela Kade Goepferd: When it comes to stress and anxiety, what are some strategies that you found effective or that we can maybe start to employ with families, as you know they’re often waiting for long periods of time to get in to see a psychologist or a therapist in the community and anything that we can do to help families?
Dr. Sara Gonzalez Rodriguez: The first piece is ensuring as primary care providers that those daily strategies of sleeping, hydration, access to healthy foods and staying on a schedule, if we can make sure that those are happening, that’s a fantastic thing. We see a lot of different families and that will look many different ways but I think keeping that daily healthy schedule in mind for wellbeing is important. And then specific for anxiety linking into distraction techniques, relaxation techniques and actually, coaching parents to point out the behavior, “I am seeing you behave in this way, in this moment, what might be going on?” And trying to link that to behavior, thoughts and feelings that the kid might be having in that moment so coaching the parents in that way. But it would be fantastic if we built our waiting rooms to have different tools to teach deep breathing and to rate our feelings the same way that we teach families to rate their pain when they’re in the office. So I do think that there’s many ways that we can start making our offices a little bit more mental health inclusive as well.
Dr. Angela Kade Goepferd: I’ve heard mixed messaging on the use of electronics for that purpose. So putting a kid who might be feeling sad or anxious in front of a screen and while it may be effective in the moment I’ve heard concern raised that they’re not actually, learning the techniques that they need to be able to regulate their feelings. And I wonder what thoughts you have on that in terms of using screens to either help calm kids down or for distraction purposes.
Dr. Sara Gonzalez Rodriguez: It’s such a case by case basis but screens aren’t all bad. We can definitely, use it as a distraction to stray away from the stressor in the moment or the very high levels of distress. And once we are in a moment where that stress has passed or we’re in a prime opportunity to be able to talk about what happened and resume dialogue or coaching about what happened in that moment and how can we make that not happen in the future or happen to a lesser intensity in the future. I think it’s totally okay to use some screens as part of the strategy.
Dr. Angela Kade Goepferd: Are there certain kids, certain communities, certain population of kids, certain kids that would be at higher risk for having anxiety? You mentioned that 30% increase that we should have our radars up for in the primary care office when kids are coming in.
Dr. Sara Gonzalez Rodriguez: Not specifically, there are so many factors that impact anxiety from biological factors to just environmental factors. So really queuing in as we’re talking to a family that’s coming into our office to family, mental health history. Significant for anxiety that genetic predisposition is pretty high for anxious traits, but also increased stress within the family or big transitions or losses within the home can queue us into, Hmm, we need to stop and think for a moment how all these things are impacting the patient that we have in our office. And should we start assessing for anxiety a little bit more than we would’ve.
Dr. Angela Kade Goepferd: And the work that you and I do, Sara, in the gender health program, we know that a lot of the kids we take care of are experiencing this externalized stress that society brings into their life whether it’s school based or things they’re hearing on the news or politics about things that might happen to them that are out of their control. I think about the kids here in Minneapolis during the immediate aftermath of the murder of George Floyd and all the stress that was happening here in the city. And I’m reminded of that when you said, “Don’t be afraid to talk about it.” Maybe a reminder that if we know things might be going on that it’s okay to ask kids and families how those things might be impacting them.
Dr. Sara Gonzalez Rodriguez: It’s absolutely, okay to bring stuff up. Both things that are happening out in the community, in the larger scope of the world but also in their immediate family bubble, just again, talking about it, doesn’t make it worse and not talking about it doesn’t make it go away. So we really need to find as providers, how to strike that balance of figuring out what might be impacting this child so that we can appropriately guide them to resources.
Dr. Angela Kade Goepferd: If we have done all of these things and a child appears to not be responding, when is it time for us to refer to a mental health specialist like yourself? How do we know when it’s time to pick up the phone or place that referral?
Dr. Sara Gonzalez Rodriguez: I’ll lean in again, into that functioning piece. Whenever the child, the caregiver or yourself as a provider are having those very concrete ways that functioning is being impacted. I think that’s a really good time to start thinking about referring someone whether it’s to a mental health provider like me or even encouraging the family to say, hey, we know that resources are scarce across the board but reach out to your school, see if their psychosocial team, their school nurse can also be linking with you, partnering with you so that we can have an extra set of eyes or check in person at school that can be having these conversations and providing these tools too as we play maybe a little bit of that mental health access game, given that it’s so difficult especially, during these times.
Dr. Angela Kade Goepferd: Thank you. I appreciate you calling out the involvement of the school personnel and it’s some place that kids spend so much of their time. So that partnership is so important with school nurses and school social workers and everyone else that’s in a child’s environment. Some schools are lucky enough to have school-based psychologists which is great. Thank you so much, Sara, for joining us today. This has been really helpful and I really appreciate the conversation. Hopefully, we will be only heading toward more mental health access for our kids than a society where there’s less stigma around anxiety. And I appreciate you being part of that solution so thanks for joining us.
Dr. Sara Gonzalez Rodriguez: Absolutely. Thank you for having me.
Dr. Angela Kade Goepferd: Thank you for joining us for Talking Pediatrics. Come back each week for a new episode with our caregivers and experts in pediatric health. Our executive producer and showrunner is Ilze Vogel. Episodes are engineered, produced, and edited by Jake Beaver. Amy Juba is our marketing representative. For more information and additional episodes, visit us at childrensmn.org/talkingpediatrics, and to rate and review our show, please go to childrensmn.org/survey.