Have you ever considered that victims of human trafficking might be walking into your clinic, hidden in plain sight, longing for someone to notice their silent signals?

In this episode of Pediatric Meltdown, host Dr. Lia Gaggino sits down with Dr. Dena Nazer , a leading child abuse pediatrician, to dispel widespread myths and expose the heartbreaking realities of child trafficking. They dive deeply into what human trafficking truly looks like, why language and empathy shape outcomes, and how pediatricians can recognize and respond to red flags—even when victims don’t or can’t ask for help. If you’ve ever wondered how to protect the most vulnerable or questioned your own role in advocacy, this conversation mixes expertise and actionable strategies you can use today.

Don’t miss this essential episode—sometimes the most critical intervention is simply being prepared to see what others overlook.

• Media Myths: trafficking is not always dramatic kidnappings—many victims are exploited by someone they know, sometimes in their own homes.
• Defining human trafficking per US federal law: for children under 18, any commercial sexual act (anything exchanged for perceived value) is trafficking, regardless of force, fraud, or coercion.
• Labor trafficking in children does require proof of force, fraud, or coercion, unlike sex trafficking.
• Children cannot legally consent to commercial sexual acts, a fact often misunderstood by practitioners.

• All children, regardless of socioeconomic status or geography, can be victimized; not just those from impoverished or unstable backgrounds.
• Adolescents are particularly vulnerable due to developmental, social, and neurological factors—especially girls, though all genders are at risk.
• The covert nature and underreporting of trafficking, with true prevalence grossly underestimated—actual victims far exceed documented cases.
• Practitioners should avoid assumptions about victim profiles and recognize that trafficking does not discriminate by background or location.

• There is an impact of language, advocating against terms like "prostitute" or "modern day slavery," as they distort public perception and can harm survivors.
• There are nuanced preferences between “victim” and “survivor,” emphasizing respect for self-identification.
• Addresses mandated reporting: outlines state-by-state differences, reminds clinicians to know their local laws, and suggests erring on the side of caution when in doubt.
• Discusses the complexities of reporting and intervention with 18+ patients, promoting support over “rescue,” and collaboration over dictating solutions.

• Red flags in clinical settings: domineering non-parental adults accompanying children, delayed care-seeking, lack of address knowledge, repeated STIs, or signs of fear and withdrawal.
• Ways to build trust and elicit disclosures: prioritize safety, establish boundaries about reporting, and use risk-factor-based screening questions.
• Trauma-informed care—responding with empathy, validation, and minimal dramatization—to avoid re-traumatizing patients.
• Connect with local Child Advocacy Centers and understanding local resources and procedures before a crisis arises.

Can medication truly transform the landscape of pediatric mental health, or are we oversimplifying the complexities of growing minds?

In this episode of Pediatric Meltdown, Dr. Lia Gaggino welcomes Dr. Jess Pierce, a hospital-based child psychiatrist whose expertise bridges the worlds of pediatrics and mental health, especially for children in rural areas. Unraveling the fascinating history of psychopharmacology and delving into the mechanisms of action for the antidepressants, this episode offers a roadmap for pediatricians navigating the maze of SSRIs, SNRIs, risks like serotonin syndrome, and difficult conversations about side effects. The nuances matter and Dr. Pierce guides us skillfully.

Discover why family history, patient buy-in, and transparent communications are pivotal to successful treatment—and why prescribing for young people demands a delicate blend of science, art, and empathy. This conversation will change the way you see—and approach—medication and the treatment of kids' mental health.

• Tracing the unexpected origins of antidepressants, including how tuberculosis and hypertension treatments led to modern psychopharmacology
• The monoamine hypothesis: understanding the neurotransmitter focus in early depression treatments
• The move beyond serotonin, dopamine, and norepinephrine: new research on neurobiology, neurogenesis, and stress response
• Prozac’s arrival and its impact in reshaping the treatment landscape for pediatric mental health

• All SSRIs share rapid absorption, high protein binding, and similar side effect profiles—but key differences can matter
• Important reasons to avoid Paxil and to use Lexapro over Celexa, particularly due to side effect burdens
• Nuanced considerations: matching specific SSRIs to individual patient needs, such as Prozac’s activating profile for low-energy depression
• Practical dosing strategies: the art of balancing “start low and go slow” with the urgency to help suffering children

• The truth behind the Black Box Warning: clarifying risks of suicidal ideation vs. the dangers of untreated depression
• Why regular, open conversations with families about medication side effects—especially sexual side effects in teens—build trust and adherence
• Recognizing and managing serotonin syndrome: how to spot symptoms and when emergency intervention is needed
• Identifying high-risk drug interactions, including situations with migraine or neurology medications

• How SNRIs differ from SSRIs in action, side effects, and indication—especially in pain syndromes or where activating effects are desired
• The use of Wellbutrin as an alternative with fewer sexual side effects, and cautions for seizure-prone populations
• Strategic guidelines: the five-step approach to medication choice, considering patient history, family response, symptoms, buy-in, and comorbidities
• Critical cautions with genetic testing and the limitations of using these results to guide first-line medication choices

• Dr. Pierce’s PPT on Pediatric Psychopharmacology Hello! Here's the link to the slides: Psychopharm...

Are you struggling to support young patients—and maybe even yourself—with the emotional aftermath of our “new normal”?

In this compelling episode of Pediatric Meltdown, Dr. Colleen Cullinan returns to unpack the reality of pediatric depression in a world rocked by uncertainty. Discover why traditional approaches, like focusing solely on symptoms, may actually miss the bigger picture when kids are faced with unprecedented stress. Learn how changing the narrative, adopting techniques such as Acceptance and Commitment Therapy (ACT), and making small, values-driven changes can help children—and parents—find hope, function, and connection again. This episode isn’t just about treating depression; it’s about transforming how we relate to struggle and building resilience against the tide of ongoing adversity.

Tune in for real stories, actionable tools, and a refreshing reminder: even the heaviest feelings can be given a name, a shape, and ultimately, a little less power.

• The pandemic has significantly amplified youth mental health issues, leading to increased rates and severity of pediatric depression and anxiety.
• Symptom checklists like the PHQ-9 now reveal almost universal distress—so much so that a "normal" score is rare.
• Chronic uncertainty and prolonged stress (for both kids and adults) exacerbate feelings of hopelessness, helplessness, and irritability.
• The primary care challenge: shifting from symptom identification to understanding the real-life impact on activities, relationships, and overall well-being.

• Connection—not just checking PHQ-9 scores—is a critical protective factor for youth mental health and should be the heart of clinical encounters.
• Traditional Cognitive Behavioral Therapy (CBT) and newer Acceptance and Commitment Therapy (ACT) are compared — with ACT focusing on accepting thoughts and changing relationships with them, not just “fixing” or disputing them.
• Dr. Cullinan explains how ACT techniques, including physicalizing and naming despair, help kids distance from and better manage their feelings.
• The “beach ball” metaphor illustrates how fighting negative thoughts can cause you to miss life’s joys—and how letting them coexist with living can restore function and hope.

• Practical examples include using humor, metaphor, and even quick physical challenges (like the “lemon” exercise) to help kids gain distance from distressing thoughts.
• Naming depressive feelings or thoughts (e.g., “pathetic,” “Bob”) can help externalize and reduce their influence, making them easier to talk about and manage.
• Motivational Interviewing is highlighted as a powerful tool—but only if it genuinely centers each child’s unique values and interests, not the provider’s agenda.
• Avoidance, not just the presence of sadness or fear, is flagged as the true engine of suffering; the focus shifts to acceptance and gentle behavioral activation.

• Children’s beliefs and “frames” about themselves and the world are shaped by repeated messages—caregivers can help reframe these with new, nurturing narratives.
• Safe, stable, nurturing relationships offer the strongest protection and resilience against depression and trauma, as explored through frameworks like toxic stress and child transformation health.
• Providers can make meaningful impact in just minutes with new language, metaphors, and reframing exercises—even in a busy primary care setting.