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.

Have you ever wondered why anxiety in children can look and feel so physical—and what we as pediatricians, parents, or caregivers can do about it?

We’re visiting a fan favorite from Episode #26 of Pediatric Meltdown, Dr. Lia Gaggino sits down with Dr. Colleen Cullinan, a leading pediatric psychologist, to dissect the powerful 3 B’s approach: Brain, Body, and Behavior. Together, they reveal eye-opening truths about integrated behavioral health, the ways anxiety manifests in kids, and practical, actionable strategies for managing emotional meltdowns in real-time. This is not just about recognizing anxiety—it's about transforming how we support kids inside and outside the exam room. If you want to empower families, level up your clinical skills, and make a tangible difference, don’t miss this conversation.

This episode could change the way you think about pediatric care—forever.

• Integrated behavioral health bridges the gap between physical and mental health, creating seamless care experiences for families.
• Primary care is often the first—and sometimes only—entry point for children facing emotional or behavioral challenges.
• Partnerships between pediatricians and behavioral health providers increase accessibility, reduce stigma, and foster earlier intervention.
• The synergy and trust between pediatricians and psychology professionals leads to holistic, effective patient care.

• Primary care providers serve as trusted anchors, introducing mental health as an essential component of overall health.
• Familiarity with a child's history allows pediatricians to recognize subtle behavior changes and collaborate meaningfully with behavioral specialists.
• Normalizing physical symptoms of anxiety (like stomachaches and headaches) helps bridge conversations from medical to emotional concerns.
• Educating families on the inseparability of physical and emotional health empowers them to seek support without shame.

• The "3 B’s": Brain, Body, and Behavior, are interlinked—anxiety in the brain triggers body sensations, which guide behavior, often leading to avoidance.
• Psychoeducation is key: Emphasizing to families and youth that everyone experiences anxiety validates their feelings and reduces shame.
• Simple, actionable distress tolerance tools—breathing exercises, grounding techniques (like the “five senses” method), and focusing attention—can be taught in minutes during a regular visit.
• Providers can help children recognize “worry thoughts” and redirect their response before anxiety spirals into withdrawal or meltdown.

• Distress tolerance techniques can bridge the gap until a child can access specialized behavioral care—or be sufficient for milder cases.
• Functional impairment is the marker for when anxiety moves from “manageable” to requiring traditional CBT or higher-level intervention.
• Exposure therapy explained: At its core, CBT for anxiety involves identifying fears and encouraging gradual, manageable exposure to them, with improvement through repetition.
• Advocacy for integrated behavioral health, resource sharing, and ongoing partnerships with community therapists are essential for sustainable, high-impact child mental health care.

Are pediatricians prepared for the mental health crisis that’s impacting so many of our children today?

In this episode of Pediatric Meltdown, host Dr. Lia Gaggino sits down with nationally recognized child psychiatrist and podcast host Dr. Elise Fallucco to uncover the urgent realities facing pediatric practice. From understanding why a simple podcast name change can transform the reach of critical mental health education, to exploring the real-world, stepwise journey pediatricians navigate when facing complex child anxiety and medication management, this episode is a masterclass in practical empowerment. Listeners will discover actionable strategies for burnout, the evolving landscape of pediatric mental health treatment, and authentic stories of resilience, support, and resourcefulness. The stakes have never been higher—and the need to equip pediatric clinicians with the right knowledge and mindset is more critical than ever.

Don’t miss this invigorating roadmap for providing exceptional care in panicked times.

• Pediatric mental health education is increasingly being disseminated beyond in-person local trainings, leveraging digital platforms like podcasts to amplify access and reach.
• Clear, descriptive branding ensures the right clinicians can find mental health resources at the exact moment they need support in practice.
• The main driver in choosing content is what pediatricians most urgently seek: practical, actionable advice about managing medications for anxiety and ADHD.
• Making specialized knowledge accessible via on-demand, digestible podcast episodes empowers clinicians to feel less isolated and more competent.

• Anxiety has emerged as the most common and burdensome mental health concern for children, exacerbated by societal stress and recent global events.
• Differentiating normal anxiety from clinical anxiety is crucial: functional impairment and life disruption are key markers for escalated intervention.
• Coping strategies for clinicians are vital; the “three pillars” are staying busy with purposeful activity, reaffirming personal/professional mission, and prioritizing self-care.
• Peer connection, exercise, and carving out time for meaningful relationships are highlighted as essential personal de-stressors.

• Pediatricians experience a four-stage progression from fear and avoidance to high-confidence care in managing pediatric mental health—each with unique challenges and rewards.
• Access limitations to child psychiatry have forced primary care clinicians to expand their skillsets and comfort zones, often out of necessity.
• Collaborative consultation programs, like psychiatric access hotlines, accelerate learning, build confidence, and foster an environment where sharing expertise is normalized.
• Developing fluency with diagnoses and medication management leads to more effective and streamlined care; “herd immunity” and practice culture shifts increase collective capacity.

• Barriers to therapy—including logistics, family skepticism, and stigma—limit effective care, even as access improves; motivational interviewing is a partial solution but not a panacea.
• Integrated behavioral health models and school-based clinics offer promising solutions by reducing friction and meeting children and families where they are.
• Time constraints and misaligned incentives remain top frustrations; procedures are often reimbursed more than complex mental health care, despite the latter’s intensity and impact.
• Empathy,...

Can one person truly make a difference in the complex world of pediatric healthcare?

In this episode of Pediatric Meltdown, host Dr. Lia Gaggino explores how primary care pediatricians can step up amidst the chaos in Washington DC and stand as the trusted advocates children need. While Lia prepares for the pediatric academic society PAS in Honolulu, she is wrestling with the disastrous current health policy challenges and calls for local action. Lia pleads with her peers to organize and cause “good trouble”. This episode underscores that our most vulnerable population — children — deserves the unwavering dedication of empowered and informed advocates.

In pursuit of crafting a brighter future for children's health, will you rise to meet the challenge?

[00:00:04 - 00:01:21] Preparing for Change and Connection

• Pediatric Meltdown is dedicated to children's mental health and emotional well-being.
• Dr. Lia Gaggino shares her passion for facilitating thoughtful conversations with experts.
• New and creative medical approaches are thriving and contributing to community upliftment.
• Enjoying family time and Hawaii's scenic beauty is part of Lia’s plan to recharge.

[00:01:21 - 00:04:19] The Chaos in D.C. - A Call to Action

• The state of national politics is concerning, described as a "dumpster fire."
• Staying informed plays a crucial role despite the overwhelming current events.
• Balancing leisure with staying critically aware of policy changes affecting pediatrics.
• Connecting with pediatric colleagues to brainstorm actionable steps.

[00:04:19 - 00:08:39] Advocacy for Children’s Needs

• Emphasizing the trust placed in pediatricians and the responsibility that comes with it.
• Safe health practices are under threat from misinformation spreading rapidly.
• Vital programs and advisory committees crucial for child safety are being dismantled.
• Highlighting the unnecessary and detrimental effects of defunding health initiatives.

[00:08:39 - 00:12:39] Empower Your Voice and Community

• Highlighting real stories as powerful tools for advocacy.
• Breaking down scientific data into relatable family narratives aids understanding.
• Demystifying Medicaid's role as crucial support for countless families.
• Urging listeners to take definitive action, whether through social media or community forums.

Resources Mentioned:

AAP Advocacy Guide Member log-in required to access

On Tyranny Timothy Snyder

AAP MMR Vaccine Information

AAP Medicaid State Fact Sheets

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186. Immigrant Children and Families

158. Preventing Youth Suicide

100. The Art of Medicine

Tweetable Quotes:

"We've witnessed chaos, unprecedented and relentless. The landscape of Washington DC is reflective of a larger societal unrest, a crucible that now must forge strength and

Are you feeling overwhelmed by the world's chaos and seeking hope amidst uncertainty?

In this moving episode of Pediatric Meltdown, host Dr. Lia welcomes Dr. Robert Saul to discuss the powerful principles guiding his commitment to advocacy and change. Dr. Saul introduces the transformative 12 words that have anchored his life's work and how these principles can propel communities forward. Together, they examine the impact of truth, trust, and the little-known role of the communal aspect in tackling societal issues. As Dr. Saul passionately delves into historical and modern-day examples of lying within power structures and challenges us to confront uncomfortable truths. Discover where the true power of change lies and how understanding our roles can lead to actionable advocacy.

This episode isn't just a conversation—it's a call to action for those yearning to make a difference.

• Discussing the importance of comprehensive clinical encounters beyond quick checkups
• Stressing that empathy and genuine presence build deeper connections in healthcare
• Highlighting the responsibility to offer hope and guidance, not merely prescriptions
• Suggesting that professionals and caregivers must pause to recalibrate when stress levels rise

• Exploring the idea that acknowledging our collective part in societal problems is the first step
• Underlining the distinction between culpability and willingness to engage in solutions
• Discussing how seeing oneself as part of the issue spurs commitment to meaningful action
• Reminding listeners that we are interconnected in every community concern

• Defining trust as the “currency” of relationships and community life
• Arguing that telling the truth consistently is essential for building and preserving trust
• Noting that children thrive when caregivers, professionals, and policymakers work together with integrity
• Suggesting that widespread misinformation undermines the health and wellbeing of communities

• Encouraging continued involvement in committees, local boards, and mentorship roles
• Highlighting the drive to create community programs focused on healing and trauma-informed care
• Planning future projects that address truth, trust, science, diversity, and civility
• Ending with an affirmation that sustained efforts at all levels can foster a more promising future

1. https://mychildrenschildren.com/my-childrens-children-name/
2. https://mychildrenschildren.com/better-is-good-incremental-steps-forward/
3. Power S. The Education of an Idealist: A Memoir. Dey St. 2019; 580 pp. (p. 282)
4. Snyder T. On Freedom. Crown, New York; 2024. 345 pp.
5. https://mychildrenschildren.com/infant-mental-health-part-i/

Have you ever wondered how pediatricians balance autonomy, mentorship, and the pressing demands of modern healthcare?

In this episode of “Pediatric Meltdown,” host Dr. Lia Gaggino welcomes Dr. Chris Peltier, MD, FAAP, who describes the rewards and hurdles of serving children through private practice, collaborative initiatives, and academic roles. He underscores the power of supportive peer networks to tackle shifting hospital structures, financial complexities, and the mental health needs of growing populations. His reflections reveal how advocacy, teaching, and flexibility can sustain a genuine passion for pediatrics.

Will these strategies ensure a vibrant future for the next generation of caregivers?

• Shifts toward hospital system acquisitions reduce physician independence.
• Succession planning gaps leave practices vulnerable to buyouts or closures.
• Administrative decisions can feel distant from day-to-day patient care.
• Becoming an employed physician can alleviate the stress of business management.

• Collaborating across independent practices can reduce expenses, such as vaccine costs.
• Sharing vendors and resources fosters a supportive rather than competitive environment.
• Group quality improvement projects tackle issues like asthma or anxiety in children.
• Large networks can negotiate better insurance contracts on behalf of multiple practices.

• Intrinsic motivation—such as the joy of mentoring—often drives physicians to teach.
• Efficient time management (e.g., scribing during patient visits) enables bedside teaching.
• Chapters and national organizations collaborate to advocate for preceptor stipends.
• Small but meaningful policy changes (like state tax incentives) can bolster teaching efforts.

• Mental health screenings, including suicide risk assessments, become embedded in well visits.
• Working with community partners and even firearm ownership groups promotes harm reduction.
• Coordinated action with lawmakers helps defend programs that protect vulnerable populations.
• Sharing successful programs across state lines broadens the reach of proven solutions.

Contacting Dr.Peltier

FaceBook:: https://www.facebook.com/cpeltier007

X:@cpeltier007

INstagram:: https://www.instagram.com/cpeltier007/

The Pediatric Management Institute https://pediatricsupport.com

AAP Section on Administration and Practice Management SOAPM

AAP Council on Community Pediatrics COCP

AAP Advocacy...