Dr. Chad Perlyn (Host): Welcome to the For Peds Sake podcast, a Nicklaus Children's Hospital podcast that is all about putting children at the heart of healthcare. I'm your host, Dr. Chad Perlyn, a pediatric plastic surgeon here at Nicklaus Children's, and I am so excited to welcome you to today's episode. This is going to be such an important one.

Today, we are joined by Dr. Sara Rivero-Conil, a pediatric psychologist here at Nicklaus Children's, to talk to us about something so critical, pediatric mental health. And I'm also excited to welcome Sara to the podcast because she has two children, a teenager and a preteen, almost the exact same age as my kids. So, we really look forward to this conversation and sharing experiences as clinicians, as parents, and getting some great information out to our families. Thank you for being here with us.

Dr. Sara Rivero-Conil: Thank you for having me.

Host: So, let's jump right in. Tell us a little bit about your story and why you became interested in becoming a pediatric psychologist.

Dr. Sara Rivero-Conil: Well, I love human behavior. I love emotions. I am a high energy person, as I've been told. And I love working with kids. And there's nothing better and more rewarding than working with kids and giving them the tools to deal with life. I mean, life is hard. Society is hard. As adults, sometimes we struggle. So, why not work with kids and give them the tools they need for other life?

Host: Wonderful that you've dedicated yourself to this field. And one that has taken so much prominence in the media postpandemic, what we're hearing in schools and challenges today. Tell us some of the common problems you see in children today and some of the issues in diagnosis that most commonly you treat.

Dr. Sara Rivero-Conil: Great question. So, a lot of what we see is no different than what's happening across the country. We're seeing a lot of anxiety and depression. And in all ages, you know, we can see kids with anxiety as early as four years old, three years old, they just show that differently. So, what's pretty interesting is parents call the office all the time and they say something's different with my kid, something's going on, it's emotional, it's behavioral. But when we come in and assess it, we're able to share what it is, anxiety, it's depression, and it's impacting their life. That's the biggest thing, you know. Again, we want to make sure our kids have the tools to conquer the world and have fun while they're doing it, right? So, a lot of anxiety, a lot of depression is what we're seeing in our practice.

Host: It makes a lot of sense. You mentioned something, and I know this is a question that every parent listening will think about. What are the signs that we should be looking out for as parents that something may not be right with our child, that they may be having anxiety or depression, as you said. And for particularly those of us who have teenage kids, how do we know the difference between a real medical or psychological condition and just the sort of lay term that we all say of just being teens today. My 15-year-old never wants to get out of bed in the morning. Is that an issue? Should I be worried? Or is it just a teenager? Talk to us about that.

Dr. Sara Rivero-Conil: So, it's a great question. You know, we call them our red flags. I love to tell parents and educate them on what to look for. I share with them, "You are the expert on your child, so you know when things look off." So, keep an eye on sleep. Are they oversleeping, having difficulty falling asleep? Are they having difficulty staying asleep, different aspects of sleep? What's going on with their appetite? Are they overeating? Do you see that there's any changes in appetite? Impact on social functioning, now are they withdrawn? Are they not doing the things they used to enjoy doing? Other things to look at is a decline in academic performance. So, you have an A student, all of a sudden they're not turning in assignments. They're getting bad grades. You're seeing those changes.

And don't wait too long to ask your child what's going on. You know, I hope we talk a lot about communication, because I think that's the one thing that is hard with adolescence. And as parents, as a parent, I have to put my psychology hat on sometimes and it's not easy. I talk with my parents and I say, "I know it's not easy, but stick with it. Your kid matters. You matter. Ask them what's going on. Listen to them." Listen more than you talk works great with teens.

Host: I think that's great advice. And let me re-say it, so I learn it for myself. Listen more than you talk. Is that right?

Dr. Sara Rivero-Conil: That's the key. You know, I tell a lot of parents and I do this with my daughter. She's going to kill me hearing this, but she knows it's strategic. I ask her, "Do you want me to listen to you or do you want me to give you advice?" And depending on what she tells me, I do it. That's the hard part. Because sometimes you want to tell your child, do this instead, you want to protect them. When they're learning how to walk, you tell them, "Get back up and let's do this." You know, and you want to protect them at all times. And as teens, there's only so much we can do. We're not always going to be there to protect them. So, what you want to do is teach them how to problem solve on their own, and that's hard. That's so hard because you're listening with your heart, and that's, you know, your child.

Host: Such, such important advice and a great segue to my next question. What about digital media? Whether it's Facebook, Instagram or TikTok, or whatever the platform of the day is that our kids are on today, phones, tablets, and everything that comes with it. Lots of studies have shown the effects of this on children's mental health, particularly young girls, adolescents. Tell us your thoughts as a pediatric psychologist on how social media, digital media, digital technologies are affecting our kids' well-being today. And what should we do as parents about it?

Dr. Sara Rivero-Conil: So, technology is a beautiful thing, but such a dangerous tool in the wrong hands. One of the things I tell parents is you have to mindfully mentor your child, because if you don't, someone else will. And I think what we want is our kids to learn our values and our morals as much as we can. So, we definitely see that using technology and social media helps them connect with friends and helps them explore their interests.

But on the other hand, we're also seeing that some of these kids, they're measuring their self-worth on how many likes they have, how many comments they have. They're constantly looking at other things and trying to get that right picture. They're socially isolating themselves. They're spending so much time on their phones. So if they're on their phone, they're not having these in-person interactions that they crave. And then, the pandemic really turned us, that was their only way of socializing. So, we're kind of undoing a little bit of that now.

And as parents, I tell them all the time, put your own phone down. We got to model these behaviors for them. We got to teach our kids the world is scary, and it is literally in their hands right now. So if we don't teach them, they're going to learn, they're going to be curious. They have curious minds. They're going to Google everything, so be ready for that. And when you're mindful mentoring, tell them about the good and the bad and how to navigate the things. Like I said earlier, we have to help them learn these problem-solving skills because at one point we want them to do this on their own. And teens are hard because they don't want to be told what to do. I haven't met one teen that likes to be told what to do. So, you know, being cautious with that is so important.

Host: You said a phrase which just caught my attention, I think it's really magnificent, mindful mentoring. What an important concept. And as you said it, I was thinking yesterday about my 11-year-old who was in a parking lot, a busy parking lot on his phone, looking at digital media, whatever it was, and I reprimanded him. I said, come on, you're in a busy parking lot. You got to pay attention, get off your phone. And what did I find myself doing 15 seconds later, right? Answering a text that came through as I was walking through the same parking lot. So, I'm going to take that to heart. I hope all our listeners do too, this notion of mindful mentoring and reflecting our behaviors with what we're talking to our children. That is really well said.

Sara, I know that every condition is different in every child is different. But are there any common themes? You touched on this a little bit before, that parents should be looking for or watching out for in terms of when to engage a practitioner or clinician in this space? And who should that be? Is it the pediatrician? Is it someone at the school? Do they reach out directly to a psychologist or a pediatric psychiatrist? Talk us through sort of this process of maybe when you see a red flag and touch again on what they are because they're so important and then what next, what to do next so our families know how to reach out for help.

Dr. Sara Rivero-Conil: I love that question, because what we know in research is that kids or people, we're getting services 8 to 10 years after the first time they have a symptom. That's a very long time. So, I love working with kids, so we're hoping to instill some of these skills early on. So, parents are the expert. You know your child best. If you are seeing any of those changes we talked about earlier, changes in sleep, appetite, academic functioning, they don't want to do things they used to enjoy doing, they're isolating themselves, start having those conversations.

Pediatricians are oftentimes a great point of contact for families. They've seen the child growing up. The child typically trusts them, right? And having them talk to their pediatrician like what's going on is a great segue to getting some support and they can assess if they need further support and who the right person is. But when you feel that your child is engaging in things and it's persistent, right? It's not one day. On weekends, your teen is sleeping in. They're probably sleeping in because they're exhausted and going through a lot throughout the week. But you're seeing some differences, seek help. Don't wait. Don't wait. I would rather, any day, have patients come in through my door and I say, "It's okay. It's called adolescence. Here are some tools on communication, because I think mental wellness is so important. We don't have to have a diagnosis to learn some of these skills, but we're doing that so late. We're doing that when we're failing classes. We're getting the help when sleep has impacted memory and academic functioning and social functioning. So, just pay attention and how you do that is listening. Listening is so key.

I'm going to give you a tip that I tell a lot of parents and I do practice this a lot. Now, my kids are going to listen to this and know exactly what I'm doing at all times. When I'm driving with them and they start talking to me, they get chatty, I take the long way home. I drive slower, I stay quiet, and I just listen. And I'm being mindful in that moment. I'm enjoying being a mom in that moment. And some of the things they're telling me, you know, it's scary what's happening, but I love that they're telling me. I love that they're asking me, right? Because if I'm not listening, they're going to go ask someone else. And it might be a kid in school that doesn't have the right tools either. So, I think communication, you know, I keep going back to that because it's so hard as adults, society is so hard. There's so many things going on and adults are struggling with all of that. Our teens are not doing any different. And with social media, bringing it back to social media, they're seeing everything that's going on. There are things my kids have come home and told me about because I'm working, I'm not watching the news and I'm learning it from them.

Host: Do you have any thoughts on as we engage our kids in conversation, whether it's in the car ride home, as you say, which I think is a great opportunity or somewhere else. Any tips for parents on how to get that engagement going? I've heard things like, "Don't ask your teenager, 'How was your day today?'" It's a non-starter. You're going to get a one-word answer, right?

Dr. Sara Rivero-Conil: They're going to say good or bad.

Host: It's good or bad, right? So, you know, I've heard from folks, you know, tell me one thing happened today that was interesting to you, or something like that, to get the conversation going. Because as you said, who knows what comes from there, right? Give us some advice on that.

Dr. Sara Rivero-Conil: That's a great question. So, some things you can ask is, depending on what you're worried about. "Who did you eat lunch with today? What did you have for lunch today? How was your math class? What was going on in that? Did you learn something? Would you go back and change anything about your day?" And teaching them gratitude while you're having these conversations, why don't we get two things in there at the same time? What are you grateful for? What did you love?

You'd be surprised how many adults have a hard time with gratitude, recognizing the little things and being mindful of what their day is. So if we're starting these conversations early on, I'm talking about those young parents right now, your kid is two and three, talk to them, you're building vocabulary, you're teaching them emotions. And when they say something went bad, you listen to them and you say, "I'm sorry. It's okay to not be okay," because again, as parents, we want to protect them. "Oh, it's okay. You'll get an A next time. It's okay," or we'll say, "You should have studied more."

And I want parents to be mindful of what's happening. You know, when you are talking, there's some things you want to ask yourself before you do that. First one I said earlier is, do you want me to listen or you want me to give you advice? And the second one is when you're talking to them, you want to ask yourself, "Am I trying to reprimand or do I want to teach them?" Do I want to teach them, "Don't pick up that phone while you're crossing the street" and do I want to reprimand, right? "No, you shouldn't do that," but tell them why you shouldn't be doing that so that you teach them. And the way your tone comes across, if you're coming across in a disciplinary way, they're not listening as much. So, try to balance that out. There's discipline. We need that. We need to, you know, reprimand our kids. Sometimes they're doing things they shouldn't be doing, but come back and say, "Hey, I said this because I was worried. I was worried you can get hurt. I'm worried, you know, something may happen that's going to impact you so on and so forth." But to ask yourself, are you trying to teach? Are you trying to reprimand in those moments and stick to it?

Host: Mindful mentoring. I think that's a great takeaway from today's discussion. I want to come back to a minute for social media, because something popped into my head. And I know there's lots of different thoughts and different theories on this and different recommendations from different accreditation bodies, but perhaps you can share your thoughts both as a child psychologist and as a parent on the age of social media. When should kids begin to start to have access to it? Any thoughts you can share with parents there? Because I know this question is on a lot of people's minds.

Dr. Sara Rivero-Conil: It's a struggle because we can't shelter our kids too long, because then they will be socially isolated. These kids are connecting and sending invitations through social media. And if your child's not on that social media, they're not getting invited. That's how I learned so much more, right? Getting my teens into social media. But be mindful as to what social media you're using. Learn those parenting ways of connecting and being their friend without really getting into their space, being a friend, talking to them, like, "Let me see what you're doing."

And having those conversations early on is so key when you give them this powerful tool. Once you give it to them, it's really hard to take back. Having that conversation early on. "Listen. These are the pros and cons of it. You're responsible enough. And I know you asked me for an age, but I think you really have to gauge your child's responsibility and maturity. If they're not mature or responsible enough, but yet you think that they're old enough, right? They're 13 and all their friends are on TikTok or doing something, give them only a certain amount of time on it and teach them. Teach them how to use it. Teach them what to say. I'm so surprised every time I have a child who shares, "Look at the text I got from a friend and they're heartbroken about it," and I see how they respond. They don't know how to socially communicate their emotions. I mean, emotions are complicated, right? You got to name them, you gotta figure it out, then you got to talk about them. So, teaching them how to do that, I think, is the biggest thing, but you know your child best.

Host: Great advice. And I think great advice on the importance of us teaching our children to communicate through difficult situations, which will ultimately help their mental wellness as compared to hitting an emoji, and not even really understanding often the meaning behind it. Great, great advice.

Two last questions, and they're big ones. You mentioned mental wellness. And I know you have been an advocate for this for a long time. And a huge supporter professionally of this notion. And for our listeners, everyone will be familiar, you go once a year to get your height checked for your child. Or if you're an adult, preventive screening. You get a mammogram, or you get a colonoscopy to check your colon. But who's checking our brains, right? Who's checking our mental health, our mental wellness, a well checkup for our body and a well checkup for our brain. Maybe you could just comment a minute on your advocacy work in this space, because all of us at Nicklaus Children's think this is so important.

Dr. Sara Rivero-Conil: I love that program. So right now, we've partnered with our pediatricians here at Nicklaus, where we have a psychologist embedded and working with them and just checking in on kids during transitionary periods. I mean, they're also seeing kids already those 8 to 10 years later, right? But checking in on when they're going into high school. Do they have the right tools when they're going into middle school? You know, wellness is so key. And checking in with someone once a year would be a dream. We have done some advocacy at the state and federal level talking about why are we not having something beyond the pediatricians are doing a great job of us trying to assess and keep up with all of that. But it's beyond that sometimes. It's giving the tools as well that, you know, in psychology we can do.

And one of the beautiful programs that leads to that mental wellness we're doing here is called like Wise Girls. And it's giving these kids tools how to stand up for yourself, how to say no, right? Teenage girls learning how to say no. What a beautiful thing. Teenage girls learning how to stand up for themselves and friends and having positive self statements. Walking out with their chin up and feeling good about themselves. Those are the skills and I say girls, because we started with that population, but giving them the skills to face society and the rest of their life. I mean, how beautiful is that? Because you never know when mental illness is going to strike. Why not have the tools beforehand?

Host: Yeah. You really have been an amazing advocate for our community's children on behalf of us all. Thank you for that.

Last question. we've talked a lot sort of in generality about mental health in teens and young children. For those parents who are listening today or perhaps teenagers who are listening today, who do have children or themselves with significant issues, behavioral or mental health issues, whether it's anxiety or depression or other challenges, who may be feeling hopeless, who may be feeling lost, maybe you can end with some thoughts for those families or patients listening about what help is available and what their future holds.

Dr. Sara Rivero-Conil: Well, the first thing is, you're not alone. You're not alone. And we're here to help. Find that person that you trust and ask for help. You know, these podcasts are so important, because sometimes people want to help and don't know how to and that's why we gave a lot of tips today as to how to listen and communicate. But get the help, talk to a trusted individual. The school systems have wonderful counselors that can guide the path to get some support. But the most important thing is you're not alone and it's okay to not be okay. Let's get some help though.

Host: It's wonderful. Thank you. Sara, to you, to the rest of the psychology team at Nicklaus Children's, to your medical colleagues, the psychiatry team, thank you. You truly are heroes for our community's children in trying to improve their lives, making a difference for them and their parents in such a challenging area, particularly today. So on behalf of us all, thank you. It has really been a pleasure having you on the podcast today.

Dr. Sara Rivero-Conil: Thank you.

Host: Of course. This concludes this episode of For Peds Sake podcast. We've hoped you've learned some helpful tips from Dr. Rivero-Conil. We're all here to answer any additional questions through our psychology and psychiatry program. Make sure you stay tuned for the next episode. And we are excited to continue diving deep into the world of pediatric healthcare. Thank you.