I recently connected with Dr. Nerissa Bauer, a wonderful behavioral pediatrician. While pediatricians offer general primary care services to children, behavioral pediatricians assist in specific difficulties, struggles, or deficiencies in the growth and development of a child. I asked her to share how you can work with a behavioral pediatrician when you have concerns about your child.
Strategies to partner with your child’s doctor about ADHD and behavior concerns
What should I do if I have concerns about my child’s behavior?
It is essential to keep calm when your child has a meltdown or tantrum or acts in a way that causes conflict and strain within the family. It can feel overwhelming and stressful, especially if the behaviors are happening in public, cause teachers or daycare providers to call parents while at work, or lead to suspensions.
The important thing to remember is that your child’s doctor should be considered when reaching out for help. Pediatricians and family physicians are trained to look at patterns of what is happening in the context of your child’s developmental age and other factors that can help explain why a behavior is happening in the first place. One of the critical things to remember is that a “behavior” signals something else going on—whether due to an underlying physical, developmental, or emotional issue. Your child’s doctor can help uncover more clues as to the WHY of the behavior.
What are some key points to tell my child’s doctor?
When you are preparing to see your child’s doctor, gathering some important information can be helpful. It is common for doctor’s appointments to be brief (15 to 30 minutes). Many parents may feel uncertain about what to focus on or how to convey how their child’s behavior has impacted the family and their concerns.
Here are some key points to remember when gathering information for your appointment:
- When did the behavior start, and how long has it been happening?
- Notice clues as to what triggers the behavior. Is your child hungry or tired? Does the behavior only occur in one setting or across settings such as home and school? Does it reliably occur between siblings or peers, or does it seem to happen with certain adults?
- What has helped and not helped when responding to the behavior? Your child’s doctor will want to know how you usually handle the behavior and whether it has helped.
- Consider whether there have been any recent stressors or changes to your daily routine.
- Child behavior can be affected by conditions that may run in families and things that have happened in their environment. Your child’s doctor will likely ask you about any behavioral and mental health conditions that may affect you or relatives but also ask more in-depth questions about any adverse childhood experiences (ACEs) that might have been scary, worrisome, or traumatic.
- Print out copies of emails or texts from teachers or daycare providers if they have reached out to you about concerning behaviors
- Talk to your partner or other adults who help care for your child to see if they have any other observations or stories to share. Helping your child’s doctor understand the context of what was happening when the behaviors occurred can give critical insight into the underlying reasons for the behavior.
- How is the behavior impacting your child, you, the family, and their self-esteem?
- This is probably the most important tidbit of information to share with your child’s doctor. While it can take some time to discover the underlying reason for your child’s behavior, knowing how you and your child are faring can lead to more immediate emotional support.
What are Adverse Childhood Experiences (ACEs), and why is it important to talk about them?
Life is full of ups and downs. Adverse childhood experiences or ACEs are events that happen and can be unpredictable, traumatic, and can affect child behavior. There are ten categories of ACEs which include physical, emotional, and sexual abuse, neglect, parental mental illness, exposure to domestic violence, and parental separation and divorce. These categories originated from the landmark study first reported by Drs. Anda and Felitti found associations between childhood experiences and later physical and emotional health problems. Other experiences such as community violence and racism are also important considerations that can affect how a child and family function daily. Science has shown that when children experience ACEs, it can lead to stress or “toxic stress,” especially if these events happen over a period of time. Toxic stress activates the body’s stress-response system and can lead to physiologic changes in the body and brain. Your child’s doctor may ask about ACEs or conditions affecting your family and why they may suggest other referrals to help ease family stress. For instance, your child’s doctor may sometimes recommend other supports such as parenting support, food pantries, or housing assistance if needed.
The good news is that while ACEs and toxic stress are important to identify early, science has also shown us that children fare better when they have access to safe, secure, and nurturing relationships and positive childhood experiences. These things act to “buffer” the hardships and help build resilience. Your child’s doctor may also assist with parenting techniques or make referrals to coaches or therapists.
After talking to my child’s doctor, what are the next steps?
After a careful history and review of any documentation brought in by the family, your child’s doctor may want to get more information from teachers or daycare providers by passing along additional screening forms. These forms help gather more information about the frequency, severity, and impact of your child’s behavior from their point of view. Sometimes a referral is made to other specialists who might order more tests or other community providers who can begin to work with you and your child on key coping skills.
If your child’s doctor should make a referral, it is important to understand whom they are referring you to and their role on the team. It is also important to understand what happens after the referral is made and to report back to your child’s doctor if there are challenges to connecting to the referral source, as they can help ensure forward momentum.
Knowing that when your child acts out or is struggling, you do not have to face these challenges alone is important. It can be stressful and isolating; however, your child’s doctor is a dependable professional who can be an integral part of your support team.
Dr. Nerissa Bauer is a behavioral pediatrician and entrepreneur in Carmel, Indiana. She left academia in December 2018 after burnout. She has a part-time behavioral health practice. She created TEACH ME ADHD, an online course for families, and is the host of the Let’s Talk Kids Health LIVE show on behavioral health & parenting, and CEO of Let’s Talk Kids Health, LLC. She is also a spokesperson for the American Academy of Pediatrics. For more information, go to her website: https://www.letstalkkidshealth.org