← The Pediatrician Next Door - Simple Advice on Parenting and Family Health
The Pediatrician Next Door - Simple Advice on Parenting and Family Health
Ep. 119: When Kids Worry: What’s Normal and What You Can Do – with Juila Krankl, MD
00:25:55
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- [00:00]
Dr. Wendy Hunter
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- [02:56]
Dr. Julia Krenkel
Yeah, I think the biggest misconception is that there's Anxiety disorders, and that's it. So either you don't have anxiety at all or you have an anxiety disorder. And I think it's really important to normalize the idea that every single human being has anxiety. It's a normal part of the human condition. And we need anxiety. Anxiety is there to protect us. Right. So anxiety is something that is biologically wired in us to help us anticipate problems in the future and respond to them skillfully. So if we're experiencing anxiety rather than viewing it as a problem, we can say, okay, what is my anxiety trying to call my attention to? Right. And so then we can use it as an opportunity. Right. We can use it as an opportunity to try to figure out what action can we take to resolve this thing that we're worried about. Right. So I view all anxiety as an opportunity until when it gets to a level of a disorder is when it's excessive or it's impairing someone's ability to function. Right. So when we call it a disorder, it's not just that you have anxiety, because everyone has anxiety. It's when it starts to interrupt their daily functioning.
- [04:12]
Dr. Wendy Hunter
Yeah. So the most common things I experience, and maybe you can comment on these, is parents bring their kids to me, I'm a pediatrician for either not being able to fall asleep, not being able to stay asleep, or not being able to go to school because they're just too anxious. So those are the places that I see it interfere with kids often. And so you're right. Like, it's not. Well, it is kind of a disorder at that point. But reframing that or, you know, parent will say, well, he's not anxious. Like, well, but he is. So where do we go from there?
- [04:42]
Dr. Julia Krenkel
Yeah, I mean, I think stigma is fading, but it's still there. You know, a lot of times it's hard for us to admit that some of our difficulties maybe are coming from a mental health place. Right. So I think, you know, as doctors, it's our job to be really gentle with people and meet them where they are. And I think what's hard with kids is kids, oftentimes they feel their anxiety physically, which is normal, by the way. So it's normal for us to feel anxiety in our gut before we feel it in our brain. And our language actually demonstrates that. So, for example, when we say we have butterflies in our stomach, whether it be that we're excited or nervous, where is that coming from? We know that we have more serotonin receptors in our gut than in our brain or we have a big presentation that we're doing and a lot of times that means we gotta run to the bathroom a couple times, you know, before that presentation. So it's normal to feel anxiety in our gut or in, you know, the form of muscle tension or not being able to sleep. That's just a normal thing that happens. It's all in kind of our interpretation of it. Right. So if we interpret that as a threat, we're going to. Our anxiety is going to build. You know, when we say I'm having all these gastrointestinal symptoms, something must be really wrong. That's our interpretation of it. And you kind of touched on this earlier. The sense that our creative minds can get us in trouble. Right. Because humans were naturally creative and we can come up with all these different storylines to explain what we're experiencing. And kids are really good at this because kids are really creative. So those storylines can get us in trouble and they can also help us. So if we say, my stomach is upset, therefore something is really wrong, then we're going to say, I can't go to school today because, you know, I'm really sick. I can't, I can't do that. If instead we say, oh, huh, I'm feeling some butterflies in my stomach. I wonder if I'm feeling a little nervous. Why might I be feeling a little nervous? Oh, that's right. I've got that big, you know, I have to present my topic today in class. Oh, no wonder I'm anxious. Maybe I can go for a short walk or I can do a small meditation. Maybe that will calm down my nerves and I'm going to be able to, you know, make it to school today.
- [06:59]
Dr. Wendy Hunter
Yeah, it's really easy when you say that, I'm like, oh, yeah, that makes perfect sense. But then if I'm a parent first, how do you recognize that that's what's going on? And then I want to talk about where can you get help because we need you. Like, it's really hard for a parent or for like a nine year old to do that kind of great self talk. So. Well, how can a parent recognize that's what's going on? Because they're going to fall into the same trap of like, oh yeah, my kid definitely has something wrong with their stomach.
- [07:27]
Dr. Julia Krenkel
Yeah. I mean, and by the way, that's a fair thing to think about when it first starts to happen. Right. And that's fair. And they should go talk with.
- [07:34]
Dr. Wendy Hunter
Do they have an appendicitis?
- [07:36]
Dr. Julia Krenkel
Exactly. So we don't want to Ignore our body symptoms, Right. But over time, when we start to see the patterns, I think it's about that pattern recognition is like, oh, I tend to notice that this happens more when X, Y or Z is also happening. Right. So I think this is probably not what people want to hear, but step one as a parent is to be in tune with your own body and your own reactions to stress. Because it's going to be really hard for us as parents to help our children if we don't even recognize it in ourselves.
- [08:07]
Dr. Wendy Hunter
100%. Yes.
- [08:09]
Dr. Julia Krenkel
That's always step one when it comes to our kids struggling. Right. So I think step one is recognizing that in yourself, and then you're going to be better able to help with your kid with it. So. And naming that out loud, I think is really helpful. Like, let me give an example. So a lot of times when we get a GI bug, you know, we get food poisoning or something like that, a lot of us tend to get dysphoric. And when I say dysphoric, I mean just our thinking becomes very negative, right? I am one of these people. So when I get a gi, if I'm throwing up, I tend to get very dysphoric. And I. I didn't recognize that when I was younger, but now that I'm older, I recognize that. And one way that I can help my kids in the future is by acknowledging that when it's happening, right? To say, like, I have a GI bug and I'm, you know, just really not thinking in a very positive way today, or I'm in a really bad mood, and I think the two things are related, right? So I can verbalize that to my kids. That gives them permission to do the same when they're experiencing a similar symptom. Or, for example, when I get headaches, you know, oh, I have a headache today. I wonder what's going on. I wonder if I'm under a lot of stress right now. Oh, yeah, I had this big project at work or I had this other thing going on. Haven't been sleeping as well, like, okay, so maybe to try to reduce the chance that I continue to have headaches, maybe I can try X, Y or Z, right? So when I name it for myself, I give my kids permission to name it themselves. And it takes away that shame. Because a lot of times, too, the trap that I think a lot of people get into, and I'm sure you see this in your practice, is people feel like doctors are really dismissive about saying, oh, it's all in your head.
- [09:57]
Dr. Wendy Hunter
Right, Absolutely.
- [09:58]
Dr. Julia Krenkel
It's like almost becomes a battle between like, no, it's not all in my head. This is a real thing. And so I think the other thing that really helps is acknowledging that there's a bi directional relationship between physical symptoms and mental health symptoms. Meaning the more mental health symptoms we have, the more likely we are to have physical symptoms. And the more physical symptoms we have, the more likely we are to have mental health symptoms. And to take away the shame of regardless of where it's coming from, it's all of those options are okay. Right. And so to say, like, if it comes down to like maybe this symptom is coming from a mental health place, like that's okay. And that's no less valid or real than if it's coming from a physical health place. And those physical symptoms that that person is having, that child or adult is having, those are real symptoms. They're not making it up. It's not in their head. They really, truly are experiencing those symptoms. And it just might be that the solution is different than they thought it was going to be. Another thing I would recommend for someone who's having a lot of physical symptoms or a child would be to do body scans. I don't know if you're familiar with doing body scans.
- [11:08]
Dr. Wendy Hunter
Oh, yeah, I just recommended that to a five year old to do a.
- [11:11]
Dr. Julia Krenkel
Bedtime with her mom. Yes, yes. So my kids really like doing that, which is the simple thing that you can do is you start at the top of your head and go all the way down to your toes, paying attention to each part of your body, how your head feels, how your ears feel, you know, how your eyes feel and kind of practicing. Another thing is progressive muscle relaxation. So the idea of like actively tensing and then relaxing your muscles. And kids really like this because it feels like something physical they can do. And what it also does is it calls attention to where we hold tension because everyone holds tension in a different place, including children. Right. Whether that's stomach or head or muscles, wherever it might be, jaw. And so body scans can really help kids get in tune with their body. Like what is your body feeling right now in a non judgmental way?
- [12:03]
Dr. Wendy Hunter
Yeah. I had a 4 year old, just turned 5 this week who I saw in clinic. And the big problem was that she just cannot wind down at bedtime and just escalates because she doesn't have the skill to figure out how to wind down. And so I introduced this concept and mom started it and a day later everything is completely different.
- [12:22]
Dr. Julia Krenkel
Wow.
- [12:22]
Dr. Wendy Hunter
So they've just continued. Now, yeah, the girl's asking how many days of time. It's so easy, so easy to do. If you've ever found yourself making repeat visits to the doctor, trying to figure out why your child has chronic stomach aches, headaches, or they're having trouble sleeping, you're not alone. As we've been discussing, anxiety and depression in kids often shows up in the body before we ever hear them say something like I feel anxious. And that makes it really hard because as parents, we want to rule out every medical concern first. And we should. But once we've done that, it's worth stepping back and asking, could this be emotional? Dr. Krenkel shared a few strategies that can make a real difference at home. One simple but powerful one it's progressive muscle relaxation. That's a great calming bedtime routine to do with your child. It's like a wind down for the body and the brain. And here's another reminder. Pay attention to your own body. Kids are incredibly tuned into us and sometimes they just mirror the stress that they see in US. Dr. Krinkel recommends the book it's not all in your head. I'll put it in the show notes. It's a helpful resource for anyone trying to understand the mind body connection, especially when worry starts to to take over. We'll be right back with more tips.
- [13:54]
Dr. Julia Krenkel
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- [14:11]
Dr. Wendy Hunter
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- [14:14]
Dr. Julia Krenkel
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- [14:24]
Dr. Wendy Hunter
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- [14:33]
Dr. Julia Krenkel
Like.
- [14:36]
Dr. Wendy Hunter
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- [14:57]
Dr. Julia Krenkel
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- [15:02]
Dr. Wendy Hunter
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- [15:04]
Dr. Julia Krenkel
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- [15:07]
Dr. Wendy Hunter
But it turns out that's very illegal. So there goes my big idea for the commercial. Give it a try@mintmobile.com Switch upfront payment of $45 for three month plan equivalent to $15 per month required new customer offer for first three months only. Speed slow after 35 gigabytes of networks busy taxes and fees extra see mintmobile.com We've been talking about how anxiety can change, show up in unexpected ways in kids. And now we're going to discuss the other key pieces of the puzzle that help regulate mood. What is one of the biggest? It's sleep. Dr. Krenkel and I talked about why sleep is so critical for emotional balance and what sleep hygiene actually means. Let's get back to our conversation. Can we talk more about sleep? We really haven't touched on that a lot, but what role does sleep play? Play in regulating mood?
- [16:01]
Dr. Julia Krenkel
Huge role. So again, what research is now showing, which is really interesting, I thought you.
- [16:06]
Dr. Wendy Hunter
Were going to say. No, nothing. It's really no big deal.
- [16:08]
Dr. Julia Krenkel
No, nothing. No, no, it doesn't matter.
- [16:09]
Dr. Wendy Hunter
Just sleep.
- [16:10]
Dr. Julia Krenkel
Just sleep two hours a night, you'll be fine. Yeah. So I mean, sleep is our chance to reset. Right. And so there's so many mysteries still around sleep. But I like to think at the most fundamental level, you know, if your computer is on the fritz, if you restart it, then usually it gets better. Right?
- [16:28]
Dr. Wendy Hunter
That's a great analogy.
- [16:29]
Dr. Julia Krenkel
Yeah. So sleep is the same way. So if we get the amount of sleep, a good quality sleep, it helps us reset and it's really important for maximizing the functioning of our brain. Right. Our brain uses up a lot of calories and a lot of energy and we need to make sure it has some time to rest. So sleep is super important. And it's kind of interesting because a lot of research is now coming out about different medications and how do different medications work. And we're finding a lot of medications that we've been using for a really long time that one of the reasons why they work is by improving sleep.
- [17:07]
Dr. Wendy Hunter
Which medications are you talking about? Like anxiety, depression medications or sleep medications?
- [17:12]
Dr. Julia Krenkel
So one medication that we prescribe sometimes is called Mirtazapine. It's a medication that helps with depression, anxiety and sleep. And what we find is, you know, most antidepressants take a while to kick in because they're trying to kind of maximize the amount of serotonin that our brains see. But that takes a while. Cause our brains are smart and they're like, wait, hold on, what's going on? And it takes our brains a little while to reset, but mirtazapine tends to kick in faster. And the question is well, why is that? And there's some research that's showing that part of the reason why it works faster is because it, it is sedating and so it helps get sleep on track quickly. So for someone who's depressed or someone who's anxious, if you can get them sleeping, you can see improvements in their symptoms more quickly. Or like the old school antidepressants that we don't use as much anymore, but they're called TCAs or tricyclic antidepressants. They tend to be sedating too. And so the question is, well, you know, why are they helpful? One of the reasons why is because they help get sleep back on track. Right?
- [18:17]
Dr. Wendy Hunter
Yeah, that's fascinating.
- [18:18]
Dr. Julia Krenkel
Right. So we can use medications to help us sleep, but there are so many non medication approaches that we can use to help us sleep too. And so it's hard when you're in that cycle of not sleeping because then we tend to have what we call anxious ruminations about not sleeping. So you're not only anxious that you're not sleeping in the moment, but you're anxious during the day that you're not going to sleep tonight. Or you're anxious when you lay down, like, oh, is it going to be another hard night tonight? Am I going to have trouble falling asleep tonight? Night. So those anxious ruminations tend to get us in trouble. That's where mindfulness comes in. Right. Bring us back to the present moment. That's where those body scans, gratitude, progressive muscle relaxation, all those things can help us stay focused on the present moment so that we're not getting into that downward spiral of anxious ruminations. Kind of the most evidence based strategy for improving sleep for people who have insomnia is called cognitive behavioral therapy for insomnia. And it's based on a type of therapy that we is probably the most popular for anxiety, cognitive behavioral therapy or cbt. But then it is adapted it specifically for insomnia.
- [19:26]
Dr. Wendy Hunter
Oh my God, I wish I had known about this. Sorry to interrupt. I have a couple patients. This would have been so helpful.
- [19:33]
Dr. Julia Krenkel
Yeah, yeah it is. The Calm app doesn't necessarily have a CBT for insomnia program, but they have a series called the seven Days of Sleep which I recommend. It's usually it's about 10 to 15 minutes each day and it's kind of giving you some cognitive behavioral therapy for insomnia and sleep hygiene tips. So what is sleep hygiene? Because that's a very important part of getting good sleep.
- [19:55]
Dr. Wendy Hunter
Yeah. What is sleep hygiene? So we talk about it all the time. In medicine, yeah.
- [19:59]
Dr. Julia Krenkel
So just like we have hygiene for our teeth, you know, we need to brush and floss our teeth. It's important for us to have hygiene for our sleep. So our ancestors naturally had this. So oftentimes when I think about sleep hygiene, I just think about kind of putting ourselves into habits that our ancestors didn't need to think about. So our ancestors didn't have electric light, like, you know, electricity. Naturally, as the day went on and the sun set, it started to get darker and darker and darker. Right. That releases melatonin in our brain naturally. So a lot of people take melatonin over the counter, Right? But melatonin is naturally released in our brain as it gets dark outside. So when we're indoors and we have all of these lights on in our house, or if we're using screens which emit blue light, we are blocking our brain's ability to release melatonin. So one of the things that we want to do with sleep hygiene is be in a progressively darker environment in the evenings. So I like to turn down the lights in our house so that it's kind of dim lighting or candlelight lighting, you know, as you get close to bedtime. And by the way, I don't mean actually have candlelights, I just mean it's that dim light that you have. And that really is gonna help our brains do its job. Right. Our brain's job is to release melatonin, which helps our brains go to sleep. That's a big part of it. Another thing is kind of having a wind down routine. So we don't wanna be at practice till 8:30 at night, and bedtime is 8:45. Our brains need time to go from intense activity to bedtime. So not doing our homework till, you know, two minutes before bedtime or not watching a really engaging show right before bedtime. Really, we don't want to exercise right before bedtime if possible. Although I'll take any exercise I can get. So this idea of kind of having like a cool down period, maybe of about 30 minutes leading up to bedtime, and then having access to like exposure to sunlight. The same way we want to have less and less lights leading up to bedtime, we want to have sunshine in the morning because it helps regulate our circadian rhythm, which is our internal clock that tells us to sleep. Right? And then probably another really, really important thing, which really hard to do, is to have our bedrooms be reserved for sleep for our kids. So ideally, our kids wouldn't have screens in their bedrooms and they wouldn't do their homework in their bedrooms because it's too stimulating. So that's hard because as parents, we need to set the example. So if we want our kids not to do those things, that means we gotta not do those things in our bedrooms as well. And that way our brain associates our bed with sleep, and it associates our bedroom with sleep. If that's not possible because of the configuration of someone's house, then even just having a desk that a child will work at, versus a lot of kids tend to do their homework in bed or do things in bed. And it's like, you got to get out of your bed because otherwise your brain starts to associate it with being awake. So those are just a few sleep hygiene techniques. I have a whole list in the book, and they're readily accessible online too. If you google sleep hygiene, you're going to find a ton of really great resources. But the idea of, like, us giving our brains the best chance to fall asleep at night is really important.
- [23:13]
Dr. Wendy Hunter
You know, we talk a lot about gratitude journaling, and I find families and myself, like, that's just not gonna happen. But I think there's a family maybe that told me they have a jar and they write a slip of, I don't know, something like that. Do you have any tips on how to incorporate that into the family?
- [23:27]
Dr. Julia Krenkel
Yeah, a lot of families like to have a jar where, like, again, maybe at dinner time. And just for us, we eat family dinner every night. So it's like the time that we all come together. So it's a good opportunity. But you could even a gratitude jar somewhere prominent in your house, and you have like little slips of paper and then you just write something you're grateful for. You put it into the jar. When the jar gets filled, then you can go around in a group and read out those things that you're grateful for. So it's like acknowledging the gratitude in the moment and then having an opportunity to come back. Especially on a hard day, if you're having a really tough day and everything's not going your way, or you have a difficult loss or a difficult failure. Bringing back those, oh, look at, in the past month, look at how many things I've been grateful for. That can be really powerful for kids and adults.
- [24:17]
Dr. Wendy Hunter
Gratitude, it's one more powerful tool for supporting kids mental health. It doesn't have to be complicated. Encourage your child to say thank you. Not just for gifts, but for things like, you know, thanks for coming to my game, thanks for helping me with my project. Even better, have them write thank you notes. We don't do that anymore. It's a simple way to remind them and us that we're not alone. There are people in our corner, there are people who want to give us things, there are people who think about us and we're grateful. And speaking of gratitude, thank you. I'm so grateful for you to listen to this, for caring about your kids emotional well being and for being part of this community. For more from the Pediatrician Next door, find me on the web@ pediatriciannextdoorpodcast.com if you've got a question about the weird things kids do, send an email to hellopediatriciannextdoorpodcast.com for a chance to hear your voice on the show. I'm Dr. Wendy Hunter and I'm the Pediatrician next door. This show is produced by Red Rock Music. Make sure to subscribe and leave a review where it wherever it is you're listening. I'll be back next time with more. You say you'll never join the Navy, that living on a submarine would be too hard.
- [25:41]
Dr. Julia Krenkel
You'd never power a whole ship with nuclear energy, never bring a patient back.
- [25:46]
Dr. Wendy Hunter
To life.
- [25:49]
Dr. Julia Krenkel
Or play the national anthem for a sold out crowd.
- [25:54]
Dr. Wendy Hunter
Joining the Navy sounds crazy. Saying never actually is. Start your journey@navy.com America's Navy forged by the Sea Support for this podcast and the following message comes from America's Navy the Navy offers new graduates hands on training and experience in careers like computer.
- [26:14]
Dr. Julia Krenkel
Science, aviation and medicine, plus education and sign on bonuses. Parents help your grads start their career today@navy.com.