Is the true heart of pediatrics found in the connection between practitioner and family?

In this powerful episode of Pediatric Meltdown, Dr. Lia Gaggino sits down with physician, educator, and hand-in-hand parenting advocate Dr. Pam Oatis, who brings decades of primary care and hospital experience to the forefront. Together, they explore how listening, humility, and authentic relationships transform patient outcomes far beyond medical treatments alone.

From the challenges of working in high-need communities to navigating tense family moments and exploring ethics in end-of-life care, this episode delves into the artistry that makes pediatric medicine so uniquely soul-filling. If you’ve ever questioned whether technical skill is enough—or wondered what truly heals—this conversation will invite you to see the science of medicine through the eyes of connection and compassion. Don’t miss the life-changing insights you’ll carry into every patient encounter.

Be sure to catch the special announcement in the Takeaways.

[0:01 - 07:59] Leaning Into Pediatrics: Beginnings, Inspiration, and Learning From Families

• Understand why primary care pediatrics is infinitely rewarding—not just for the broad medical knowledge it demands, but for the lifelong learning about people, relationships, and cultures it provides.
• Learn the importance of setting parents at ease through open-ended questions and authentic appreciation, establishing trust and safety from the very first visit.
• Explore how humility and willingness to learn from families reveal the limitations of one-size-fits-all approaches and fuel long-term, mutually respectful relationships.
• Hear personal stories illustrating the deep impact of simple listening skills, such as appreciating each parent and seeing profound transformation in both relationships and care outcomes.

[08:00 -16:40] The Power of Listening and Cultural Humility in Pediatric Care

• Uncover how being attuned to parents’ fears and self-doubt allows physicians to connect deeply, providing reassurance and support that transcends medical advice.
• Examine situations where cultural differences and past experiences inform parenting approaches, challenging providers to pause, listen, and reflect rather than judge.
• Appreciate how open, honest dialogue about discipline and race can lead to decades-long partnerships founded on mutual respect and understanding.
• Acknowledge that the wisdom and resilience of families, when honored, can lead to better outcomes than following protocols alone.

[16:41 - 26:01] Human Connection: Biology, Society, and the Foundation of Care

• Investigate the deep human need for connection, acknowledging our social wiring and the essential role that physical and emotional closeness play from birth through adulthood.
• Discover why the medical “team sport” approach leads to improved outcomes—not just for children, but for providers and families navigating medical complexity together.
• Identify the under-recognized burdens society places on parents and why framing parental challenges as cultural rather than personal failures empower families.
• Explore how respect, dignity, and honest collaboration form the backbone of effective care—and why accurate patient histories and trusting relationships matter as much as diagnostics.

[26:02 - 07:59] From Touch to Teamwork: Bioethics, Palliative Care, and Listening Partnerships

• Learn how physical touch is not just diagnostic, but profoundly healing, fostering trust and well-being in children and families.
• Understand the evolution of bioethics and palliative care as disciplines built on listening, respect, and honoring families’ definitions of meaning and...

Are you curious about what really happens behind the microphones of a successful pediatric podcast—and the unconventional journeys that brought an incredible team together?

In this special milestone episode of Pediatric Meltdown, host Lia brings her entire production and strategy team on-air for an unfiltered, dynamic conversation. Discover the circuitous career paths that shaped a jazz singer-turned-podcast producer, a teacher turned ADHD coach and social media strategist, and a web developer with a nomadic spirit.

Uncover the highs, lows, and learning curves of building a polished show from the inside out—including struggles with self-promotion, harnessing social media, and the mounting pressures (and joys) of creative collaboration.

If you've ever wondered what it takes to sustain a podcast for (close to) 250 episodes, or you’re searching for inspiration to pivot in your own career, this story of grit and reinvention will leave you rethinking what’s possible.

• The show’s launch was serendipitous, sparked by a leap of faith rather than a long-held ambition to podcast.
• Early challenges with off-shore podcast management led to seeking more control and expertise locally.
• The pivotal connection to a new producer happened via networking with Adam Schaeuble of Podcast Business School.
• The team shares first impressions and mutual support, setting the collaborative tone for the episode.

• Team members discuss how their entertainment, teaching, and customer service backgrounds unexpectedly prepared them for podcasting and digital media.
• D.R.’s “Mouthy Broad Media”company name was inspired by a personal family story, blending creativity with homage.
• The learning curve of audio, websites, and social strategy is highlighted as an ongoing, shared challenge.
• The importance of curiosity, open-mindedness, and adapting to unexpected opportunities is emphasized.

• Social media emerges as both an essential tool for growth and the greatest challenge for the host, who dislikes self-promotion.
• Each team member brings different comfort levels and tactics for tackling visibility and audience engagement.
• Discussion of burnout, professional transitions, and how the pandemic prompted new career directions.
• Strategies for supporting each other (and listeners) through ADHD, workflow experimentation, and honest dialogue about what works (or doesn’t).

• The team shares their current services: web design, social media strategy, podcast production, ADHD coaching, and consulting.
• Emphasis on collaboration (“it’s all right here”)—listeners are encouraged to reach out for services or to get started themselves.
• Honest reflections on the tricky pursuit of monetization and the value of creative fulfillment.
• Recommendations for further learning, including Colleen Cullinan’s ADHD series and Peter Jensen’s adult ADHD episode.

Resources Mentioned in the Episode:

D.R. Fay - MouthyBroadMedia.com

Margaret Faucella -

How do we help kids and teens when social media is fueling a resurgence of body image issues and eating disorders? In this special conversation, Lia’s daughter, Julia Parzyck shares her personal and professional journey navigating the tumultuous landscape of body acceptance in a world obsessed with appearance. The episode explores the influence of social media platforms, like TikTok and Instagram, and the impact they have on pediatric mental health and body positivity. Listeners will discover practical parenting strategies rooted in empathy, compassion, and my own past mistakes. Body acceptance is an ongoing journey, not a destination. Are we ready to support the next generation in building resilience against the ever-present pressures of body image issues?

• Explores how diet culture and body expectations have worsened for teenagers in the age of TikTok and “skinny talk,” surpassing early 2000s pressures.
• The proliferation of pro-eating disorder content, now openly accessible through social media, and how it’s masked as harmless tips.
• Contrasts curated body-positive environments with the harsher realities faced by today’s youth on unchecked platforms.
• Highlights the rise of the “skinny talk” hashtag/movement and its troubling normalization of disordered behaviors and comparison.

• Julia redefines “softness” as a source of strength, both in body and emotions, coining the phrase “soft body baddie” for her community.
• Childhood anecdotes—ranging from fashion flair to forming the hilariously named "labia band"—remind listeners of the roots of self-expression.
• Explores how embracing personal quirks and struggles, like anxiety and neurodivergence, leads to greater empathy in work with children and coaching.
• Reflects on how family dynamics and navigating outspoken personalities shape resilience, communication, and mutual growth.

• Discusses the transformative impact of family therapy, learning emotional independence, and accepting that parents can’t always “fix” pain.
• Julia’s journey through heartbreak (a called-off wedding) reveals the non-linear, ongoing process of healing and redefining self-worth.
• Explores the leap of faith required to pursue a career in body-positive coaching and online content, with all its uncertainties.
• Highlights the value of embracing risk, letting go of the need to “do it all over,” and recognizing how adversity can fuel growth and new purpose.

• Shares insights on how political landscapes influence fashion, body ideals, and the subtle ways women are controlled through image and expectation.
• Resist setting rigid future goals, focus instead on finding joy, balance, and meaning in work and life, post-trauma.
• Stresses that body image work is lifelong, and that society will likely never “fix” its obsessions—progress is about grace, not perfection.
• Leaves listeners with the message that taking up space, nurturing empathy, and living for personal fulfillment, not external approval, is an act of quiet revolution.

Connect with Julia Parzyck

Instagram: Fit Fat and All That

Here are some more episodes you may...

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,...