Health & Fitness

Pediatrics: Helping Your Child Through ‘The Hard Stuff’

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Parents know a few things when it comes to their children’s health, but there’s plenty still to learn. Glean tips from local physicians as they cover the basics.

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If you’re a parent, you already know you’re supposed to feed your children nutritious meals and encourage them to exercise. But sometimes, helping your child live a healthy life can be more complicated.

How do you know if your child has a mental illness? How do you teach your child to cope with anger?

And what if your child is going through an “embarrassing” health problem, such as a lack of control over their bladder?

Pediatricians and pediatric specialists in our region can help parents and children navigate these issues.

Confronting Mental Illness

A routine doctor’s visit isn’t just about a patient’s physical health.

“Mental health illnesses are pretty common – we probably spend 10 to 15 percent of our days seeing kids or teens who have some sort of mental health diagnosis,” says Dr. Leah Farley, a pediatrician at Beloit Health System. “We see ADHD more often in the younger kids, and with teenagers we tend to see more anxiety and depression.”

Farley asks all of her teenage patients if they have concerns about their mental health. Sometimes, this may lead to a standardized questionnaire screening.

“I generally try to do counseling with both the parents and the patient in the room about warning signs of anxiety and depression,” Farley says. “One of the biggest things for parents to recognize is that these illnesses in teenagers may not always present as their child seeming particularly anxious or sad.”

In many instances, teens display decreased motivation, poor concentration or increased irritability. But warning signs vary case by case, which is why routine checkups with a pediatrician are important.

If a parent calls with concerns, Farley jumps into triage mode.

“If there’s any concern that the child has any sort of suicidal ideation, then we send them directly to the emergency department where they’ll be evaluated by a social worker or a psychologist to make sure the child is safe at home,” she says. “In the absence of suicidal ideation, generally what we’ll do is we’ll set up a visit for the parent to bring the child in so we can sort through the next steps.”

A diagnosis of depression or anxiety is based on criteria in the DSM (Diagnostic and Statistical Manual of Mental Disorders). Based on screening evaluations, Farley can usually fit a patient into a diagnosis. Sometimes, if the diagnosis is questionable, she’ll refer the patient onto further neuropsychiatric testing.

Treatment is case by case and depends on the severity of the illness. “It also depends on the child’s family and social structure,” Farley adds. “I always try and work with families to first do lifestyle modifications to help with mood.”

A common lifestyle modification is making sure the child is getting an appropriate amount of sleep, at least eight to 10 hours a night, without phones or TVs on in the background.

“The other thing we commonly see is kids who aren’t active enough,” Farley adds. “The more physical activity you get, the better it helps with mood. So, really try to make sure your kid is getting out, getting active, moving around, not spending all day on their phones or sitting around at school.”

She also talks with patients about healthy nutrition and self-soothing techniques like guided meditation or mindfulness. If lifestyle modifications aren’t able to counter the severity of a patient’s depression or anxiety, medication may be appropriate.

Farley always recommends therapy and medication concurrently. “With every patient I’m seeing who meets criteria for depression or anxiety, I really try to get them into therapy because they’re able to work on different behavioral techniques to help their mood and prevent this from resurfacing as an adult,” she says.

More than anything else, Farley encourages parents to talk openly with their kids and teenagers about mental health.

“The biggest thing is getting the whole family onboard with being committed to treatment because it does take time, there are multiple follow-up appointments, and you need to have everybody in the family working to help the child out,” she says.

Managing Childhood Anger

All parents have to deal with an angry child at some point. It’s inevitable; anger is a normal reaction in both children and adults. But teaching children how to appropriately respond to angry emotions is an ongoing process for parents – one of utmost importance.

“Angry, mad, irritated, frustrated, irate; we’ve all experienced these feelings,” says Dr. Adam Angelilli, a pediatrician at FHN. “The natural, instinctive survival response kicks in: flight, fight or freeze. What if we, as parents, can teach our children to overcome these instinctive reactions and choose more appropriate responses?”

Most of children’s behavior is learned from their environment, Angelilli adds. Therefore, it’s vital that adults teach children to communicate their emotions and cope with their feelings.

“Imagine the child’s perspective, from which they go through angry episodes without knowing how to describe what they are experiencing,” Angelilli says.

“When toddlers ‘throw tantrums’ they are usually experiencing these intense feelings and emotions without the means to communicate their feelings. Furthermore, they do not have coping skills to manage their emotions, so they quickly become frustrated.”

Angelilli advises parents to evaluate their child’s feelings.

Let your child know they are going through a difficult situation, and you are there to help them. Tell them their feelings/emotions are normal. Share instances in which you also experienced these feelings.

In addition, help to identify the feelings or emotions for your child. Give the emotions names, so your child can begin to tell you how they feel.

“Remember, they are just learning words and beginning to associate words and meanings,” Angelilli says.

Furthermore, encouraging your child to act with intention is a positive and important step.

“There are many constructive outlets for expression of emotions: art, music, dance, theater/acting, sports, writing stories or poems, or even just taking a walk,” Angelilli adds. “Personally, I tend to go toward music and/or sports.”

Angelilli has even employed these skills with his own son.

“As a parent, I told my son – about 3 years old at the time – that he could take a baseball bat and hit baseballs, take a golf club and hit golf balls, or kick a ball if/when he feels angry,” Angelilli says. “I also explained that it is absolutely unacceptable to use the bat or golf clubs to hurt people or destroy property. A few days later, he said, ‘Dad, you’re making me feel so angry that I feel like punching you in the face!’  My response was, ‘Thank you for using your words. Thank you for not punching me in the face. Now, let’s talk.’”

When children are taught to express and manage their emotions, they can overcome the survival instincts of violence, Angelilli adds.

“Children learn from observing and imitating behaviors. It is vital that we, as adults, set better examples for our children, especially if we want to see positive changes in our communities.”

Filling a Need in the Rockford Region

An estimated 13 million children in the United States suffer from a lack of control over urination or defecation, a condition known as incontinence. This common problem is just the beginning of what Dr. Patrick McKenna can treat as the director of pediatric urology at Mercyhealth Physician Clinic-Riverside.

“By far, the most common non-surgical problem we handle, especially in little girls, is voiding dysfunction,” McKenna says. “This includes a whole category of illnesses, the primary one being accidents during the day. Recurrent urinary tract infections are often associated with this.”

McKenna also performs complicated reconstructive surgeries; one of the most common is a procedure to correct hypospadias – a condition that occurs in roughly one out of every 200 male births. The urethral opening isn’t in the correct place, so surgical intervention is required.

To manage these problems (and many others) in patients in the Rockford area, McKenna and a team of medical professionals have created a program with three components.

First, the Midwest Mercy Center for Reconstruction is focused on urological surgeries. Second, the Antenatal Program manages urological problems detected in children before birth. Finally, the Continence Center focuses on non-surgical issues, such as incontinence.

“Those will be our three signature areas, but we’ll also take care of the more simple pediatric urology cases, too,” says McKenna, a recent addition to the Mercyhealth team. “This will be the sixth program that I’ve developed in my career. Because of my background growing up in a small town, I really like developing programs in communities that don’t normally have the tertiary level of care.”

McKenna estimates he will perform about 4,000 reconstructive operations to correct hypospadias throughout the course of his career. Comparing that to the 13 million children who suffer from incontinence, McKenna understands why he’s asked to speak nationally about incontinence much more frequently.

“It’s obvious it does have a bigger impact,” he says.

“And you can imagine that if you have a child in school and they have an accident and wet their clothing, it’s really quite embarrassing.”

McKenna has helped to develop a program that’s close to 100 percent effective in helping these children. In the past, children with incontinence used to take long-term anticholinergic medication, which didn’t really help, McKenna says. Many of these children also had debilitating recurring urinary tract infections.

“When I was early in my career, I used to do about 130 to 150 ureteral surgeries in children per year. With our program, we’ve wiped that out. I did zero last year,” McKenna adds.

Almost 25 years ago, McKenna went to a urology conference in Virginia. An orthopedic conference was happening at the same venue, so McKenna wandered over and wound up learning about computer games that could help children rehabilitate from sports injuries.

“I talked to an incredibly fascinating fellow – I think we talked for two hours, and no one came to his booth at all,” McKenna remembers. “No one had any interest in using his games in orthopedics. After we talked and talked, he finally said, ‘This is the last day I’ll be here. Do you have any use for my games?’”

McKenna took the computer games, but shoved them into a desk drawer since, at the time, he wasn’t really a believer in biofeedback (a process of learning to control some of your body’s functions). However, the games resurfaced when a resident doctor went to McKenna in search of a new research project.

“I told him ‘Well, I really don’t believe in biofeedback, but I have these games – why don’t we put together a biofeedback program?’” McKenna remembers. “Only 20 percent of the kids were getting better with medicine, anyways.”

The resident – Dr. Tony Herndon – completed an experiment with 60 children.

At first, McKenna didn’t believe the results.

“There was an 80 percent success rate with no medicine,” McKenna says. “You can image the amount of data I had him review again.”

But the research was sound. Since then, McKenna has refined the program with the help of a team. He ran the program in Connecticut for five years, Springfield, Ill., for 14 years, Madison, Wis., for six years, and now he’s moved on to Rockford.

“To be honest, we wiped out one of the biggest operations that pediatric urologists do, so it has a big financial impact, and it may impact whether other centers have a program, or else make it hard for them to cover the costs of the program,” McKenna says. “But I’ve always found it’s best to do the right thing. So, even though this has taken away one of my favorite operations, we have solved a lot of problems for children.”

The majority of the Continence Center is simply educating children and their parents. Then, based on non-invasive tests, McKenna and his team determine what treatment the child needs. A small percentage just need medicine. The majority need a biofeedback program, sometimes concurrently with medicine. A very small number of children need surgery.

“Biofeedback isn’t just the computer games – it’s 20 minutes of going over homework related to the education component, 20 minutes of teaching the children to control their abdominal and their pelvic floor muscles, and 20 minutes of computer games that help teach them how to relax their muscles when they void,” McKenna says. “Everyone focuses on the biofeedback, but the biofeedback is really just a small part of an entire program that we put together.”

For many patients, the Continence Center is a game changer, helping kids who haven’t had success elsewhere.

But McKenna’s excited about the entire program as a whole.

“I think we can run all three major programs; the reconstructive, the continence and the antenatal, and do them all at a very high level,” McKenna says.

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