Spotlight Series: Dr. Hilary M. Bowers, MD, FAAP

Discussing Behavioral and Mental Health Care Strategies with Pediatric Patients and Caregivers

Dr. Hilary M. Bowers, MD, FAAP is Director of Behavioral and Mental Health Services with Children’s Primary Care Medical Group, serving children and adolescents across San Diego and Riverside counties.

Families across California are struggling right now with change. Kids are out of school, parents are out of work, and people are spending more time at home. Throughout this uncertain time, learning how to deal with the stress of change is a challenge that I often talk about with my patients and their families. There are many specific tools for stress management we can share with our patients, which I discussed recently during an ACEs Aware webinar. There are simple ways to approach these topics with your pediatric patients and their caregivers to encourage success.

When discussing stress management strategies, I always start by reminding my patients that you can only make one to two changes per month for them to really stick. Often, caregivers want to start with a change they feel will have the most impact. Instead, I recommend starting with the easiest change they can make as a family or with their child.

What are things your patients can do anytime, anywhere? I like to think that we all carry an imaginary toolbox with us, and in a stressful moment we start pulling tools out of the box to address the situation. If a patient or caregiver’s only tool is to scream, yell, or punch a pillow, that won’t be as successful as having stress management techniques already in their toolbox.

Starting with small changes each month adds up, and next thing you know, your patients’ family has made a whole mountain of progress. One healthy change per month adds up to twelve improvements every year.

Once I’ve set these expectations of small and manageable changes, we can discuss the intent behind these changes. We are ultimately trying to foster resiliency in each child. We are trying to cultivate their own problem-solving skills. So, I tell my patients, “It’s really all about you as a caregiver, making your child feel seen and heard and being present for them.”

Research in children who have experienced ACEs shows that having even one supportive adult in their life gives them more resilience to get through challenges. Often as parents, we feel like we must find a solution for our child. However, pediatric patients, particularly teenagers, are usually not looking for a quick fix. What they want is a listening ear and to know that they are heard, loved, and cared for.

So, I tell my families, “Just listen and hear.” When their child comes to them, even if it’s during a busy or inopportune time, they should provide space to let their child talk. Often by asking reflective questions, the child will come up with their own solution to their challenge.

Every challenge and every problem must have a solution, but we help build resiliency by just allowing children to be seen and heard. When children understand that you can lend a listening ear, they know that the next time they have a challenge they will have a trusted adult who will be present for them.

As a provider, you can educate parents to model the behavior they want from their children. Children are always watching and learning from others, and the more caregivers model the behavior they want from their children, the more successful they will be. By naming their emotions, for example, saying, “I feel frustrated” during a busy mealtime, and demonstrating emotional regulation tools, their children will be able to start identifying and resolving what they’re also feeling. This can result in reduced stress for both child and caregiver.

The words “behavioral and mental health” can sound very scary and daunting to a general pediatrician in a busy practice, but discussing small changes and the importance of listening and responding to your child are simple things families can implement to help their child.

It’s important to know, for ourselves and our patients, that we are not in this alone. I often use a sports analogy and say, “We have a bench of people around us that support us. The child is in the middle and they have parents, caregivers, grandparents, extended family, and teachers.” Sometimes parents don’t have all the answers. That’s why they come to the pediatricians, counselors, and specialty care, who are also waiting on the bench for that child. When families are struggling, they can come to us to learn skills for expressing themselves in healthy, productive ways so that everyone can get what they need and be able to feel seen and heard.

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Learn more from Dr. Bowers in the ACEs Aware webinar “Regulating the Stress Response for Kids: Practical Tips for Primary Providers.”

Find more practical stress-busting tips for kids on the ACEs Aware blog.

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