You're listening to Voices of Your Village. This is episode 154 in this episode. Dr. Smita Malhotra, a pediatrician, and I got to dive into building resiliency in kiddos. What a year for building resiliency. I feel like we've all had so much practice over the last year and as we head into 2021 here, I want to look at how do we take challenges from "I didn't get the cup I wanted" or "I'm frustrated as I'm trying to do my schoolwork" to "I can't see my friends or go to school in the way that I used to", how do we take those things and navigate them and work through them and come out the other side resilient. Dr. Smita has a practice in California, and she's doing this work that I believe so deeply in where she's bringing other disciplines into the practice. From pediatricians to occupational therapists and speech language pathologists and developmental specialists bringing everyone in house and looking at how do we call on other disciplines to support parents and caregivers and kiddos on this journey. I loved getting to chat with her and I'm so excited to share this interview with you. Before we dive in let's chat about this membership. I am so jazzed. We have a brand new Village Membership going live on January 22nd. In the membership, you will get access to Tiny Humans Big Emotions and our re-parenting class and then you'll get access to our team with more support tools and resources to actually implement this work. Do it every day. We wanted to create a space where we could guide you through the courses and what it looks like in everyday life to do this work. To re-parent ourselves, to rewrite those narratives and that social programming that comes from our childhood and show up with intention with the tiny humans to raise emotionally intelligent humans. Our membership platform is the way to go here. Our team is pouring so many tools and resources and support into this a space where you get to come and ask your biggest questions on this journey and for us to guide you along the way. The membership goes live on Friday the 22nd so mark your calendar. We are only opening the cart for the membership for a limited time and then it will be closed. So now is the time! If you want to learn more about the village membership, make sure you're following along over on Instagram at @seed.and.sew and feel free to shoot us an email: [email protected], I would love to hear from you. Hear your biggest questions and make sure you are ready to go on January 22nd. This is such a dream come true for me, and I'm so so jazzed to bring this your way. All right folks. Let's dive in!
Welcome to Voices of Your Village, a place where parents, caregivers, teachers and experts come to support one and other on this wild ride of raising Tiny Humans. We combine decades of experience with the latest research to create the modern parenting village. Let's dive into honest conversation about real parenting challenges, so it doesn't have to be this hard. I'm your host, sleep consultant, child development specialist and passionate feminist, Alyssa Blast Campbell.
It feels so intense to be on this journey and feel like there's so much work to do and maybe you're bringing things from your own childhood or maybe co-parenting is a challenge and you're trying to figure out how to navigate that. Maybe at each age and stage you are like, "wait Alyssa, how do I do this? This new thing is coming up and I need support." As folks were coming into our Tiny Humans Big Emotions and re-parenting courses, I found myself wanting to guide them through the courses. So not just give you the information but walk you through step-by-step how to implement this in everyday life. You wanted a comprehensive space where we could continue to pour in resources and have bonus webinars and workshops and give you the opportunity to connect not just with our team, but with other folks who are doing this work to who have committed to raising emotionally intelligent humans and want to walk alongside you in this journey. So, I was dreaming about this and I realized we can make it happen. I'm so excited about our village membership program where we're going to be walking you through this work; a space where you get to bring your biggest questions. As our social media grew it just became too much for me to do in DM's and in messages and I wanted to create a spot where my whole team can pour into you; where I can show up live and walk alongside you. We're dreaming up so many fun ways to support you inside the membership and some exclusive deals for our members. The membership sign-up goes live on January 22nd, so mark your calendars. The sign up will be open for less than two weeks. So reach out send us an email: [email protected] or come on over to Instagram and ask your questions; let's dive into this. We want to make sure you are ready to go when signups launch so that you don't miss out on this opportunity. I want to support you in doing this work every day. Mark your calendar for January 22nd to dive into community in our Village Membership: the space that I'm really excited to be able to raise my tiny human in. January 22nd: mark your calendar now!
Hey everyone, welcome back to Voices of Your Village! Today, I'm here with Dr. Smita Malhotra and you are a pediatrician, yeah? For, like, 10 years?
00:06:52 Dr. Smita Malhotra
Yeah for longer than 10 years. Yeah. I can't believe it!
Awesome and a mom of two?
00:06:59 Dr. Smita Malhotra
Yes, six and three years old--
and I stalked your Instagram and they're really adorable.
00:07:05 Dr. Smita Malhotra
Oh, thank you! They're beautiful mixed black and Indian babies. I called them "blindians" so--
They are gorgeous! Can you share a bit with our village about, kind of, what brought you into this work?
00:07:21 Dr. Smita Malhotra
Yeah sure! So, my name is Smita Malhotra, as you said. I'm a mom of two, six and three year old daughters, they're beautiful. I'm a pediatrician in Los Angeles, and I've been a pediatrician for about 12 years now, and currently I run a program for Los Angeles County that helps children who are experiencing trauma and helps their families to build resilience for their children. And so, I mean, I've always wanted to be a pediatrician, you know, I came into this work, I think, understanding my own childhood. I realized how impactful childhood can be even though it's short. It's very impactful and can last for a lifetime. And so I knew that if I wanted to first of all go into medicine and impact a person's life, I needed to start in childhood. So I knew I was going to do pediatrics when I even started medical school. It was just innate in me. But to be honest, I did not discover my true passion for Pediatrics until two years after I finished my residency training. So in 2010, and that was when I discovered the work of Dr. Vincent Felitti. Are you familiar with his work?
00:08:41 Dr. Smita Malhotra
Okay, so Dr. Vincent Felitti, he's an adult doctor, and in 1998 he published this study in the American Journal of Preventive Medicine and he surveyed more than 17,000 adults about their history of exposure to childhood traumas. So abuse, neglect, family dysfunction and he called these adverse childhood experiences or "ACEs".
Ah okay, yeah. That was actually my question when you said you were working in LA in the program you are working on, I was like "ooh aren't you're working with kids with a number of Aces?"
00:09:15 Dr. Smita Malhotra
Yes. Yeah. Yes. So I'm very proud of Los Angeles County because we've actually really had a campaign to bring ACEs into healthcare and addressing ACEs in healthcare. And so what Dr. Vincent Felitti did is that he asked these 17,000, more than 17,000 adults about their history of exposure to ACEs, adverse childhood experiences. And he developed a scoring system for them. So, you know, he asked about their history. There were like seven ACEs that he came up with at that time as you can understand now, there's like many more, but what he found in his study is that there was a clear relationship between high ACE scores and poor health outcomes as adults. So for example, you know a child who had an ACE score of four, or I mean an adult who had an a score of 4 or greater, is two times greater risk for developing, you know, things like pulmonary disease or liver disease than a person with an ACE score of 0 and so what that showed me is that emotional trauma in children can translate into physical health ailments as adults and you know, what Dr. Felitti taught me is that what we see in adult medicine is a result of what was present but not seen in pediatrics. And so that really changed the trajectory of my whole career. So what I discovered after reading about this study and learning about Dr. Felitti, is that a multitude of the diagnosis I was seeing in pediatrics were actually misdiagnosis of trauma. And so I saw all of these children now with this new trauma lens on and it just changed my career and I actually quit the job I was in to change the direction I was going. And back then, you know the medical system, you know, was overwhelmed, you know, we're seeing patients every ten to 15 minutes. No pediatrician has time to like uncover, like, what happened in your childhood and, you know, like they were just not ready for this. Like now we're going to screen for this and what do I do after I screen for that, you know, so it just it took many many years, but here we are, Los Angeles County has now developed a whole system of now screening for ACEs and developing our response to ACEs. And I think that has really shaped what I do now and you know, I'm thankful to Dr. Felitti for that study and many subsequent other studies that came after that.
Yeah, that's awesome. So I'm fascinated by ACEs, I think, similarly, I was working in early childhood and realized, like, so much of this comes back to emotional development. Oh wait, like all of this comes back to emotional development and kept making these connections and ended up leaving my classroom to do this. We're very relatable. And so cool that you're in a state, I mean, California is leading the nation on this work in ACEs and the only state in the nation with the Surgeon General right, now you have Dr. Nadine Burke Harris is fantastic and this is so in the forefront for her as well. I'm sure it has, like, opened so many doors for you to be able to do this work there. That's incredible. I feel like, oh my gosh now I'm like, I just want to do a full episode on ACEs with you. This is so fun. We maybe will curve that, we will do more on ACEs at some point today. I want to chat about like building resilience in kids and what this looks like and obviously a huge connection here to ACEs, but how does this play out? And how do we build it? Because we know that there are going to be a number of kids who have some ACEs, right? And even if you don't, how do you build resilience? What does it look like in our tiny humans? I was browsing your website and one thing that stood out to me was you had two sentences in there that, like, jumped out at me. You said what we believe about ourselves can impact our ability to heal and it's only through owning our minds that we can take charge of owning our health and I just think that's so true. I think we don't connect the mind-body often enough, right?
00:13:39 Dr. Smita Malhotra
Just this morning. I was chatting with somebody about anxiety. And for me, I think it's a big fancy word for I'm feeling fear and my body is having a reaction to fear, right? And its rad, I think, that we're talking more about it. But also I have a fear that we're going to normalize anxiety as a norm, as rather than I feel fear and I experienced it and I know what it feels like in my body and I can be present with it and acknowledge it and move through it, but I'm going to experience it and say that I have anxiety and be stuck in anxiety, right? And I think when we're looking at resilience in kids this is one of the common things that I've been seeing is the role of anxiety and the connection to resilience.
00:14:31 Dr. Smita Malhotra
Yes. Yes. I think it's really all about shifting that perspective. I can tell you personally. I grew up with anxiety. I mean that was-- I had a very tumultuous childhood. I moved many many places. I escaped war to come to this country. So, anxiety was in the background of my life and I think it escalated to its ultimate point when I had children, you know, because I was so anxious for them every single day and I began to realize that if I don't get a hold of this, they are going to inherit it. They're going to take on my anxiety and take on my fears and take on, you know, what I'm feeling and you're right. You know, I remember distinctly, you know, how I grew up. I was told that I was not to have emotions, right? As an Indian woman, generally in our culture, women are people pleasers and we tend to suppress our emotions to please others and I never dealt with emotions. Yeah, even my mom lost her grandmother and locked herself in her room for three days. So I wouldn't see her grieving, you know, and so I didn't even realize that grief is an emotion. She came out three days later was happy and I was like, wait a second? Didn't someone pass away? So, I had realized after having children that that needs to change going forward for my family. These ACEs can't be passed down through generations. So what we're going through right now, the covid-19 pandemic. This is an ACE for our children. This is a trauma for our children. Throughout this pandemic, actually, it has been a test of resilience for my family too. My children lost their paternal grandmother to covid-19, and so what I teach to my patients, I had to learn to teach to my family. So I think the first and most important thing our children need to see from us is that feelings are okay, right? You know this is just ingrained in me. I was very quick to be like, I feel incredibly sad and I want to cry but I can't cry in front of my kids, you know, and the first thing I did, you know, during this time was-- I preach this to other people, I have to practice it myself-- I let my kids see me cry. Now, that was probably the first time my children have seen me cry and just understanding that feelings are okay in this house, that grief is okay in this house, but that you don't have to hold that space for me. I can hold that space for myself, you know, and that's really important that you know, don't put that grief on your child. But let your child see that it is okay to feel sad, it is okay to grieve the loss of someone.
Totally, it's a whole different ball game to see somebody experience an emotion and as a child to know that they have the tools on their own to move through it to process it versus feeling responsible for them and for their processing, right? And I think that's a fine line and it's a hard line to strike for a lot of us of and I think it comes out in little ways the like, "oh, it makes me happy when you clean up your toys" or "it makes me sad when you hit me." We are responsible for our own emotions as adults, right? So you can feel sad, you can feel happy. You're going to feel all these things; you're responsible for regulating and processing. Not your child. We can hold space for them, it's not their job, and this is something people in our village get caught up on a lot of, like, how do we teach empathy without them being responsible for us and this difference of the parent caregiver relationship to the child versus a peer relationship or any other relationship that they're going to experience.
00:18:52 Dr. Smita Malhotra
Right. Right. And so, yeah, it's a really fine line and I understand it's very hard, you know, especially I have a lot of parents during this time say "well, can I tell my kids that I'm scared, you know, that I'm scared of Covid or I'm scared to go out there" and I was like sure! Yes, you should! You should tell your kids that you have this fear, but then there are ways to tell them also that it's okay to live in uncertainty. So acknowledging uncertainty, you know, none of us can predict the future a lot of times I tell my daughter, "I don't know what it's going to happen. I can't predict it, but I can live in this moment and I can thrive in this moment and we can be okay", I think letting children know that the future is uncertain, but you can still thrive in that, you know, that's like a huge part of resilience. And then the next thing is, you know, validate their feelings. They're scared and saying I understand you're scared, It's okay to feel scared. My first instinct obviously every parent's first instinct is to be like "don't worry about that! That's never going to happen."
"You don't have to be scared!"
00:20:04 Dr. Smita Malhotra
Hah, I know. My daughter, actually a six-year-old, you know, she came up to me one day and, you know, it was like I'm worried that you're going to leave me like Grandma did. You know, because you see Covid patients every day, that's what you do and and I'm worried you're going to leave me like Grandma did and I honestly did not realize my six-year-old could think that. That deeply and that intensely, you know, and my first instinct was, really, was to say, oh my gosh, you don't have to worry about that. I am never going to leave you. You know, but I had to take a moment and say, "you know, I would be scared too. I understand that fear and that is really scary for you, but there are so many things that we're doing to keep ourselves protected, right?" I realized that to make her feel seen, I had to validate that feeling. It's very very easy to say "don't worry about it. I'm always going to take care of you", and that's because that's what you want to do.
Yeah, of course you want to be like "No no, you will never feel harm." Right? Like, "it'll all be good", and I think even for, noting this for ourselves to that this is so key in building resilience. We are getting like a masterclass in it in 2020 but for us as adults to be able to identify, what is our roof here, right? Like when we are feeling scared here and now, what are you really scared of? Is it health-related? Is it financial? What are you really scared of and what would it mean if that came true? Right like what would that mean and that for me in like letting go of control or relinquishing that, you know, control is an anxiety response, right? We're like, oh if I can control this thing, then I'll feel safe. Whether it's financially, emotionally, physically, whatever. If I can control this thing, I would feel safe. which I think is why we're seeing such a dichotomy right now of folks. Everyone's doing what they think makes them feel safe, right? Or however, they feel safe and that that's different for everybody and it's hard when we're relying on the entire population to do something for everybody to feel safe when people have different barometers of "Oh, I feel safe right now."
00:22:40 Dr. Smita Malhotra
Right. So a lot of the things that we've also been working on with our children is acknowledging what we can control, right? So we started with showing our feelings, validating their feelings, acknowledging uncertainty and then acknowledging what you can control. Because that kind of empowers a child and give some sense of control to them. So, you know, I often tell my daughter's, you know, I can't predict the future. I don't know what's going to happen in the future. But we are wearing masks. We're social distancing. We're careful with our actions, and this is what we can control to help keep the rest of the world safe. And here you are, you're doing something to make the world better and that's quite a responsibility, you know, and so I often give them this analogy. This is analogy that I grew up with but people would also often tell me is that you can be like the eye at the center of a tornado. So like, where everything around you is chaotic and and changing, you can be at the eye, you can control your own self. You can control your feelings. You can remain calm even when the world is chaotic. And I like something about that, you know, like that the world may be chaotic outside, but we can be calm inside.
Oh, I love that when a colleague and I created an emotion processing method, collaborative emotion processing method, that we researched across the U.S. and as a part of our training for the CEP method, that was one of the analogies that we used, was like, finding the eye of the storm and that you get to be the eye, and our goal as the adult is to find that eye. But I love teaching that to kids too, that's awesome.
00:24:30 Dr. Smita Malhotra
Yeah because it's so tangible for them, you know. When you can give a kid an analogy that they can actually visualize, it really changes things for them. And then they they think about it all the time, you know?
So many of us right? That came from your childhood. It's stuck with you.
00:24:49 Dr. Smita Malhotra
Yes, I mean, not that I'm that old--
Right but for kids, like, it sticks with them-- it sticks with all of us,
00:25:00 Dr. Smita Malhotra
Right, right, right. Yeah. So yeah, and so I often feel that my daughter's reference it, even at school. They've drawn pictures of it at school for their projects and so it really sticks with them, analogies stick with children.
Totally. So what is this? We've been kind of dancing around it. But what does it mean to build resilience in kids?
00:25:26 Dr. Smita Malhotra
So I often followed the work of Dr. Ann Masten, are you familiar with her
A little bit, yeah.
00:25:33 Dr. Smita Malhotra
Yeah. She's a professor of Child Development at the University of Michigan and she had done this research where she followed 200 children and families in the Minneapolis public school system, and she for more than two decades, you know, analyzed the adversities and protective factors in their lives and she combined this research with all of this extensive research. She's done with children experiencing war and homelessness and poverty and she described the foundations of resilience in her book, "Ordinary Magic". I mean this book if anyone ever wants to read it. It's beautiful. She describes resilience as something that's innate in all of us. So it's not something rare, unique, special. It's not like some people are born with it, some people aren't, it's actually a muscle that you build. And so she describes these foundations of resilience, which I like to use for families when I talk to them as a mnemonic called "threads". So, you know, the first thing is a "thinking and learning brain", children love to really use their brain to learn new things. H is for "hope or belief that life has meaning" children usually get them through their faith based systems. R is great being able to "regulate their emotions" and we can talk more about what that looks like. E is for "efficacy or self-efficacy" does a child have, you know, an I can do it attitude. And then A is for their "attachment to their caregivers", do they have a secure attachment to their caregivers, where they're not holding space for their caregivers, but their caregivers holding space for them. And then D is for "developmental skills mastery", you know, so teachers often invoke this area where children experience pleasure or agency in the world by learning things in a stepwise fashion. And then S is for "social connectedness", do they feel connected to the world around them. And so based on this kind of framework, you know, that's how I talk to parents about resilience, where it's not really the adversity that's the issue. It's the threat to these basic foundations of resilience. So, as parents what we can do is we have a lot of control over some of these things and even though we're experiencing a worldwide pandemic we can keep these basic foundations of resilience intact for our children. So a lot of things I talk about is being able to talk about your own feelings with your children, you know, helping your child regulate their emotions by also being a vessel or a container, a safe space for a child to name their emotions, a sentence I often give parents to give to their child is "I feel this when this", "I feel blank when blank", you know, so they can fill it out with whatever they wanted to write and it really it opens up the floodgates, basically, for what a child may be feeling at that time and just holding space for a child every day. The other thing I tell parents is to maintain their routines. So there's a reason why pediatricians talk about night time and, you know, bedtime routines for children because routines are anchors of stability in our lives, even for adults, you know, something that you do day in day out every day, communicates a sense of safety to you. So maintaining those routines, even though the world outside is changing, is so vital and then I talk a lot about maintaining those connections and I know we are in a pandemic and we can't go out and have play dates with people but, I don't know if you've experienced this, but during this past year, I have felt more connected to people than ever before. I mean I have had people from 20 years ago reach out to me and FaceTime me. I mean, this has been the year of connection for me. Have you experienced that?
I've definitely experienced connection with people that I didn't consistently experience it with before
Yeah. I've also still yearned for in-person connection that I feel a loss of or like folks that I generally saw in person, I don't speak to or connect with as much virtually as I did in person, you know what I mean? But there are definitely folks that I didn't connect with as much in person. That I have totally connected with like thank goodness for Marco Polo's been a huge one. I got that like, I'm like, "oh, we never really hung out and chatted, but now we can on a regular basis" and we're utilizing those platforms.
00:30:39 Dr. Smita Malhotra
Right. Right. I just, I feel like we found all these creative ways to keep that connection alive. I mean, my children have talked to, just the other week, we had a family get-together for my family all around the world. That has never happened, you know and I am so thankful for all these ways that we can be even more connected. And so that's what I tell parents a lot is that our children are grieving those intergenerational, you know, support systems that they used to have and so finding creative ways to connect and supportive community of adults can buffer that toxic stress that children are experiencing being a consistent reliable nurturing adult in a child's life. I mean research has shown that that is the number one factor, that not only promotes resilience, but can reverse the damage of any toxic stress that a child has experienced. Right? And so the more that you can connect your child with all of these support systems the better and then finally one thing I really tell parents is free yourself from the pressure to perfectly parent during this time.
Yes-- need that on a billboard!
00:32:02 Dr. Smita Malhotra
I mean, you know, I'm also guilty of this. I am the same. But if you can model self-compassion during this crisis, you are going to show your child tools that will last them a lifetime.
I think it's such an awesome opportunity to like really be fine tuning, our repair muscle. We're all going to rupture; we are carrying more stress than we typically carry, right? And we're making decisions. It's the decision fatigue for me personally where it's like, okay, like this is what we're planning on for now and we'll see how that adjusts or ebs or flows or it's the constantly making the decision of like, oh, now the rules have changed and here's what we're doing and that just like constant is exhausting and I think acknowledging that and recognizing the effects it has on our own tank and our own ability to be that regulated caregiver to hold that space and how draining it is when maybe your kids were in childcare and you got to share that responsibility like maybe during the day someone else is holding space for them. And then you were able to hold space at night or on weekends, and now it might be you 24/7 and just how draining and exhausting it is to lose that in-person village. And capitalizing on this time of, like, really fine-tuning repair and acknowledging like "man, I was feeling really overwhelmed when we were coming in from outside and I was getting lunch ready and you and your brother were having a hard time getting your boots off and I yelled and I'm so sorry that I yelled. Here's what I'm going to do next time." It's just like connecting, coming back to that connection and knowing that not only are we not striving for perfect parenting but in not striving for perfect parenting we get to model repair which serves them forever.
00:34:00 Dr. Smita Malhotra
Right. Right. I think my children have taught me about apology more than anyone else. You know, I am very very aware now of how imperfect I can be and the fact that I can apologize when I've kind of not been so great during the day has really affected them in the way that they interact with others, you know. I used to always have this issue with my daughter, she would never be able to apologize and I think through this whole pandemic the amount of times I've apologized to her, she has been like "I'm sorry little sister. I'm sorry I yelled at you." And I think that's actually a large part of what parenting has taught me is humility, you know, and being able to understand that I'm not perfect and I never will be and that's okay.
That's not the goal. You know, it's truly not the goal and it reminds me of Jessica Leahy's book, "The Gift of Failure". She was on the podcast a little over a year ago and but if folks haven't read that like it is another walkthrough resilience. What does it look like to make mistakes? To allow yourself the gift of failure, to allow your kids the gift of failure. And then what do you do after that? You know,
00:35:24 Dr. Smita Malhotra
For me, that's what resilience is, it's the ability to navigate hard things. It's the experiencing something hard whether it's capital T trauma like ACEs hard or it's that you felt embarrassed when somebody said something at the dinner table that you didn't love or that your sibling took something from you and you didn't get the response from a parent that you were hoping for. Maybe you aren't feeling seen right now, right? Like, whatever this is that you can navigate hard feelings or hard experiences because you have a toolbox to do so and that you're the expectation isn't that you're happy and calm all the time.
00:36:04 Dr. Smita Malhotra
Right. And it's also I think right now the ability to reframe, you know, what you're experiencing. For the those in the United States, Thanksgiving is coming up and a lot of children are experiencing this in a whole new way, you know, not with their families. Maybe just with a couple of immediate family members and also without family members that used to be here before and so being able to reframe the situation and understanding that, "hey, this is a new way to celebrate but it's for the greater good", I think is so vital and being able to talk to your kids about changing their perspective and that in life, sometimes we have to change our perspective and see things from a different lens that's okay.
Totally, totally. And yeah that cognitive flexibility, right? The ability to say like this was my plan A and we're going to plan B and we see again this comes back to control that when we aren't experiencing, as adults as well, I think so many of us as adults are going through this right now, too, I was just having this conversation with my partner about Christmas time and just like the grief of not having the Christmas that that we are used to having and that I love and that I've experienced for years and that brings me so much joy and how I still want to experience joy even though it can't be that way and being able to hold space for that grief so that I can allow something new to occur so that I can say like, all right. What does Plan B look like? How else can this look and that cognitive flexibility component, I think we need to first hold space for that grief or the loss of the plan we expected, right? The, like, Thanksgiving we expected the Christmas we expected the school year we expected, that whatever it is, that we hold space and acknowledge those feelings. You were talking earlier about validating those feelings. I think that component is so huge before we can move on to like alright, what does Plan B look like? You know, we can't enter that problem-solving phase when you're in your amygdala. So really experiencing that and holding space for that first.
00:38:22 Dr. Smita Malhotra
and you know now that you're talking about it another thing I really Lee talk to my children about is releasing expectations, you know, when you have an idea of what something is going to look like you hold so fast to that idea you have to you have to have that mental flexibility where releasing your attachment to that outcome, you know and just enjoying the moment as it is right now and so we've come back to a lot of joy and simplicity. I honestly think even though this is a terrible time for the entire world, what it will show for our children is understanding the joy of the current moment and releasing the attachment to this outcome that we imagine. And I think as a young child who is learning that, that's going to last them for a lifetime.
That's huge. I when we were researching the sentiment that there was this little boy who like, I've kept this with me the entire time. He was four years old and when something would happen and he would get frustrated. He's building something with blocks and it crashes down etc. He would go "Oh, oh that wasn't my expectation." And I was like, oh my god, that's it! Like, that's so much of these hard feelings. It's so much of what we come back to and my husband and I do consistent checks and are like "hey, what's your expectation for this?" Like just the other night on Friday night, we were going for a walk and he was like, "hey, what's your expectation for tomorrow? There's some things I want to get done this weekend. Like here's what I'm expecting to do. Do you have things?" There's always something running in the background of this mind that I haven't communicated, right? Like what is it, Alyssa before it all of a sudden I'm like, "oh, what are you doing? Why are you doing that? I thought we were going to go do X,Y and Z" or "I thought this was going to happen", instead being able to acknowledge, we always have an expectation and when we can be aware of like what is my expectation right now? Or what's my expectation of this thing that's coming up, then we can be mindful of like, yeah that might not happen. What are some other options of things that might occur, but I think yeah, I love that you brought up expectations. I think being able to acknowledge them and realize that so much of the source of our challenge in cognitive flexibility is not first acknowledging, "what was my expectation here?"
00:40:40 Dr. Smita Malhotra
Right. I mean you can acknowledge the expectation but not be attached to it. Actually I had a child recently tell me "I'm NATO", and I was like, "what's NATO?" and she's like "not attached to outcome." Haha!
Haha I want to meet her parents!
00:40:57 Dr. Smita Malhotra
I thought that was brilliant. I was like, "oh I need to tell this to Mike!" Not attached to outcome you know, how brilliant you know, and I think truly this year has taught me to be NATO, not attached to outcome, but hope for the best and do what I can in this current moment right now.
Totally and I think what you're really describing here is mindfulness, which is super buzzwordy. And I know a lot of people are now *eye-rolls*, whatever it's so buzz wordy, but really what it is is being able to be present right when we are when we are anxious when we are experiencing fear or either in the past or in the future right we're either scared of what's to come or we're triggered by something from our past. And so when we're asserting that control we're often afraid of like, what happens if I let go of this control in the future? And with expectations, like how do we get back so you can acknowledge them without being attached to them, for me acknowledging them is that bringing of awareness. It's which is truly what mindfulness is. It's not without judgment without shame without attachment just being aware of like what is my expectation? What is happening in my body? What am I feeling right now without judgment or shame or the need to change.
00:42:13 Dr. Smita Malhotra
And that's a great way to talk to children about their feelings, you know, to regulate their feelings. First of all name it and then feel what's happening in your body as you're feeling this feeling and how you are going to look to the future. How are you going to make this current moment as positive as I can be and that's a great way of helping children regulate their feelings.
Yeah we gotta know what's happening before we can regulate, right? Can't regulate something you're not aware of. Step number one. I've shared this story with our village before, also in the research we had this little boy who is consistently exhibiting what we would consider aggressive behaviors in the classroom. He is in a mixed 3's and 4's preschool and often hitting and kicking and so we started by just awareness, like, how I see that your face is so red and your hands are so tight, you look so frustrated, like you might want to hit somebody. And just helping him and then over the course of a few months, he started to say "my hands are so tight", "my shoulders are up to my ears" and "my face is so red and I'm so angry", which was key. He had to be able to build awareness of what he was feeling before he could regulate it, right? And that's the same for us as adults. So often we will react. We will yell, we will scream, we will do something from a place of reaction from that feeling and before we can move on to like problem solving and resiliency, I think we really have to bring it back to being aware of what I'm feeling and where I'm feeling it before you can make any changes for us and the tiny humans. I think so often we talk about the tiny humans and y'all this starts with us
00:43:53 Dr. Smita Malhotra
True! Also, what we also talk about is reassuring through that feeling, you know, a lot of I think this is something that was opposite of what I've been taught in Pediatrics when we have traumatized children, you know, they're in a chronically stressed reactive state. So when I talk about toxic stress, it's really a child who's experiencing so much stress that they're, you know, their cortisol is activated, it's actually a dysregulated and they're in this fight or flight mode where they see the world in a state of constant fear. And so when a child who's going through trauma is is riled up and maybe having a tantrum or feeling these overwhelming feelings, a lot of times as pediatricians, you know, when we talk to parents about having tantrums, we say walk away and ignore it. But for a child going through trauma they’re remaining in this chronic stress reactive state. So they need to come down for that. And so a lot of times we talk about reassuring and telling children. "You're okay. You're safe, you're going to be fine." And you know, even with my own children, I've just given them a hug to calm them down, to bring them down from that state. And so I really think reassuring as well helps to regulate those emotions.
Yeah, our folks will be familiar here with the amygdala and the prefrontal cortex. We talk about how our goal is to move from that amygdala reactive brain into the prefrontal cortex. And you need to feel safe in order to do that, whether you're in trauma or not. You need to feel safe to be able to do that. And so when we are co-regulating with a child whether it's a hug or we are sometimes just regulating our self and holding that space and letting them know, "I'm here", which can let them know like "I'm safe to feel", right? Like this adult isn't dysregulated by me having this hard emotion. I'm safe to feel and express, but working on that co-regulation is so crucial in order for them to be able to regulate the cortisol or adrenaline and regain that access to the whole brain. Yeah. It's absolutely foundational and I think part of that too can be maybe piggybacking with the reassurance, is that validation, is the acknowledgement of what they're feeling so that they can feel seen and they're like, "okay she gets it", right? Like, they know what I'm experiencing, I'm allowed to feel this right here and right now, I'm safe to do so and they're there to help me if I need help.
00:46:32 Dr. Smita Malhotra
All those components of safety I think are crucial in order to regain access to that whole brain.
00:46:40 Dr. Smita Malhotra
Right. Right. And a lot of parents will say my child is completely okay at school and then they come back and they erupt and I'm like "because they feel safe with you." They feel seen they feel like, you know, you will validate their feelings and thats kind of a compliment.
It's a compliment and it's so very hard
00:46:58 Dr. Smita Malhotra
--and it's hard.
It's so hard because it can also, especially if you in childhood didn't experience that so it can trigger those inner child wounds of like "oh, but I never got this" or "where am I supposed to get this much?" We have a re-parenting class that the re-parenting and Tiny Humans Big Emotions, and folks can dive into the often dive into both of them so that we can work on that adult self, in order to support the kids because so much of this like, "all right, here's how we support the kids", we got to know first how to regulate ourselves and support ourselves. Awesome. So you do a lot of work around mindfulness in general and, you know, as I was diving into your work, like that shift from, well, I'll share about my love, Dr. Brazelton, T. Berry Brazelton was a pediatrician, he's now dead, but was a pediatrician and did a whole bunch of work in social emotional development and was really like a founding Father sort of dude in terms of bringing Child Development into the Pediatric world. And, in my dream world pediatricians are not responsible for everything that they're responsible for today, because we don't train pediatricians to be responsible for everything they're responsible for today. Like, you're not a nutritionist or lactation consultant or an occupational therapist or speech language pathologist or a child development specialist, right? And so when we're looking at, like, this as a whole and the pediatric world as a whole, I would love to hear your thoughts on what is your dream looks like as we are moving forward in pediatrics for parents to have places to turn to, to build these tools or to say like, "oh man, my kids delayed in walking or crawling" and being able to connect them to quality services like an occupational therapist to assess their nervous system things like that. What does that look like for you from the Pediatric lens?
00:48:58 Dr. Smita Malhotra
My dream is what I'm doing now. Actually, it is a multidisciplinary approach. So what I do now is I have built relationships with speech language pathologists, occupational therapist, mental health practitioners, mindfulness practitioners. My dream is that every pediatrician can have access to this network of professionals because a pediatrician can't do it alone, I mean that's not possible. Back in 2015, my husband and I started a new practice. It was called Mindful Pediatric Gastroenterology. That's now part of Salt Lake County and because of the mind-gut connection, you know, my husband's a pediatric gastroenterologist, we connected with a network of professionals to help treat our patients. And so what we had was acupuncturist, yoga practitioners, cognitive behavioral therapists, speech language pathologists, occupational therapists, you know this whole network of people that understood that a child's diagnosis is not one dimensional. I mean, there's there's so many layers to what can be going on with a child and trauma-informed Care, we're taught it's not what's wrong with this child. It's what happened to this child. And so when we look at children through that lens, then we can be better practitioners in medicine. So I want every pediatrician to have you know, a diagnostic plan which includes cognitive behavioral therapy, speech language therapy, yoga, acupuncture, mindfulness, you know, where you also work with the family and the child to bring this child back to health. For example, we've had several children coming in with, you know, abdominal pain for years and years and years and years and years, and treated with all kinds of medications, everything under the sun, and you sit down with a child alone and you say "well, what's really bothering you?" "Oh, my my dad wants me to play football and I don't want to" and just that simple fix, that pressure that releases fixes the abdominal pain. I mean, these things that we just don't have time to delve into in medicine are really big things. I think we need this multidisciplinary group of people to give that different perspective and say "hey, maybe this small thing is causing this physical ailment, this physical symptom. So, yeah, that's my dream. And that's currently what I'm doing now for LA County. We've developed all these networks and resources, even online tutoring for kids, you know, we've connected them to online tutoring to a lot of different therapies mental health practitioners that are available through Telehealth. I mean, we've come up with all kinds of creative ways during this COVID pandemic to help our children.
So that's awesome. That is what I was hoping to hear, to be honest. That also reminds me of the medical home model of like having multidisciplinary approach and I think that one of the challenges that I ran into as an early childhood educator and that now actually we've started to see a shift at through Seed, which has been cool, was like in early Ed, I was like I have a masters in child development, like this is my wheelhouse and what I'm trained to do, but family could come back from the pediatrician who said like, "oh, I'm not worried about it we will wait and see," and there was this, like, dichotomy and I wanted to be like, "can you connect me to your pediatrician? I'd like to chat with them", and ultimately one of my dear friends is a pediatrician. She was like "will you guys in child development stop putting things on our plate? Like, I wasn't trained in child development. I took one or two classes in it!" Right? Like this isn't my wheelhouse but you guys keep throwing things on my plate that's not my training. And so we were chatting a lot about this and I was like, what would it look like if that was the norm, man? If, like, when you visited the pediatrician at your visit, you weren't just visiting the pediatrician. Sometimes you were seeing a sleep consultant. Sometimes you were seeing a OT or an SLP or developmental specialist who could fine tune this system to really respond to those needs in a way that we don't train pediatricians, but we put on your plate and it's just not a functional system in that manner.
00:53:35 Dr. Smita Malhotra
And I think it should start with the training, you know? We have a lot of residents that come through and medical students that are now learning this new system and we have, in California, a Surgeon General who created, basically, the system for through her Center for Youth Wellness.
She's my girl crush.
00:53:53 Dr. Smita Malhotra
Yes, totally mine too. You know, she created this whole multidisciplinary system in her Clinic in San Francisco. And that is what we have modeled our whole system upon and I think in the future though, I think hopefully, you know, this is going to change in the future. I think ACEs and toxic stress are much more buzzwords, are greater buzzwords in our pediatric community and there have been many many communities and systems to address these issues. So I think it's going to change going forward but it's unfortunate that it took this long.
Yeah, for sure, for sure. I mean, it's how we feel that all progress, right? It's like, okay, hey, we're moving in a good direction. And it's a real bummer how long it takes. Yeah, for sure. This is awesome. Where can folks connect with you and learn more about what you do etcetera?
00:54:53 Dr. Smita Malhotra
So I'm mainly on Instagram, you know, I have difficulties keeping up with many social platforms as well as working. So my main platform is Instagram, it's @drsmita_md and thats where people can find me and also my website smitamd.com.
Awesome. Thank you so much. Thanks for hanging out with me.
00:55:19 Dr. Smita Malhotra
Thank you so much.
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