Tag Archives: behavior

“Accidental” Psychotherapy (Pedcast)

Today, I am going to tell you about an amazing experience I had last week. A longtime patient of mine, a 12 year old boy who I have known for a decade, came in for his checkup. I had reviewed his chart before walking in the room, an noticed that the last time I had seen him, he came in with classic anxiety symptoms of difficulty sleeping and concentrating, feeling anxious, and having headaches, and stomachaches. When I asked him why he felt so anxious, he said that the social aspects of middle school were overwhelming for him. The academics were easy but the fitting in with his peers…that was a whole nother matter as they say down in the South. After we talked all this over,  it was so clear to me and his Mom that he was exhibiting the somatic symptoms of anxiety. I suggested that they go and try a therapy called “Cognitive Behavioral Therapy” or CBT as it is known in the business. Yes there are medicines for this but CBT is at least as effective. Continue reading

The tech savvy parent with Dr. John Simpson (Pedcast)




Welcome  to another edition of my blog, docsmo.com.  I am your host, Dr. Paul Smolen, a general pediatrician with 31 years of practice so far and I am delighted to have as my returning guest, Dr. John Simpson, PhD clinical licensed psychologist with an abundance of practice experience under his belt and special training in adolescent psychology.   (I didn’t say decades this time did I Dr.Simpson)? Thank you for joining us tonight.  Dr. Simpson, you recently mentioned to me that, in your experience, one of the most frightening aspects of parenting today is dealing with computers and the Internet.  How did you put it? , “If you want to see parents have a meltdown, bring up the topic of computers, smartphones, and the internet.”  Well, that is exactly what we are going to do in this pedcast…discuss some of the issues parents need to deal with when it comes to the tech world.  What’s the old saying, “With knowledge comes wisdom”.  Let’s hope we all gain some knowledge AND wisdom  today.  Dr. Simpson, let me pose a general question to get us started;




Question 1.  In the practical world, how do you see parents perceiving their children’s interactions with the Internet and computer technologies? 


Question 2.  What do you see as the biggest danger or dangers of the Internet? 


Question 3.  What practical suggestions can you give parents to make sure they are dealing with computers and the Internet as effectively as possible?


Question 4.  Can online relationships on the Internet be damaging to children and how does a parent set limits? 



Question 5.  Let’s say that the parents have been as careful as possible, family meeting, computer in public place, rules have been articulated do’s and don’ts, is there still trouble to watch for? 




Dr. John Simpson, thank you for sharing your wisdom and wit with my audience and me.  You are a delight and really fun to talk to. Let’s start planning our next talk, shall we?


Your comments are welcome so please direct to iTunes or my blog, www.docsmo.com.  This is Dr. Paul Smolen, broadcasting from studio 1 E, hoping this pedcast can help you avoid some nasty fights, when it comes to your kid’s digital bytes.  Until next time.

Good, Bad, and Ugly Stress in Children (Pedcast)

Welcome and thank you for joining me for another edition of the docsmo.com pediatric blog… a blog dedicated to children and their families.  I’m your host, Dr. Paul Smolen, a general pediatrician practicing in Charlotte, NC, the Queen City as we like to call it. From the crib to the country club as we like to muse in studio 1E… if it involves children, we discuss it here. I read a lot about children and learn new things constantly.  Recently I was doing what I have done for 30 years, reading one of my pediatric journals and I came across some articles that I found extremely interesting and I thought my listeners might as well. The article gives the reader a glimpse into some of the new research about something they call “Toxic Stress”. I think after to listening to the new research child development experts are doing, you might think about infants and toddlers a little differently, I know I now do. So sit back and listen carefully to this and I hope informative  important edition of DocSmo.com.


Children know stress.   Before your child graduates from high school, you are likely to hear them complain about stress in their day-to-day lives.  Psychologists believe that your child experiences various kinds of stress well before he or she can even say the word. For older children, stress may be from academics demands, conflict with friends, or failure in sports.  Sources of stress are similarly diverse for younger children, whether it is having a toy taken away, being left by a parent or adapting to a new daycare.  Are these stresses all bad or are some of them good for your child?  We are going to analyze that question today and help you recognize different kinds of stress as well as understand how stress can affect your child’s well being.


Although we sometimes wish for “stress-free” life, we know that a healthy dose of stress is necessary to push us to wake up in the morning for work or pay our bills.  Likewise, children need stress to develop the skills to adjust and overcome new and potentially threatening situations throughout their lives.  Doc Smo pearl: Stress is the engine behind your child’s growth, propelling him or her up the next summit of life.  But when stress is severe enough to overwhelm a child’s ability to cope, even support from parents or other caregivers will not help the child adapt.  If severe stress is prolonged, especially when they are under 2 years of age, this kind of stress can lead to various short- and long-term negative health effects.  Current research indicates that a child’s brain can be so altered by severe stress that they seem never to be able to recover.  A permanent scar has been left even before they can even talk or remember the events. Doc Smo pearl:  Stressing a very small child can leave scars as bad as third degree burns.   Remember,  Scars you can’t see are sometimes the worst kind.

Young children’s brains are rapidly changing and appear to be extremely vulnerable to life events that researchers now call “toxic stress.”  In fact, they can measure this with something called an ACE score or Adverse Childhood Experience score.  On average, the higher the score, the worse the outcome for the child. Things that are considered toxic include witnessing violence toward women, divorce or separation of parents, emotional, physical, or sexual abuse, neglect of any sort, household substance abuse, having a household member with mental illness or becoming incarcerated.  Children raised in these types of environments can have very high stress hormones, impaired immune responses, and impaired memories and intelligence.  We are talking serious, real permanent, physical stuff all from “toxic stress.”


But Doc Smo, you started by telling us that stress is essential to growth in a child.  Is stress good or bad?  Which is it?

That’s a great question and the answer is “it depends”!


Researchers have identified three types of stress and “it depends” on the type.  Remember them by the title of this pedcast…the Good, the Bad, and the Ugly.


Positive stress (the good): These are adverse experiences that are short-lived and cause minor physiological changes (e.g., increased heart rate). Getting a flu shot, meeting new people, or preparing for an important test are all important part of your child’s development process. With your care and support, your child will easily climb these hilltops.

Tolerable stress (the bad): more intense adverse experiences but relatively short-lived. Examples include the death of a loved one, witnessing a frightening accident, or a house fire. With sufficient support of a caring adult, tolerable stress becomes positive stress in many cases.

Toxic stress (the ugly): intense adverse experiences that may be sustained over weeks, months, or even years. Child maltreatment, witnessing violence against your mother, or living with severely affected mentally ill adults are all examples of “ toxic stress”.


So here is what I want to shout from the rooftops and get people to remember… Toxic stress is extremely damaging to young brains, causing real physical scars that can be permanent and intervention, that is teaching families how to protect their children from this stress can really help…there is something that we can do to help thank goodness!  I find this very empowering and I hope you do too. Now that we know about toxic stress, I think we all need to do everything possible to help children who find themselves in this situation. Our help may make all the difference.


Thanks for joining me today.  I hope I got you thinking while you are getting your advanced pediatric degree.  Make sure you pass this important DocSmo pedcast to anyone who will listen because of it’s importance.  Let’s spread the word. If you want to learn more, explore the Smo Notes at the end of this talk.  This is Dr. Paul Smolen, hoping you won’t find it too strange to advocate for some change.  Until next time.

Smo Notes:

1. http://pediatrics.aappublications.org/content/129/1/e224.full.pdf

2.http://pediatrics.aappublications.org/content/129/1/e232.full.pdfWritten collaboratively by John Eun and Paul Smolen MD

3. http://www.cdc.gov/ncipc/pub-res/pdf/childhood_stress.pdf

Written collaboratively by John Eun and Paul Smolen MD



123 Magic by Thomas Phelan PhD (Book Review Pedcast)

Help support DocSmo.com by buying this reviewed book using this affiliate link. You get Amazon’s best price and DocSmo.com earns a small affiliate marketing fee.  Thank you.

1-2-3 Magic: 3-Step Discipline for Calm, Effective, and Happy Parenting

123 Magic– 4th Edition

by, Thomas Phelan PhD

Publisher- ParentMagic,Inc


Doc Smo here. Welcome to another edition of my pediatric blog, DocSmo.com.  With the help of one of my very capable interns, Angela Solis, we are going to introduce you to a great book on child discipline by a well known author, Dr. Thomas Phelan. The back cover of the book, 1,2,3 Magic  asks, “Who’s in charge at your house?” If you can’t answer “You, the parent are” , then listen up as we review our latest read. I am sure that over the years you  have read several books that describe the best way to discipline  children. After several frustrating moments and graying hairs, you might have chosen to just pick and choose methods, trying to see what will finally  have an effect. You and I know however, that the real issue is in the simplicity of the method, consistency,  and sticking to it. Being persistent. That’s where 123 Magic shines and why we are pleased to recommend the book!  This book is a simple book to read, understand, and later apply. Now in its fourth edition, it covers a wide range of issues, such as correcting obnoxious behavior, encouraging good behavior, dealing with more serious issues, and even providing assistance to teachers in their classrooms. The book begins by differentiating between stop and start behavior. Stop behavior includes the frequent but minor behavior such as arguing, screaming, and tantrums. Start behavior includes chores, homework, and sticking to a regular morning and evening routines.

The counting procedure that the book is named after, “1,2,3,” is used for stop behavior.  The start behavior includes several different tactics outlined in the book such as using a kitchen timer or charts. For correcting both types of behavioral issues, Dr. Phelan emphasizes consistency and removing emotion from the discipline process. This system may be used not only by parents, but grandparents, teachers, and other caregivers after the children have been introduced to the method, for a period of time. We were surprised by how simple his system is to implement.  It really is about counting and not yelling, begging, or hitting.  Dr. Phelan forbids parents from injecting emotion into their discipline process.  He says that children feed off of the emotions of their parents.  He calls this the “NO TALK, NO EMOTION” rule.   Many parents that open this book might think that their child will not respond to these methods but Dr. Phelan insists that with consistency and proper application of the counting method and using the tactics for start behavior, effective discipline  can be implemented in any home.  In this now fourth edition of 123 magic, Dr. Phelan has added a dynamite chapter on how parents can handle technology issues (email and internet time, texting boundaries).

No other book we have picked up  has been able to so efficiently handle this subject. This book is very accessible, written in everyday language without heavy psychology jargon. The chapters are short and may be read in bursts. In fact, many of the paragraphs are simply responses to bold-faced questions in the text, which makes it easier to find an answer to your specific question. The examples of parent and children  interactions are extremely practical and the ideas and suggestions for each behavior are doable. This does not require some kind of disciplining certification; it really is simple to adopt these practices immediately in your home. We really thought this discipline method showed respect to children by removing the often belittling lecturing, yelling, and insulting talk children often hear from their parents. One of the three big goals of the 123 method is to improve your relationship with your child, not to just get control. Now for the negatives: One downside to this book was that there seemed to be a lack of emphasis on setting a good example by the parents. He lists over and over again how important it is to avoid the parental tantrums, basically when parents lose control while trying to discipline, but he does not comment on what the children observe in the home. For example, the parents may be calm with their children but perhaps not with other adults. He also states that oppositional defiant disorder and conduct disorders may be created by poor parenting and  frankly, we are not sure that is correct. Lastly, the book was poorly edited, in the eBook edition that we read.    All in all, we agree that  one of the goals of parenting is to improve your relationship with your children. This book certainly does that by providing a simple discipline method, useful to all parents, and respectful behavior towards both parties. This is especially great for parents with children between 2 and 5 years old who are looking to get off to the right start with boundaries and limits as well as encouraging good habits in the home. We give it 5 out of 5 stars. Go buy and read it.

We hope you found that book review helpful.  For more reviews of pediatric books and literally hundreds of other discussions of pediatric topics, please visit my website at www.DocSmo.com and explore. Your comments are welcome so go ahead and leave one on iTunes, Facebook or my blog. This is Dr. Paul Smolen, hoping instead of a scream, your child will behave like a dream.  until next time.

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