Kids' Health, Parent Advocacy & Pediatric ENT: What Every Parent Should Know with Dr. Emily Boss

Every parent wants to make the best healthcare decisions for their child—but knowing when to worry, when to seek a specialist, and how to advocate for your child can feel overwhelming.

In this informative and empowering episode of Mom's Brain Is a Coffee Stain, Kayla sits down with Dr. Emily Boss, a nationally recognized Pediatric ENT (Ear, Nose & Throat) surgeon, public health researcher, and systems leader at Johns Hopkins, to discuss some of the most common pediatric health concerns families face today.

From frequent ear infections and enlarged tonsils to hearing loss, sleep issues, and navigating today's healthcare system, Dr. Boss shares practical advice every parent can use. She also discusses the importance of partnering with your child's healthcare team, asking questions, and trusting your instincts when something doesn't seem right.

Whether you're the parent of a toddler with recurring ear infections, a child struggling with sleep or hearing concerns, or simply want to better understand pediatric ENT care, this episode is packed with valuable insights that can help you feel more confident advocating for your child's health.

In This Episode We Discuss:

• What a Pediatric ENT (Ear, Nose & Throat) specialist treats
• Signs your child may need to see an ENT specialist
• Tonsils, adenoids, snoring, and sleep-disordered breathing in children
• How hearing impacts speech, language development, and learning
• The importance of early intervention for pediatric health concerns
• Tips for communicating effectively with your child's healthcare team
• How parents can confidently advocate for their children
• Balancing a demanding medical career with motherhood and family life
• The role of public health in improving care for children and families
• Encouragement for parents navigating medical decisions

A Powerful Reminder

✨ You know your child better than anyone.

✨ Asking questions makes you an informed parent—not a difficult one.

✨ Early evaluation and treatment can make a significant difference in a child's long-term health and development.

✨ Healthcare works best when parents and providers work together as a team.

Key Takeaway

Parents don't have to navigate healthcare alone.

When you trust your instincts, ask questions, and build strong partnerships with your child's healthcare providers, you're giving your child the best opportunity to thrive.

Guest Information

Dr. Emily Boss

Pediatric ENT Surgeon, Public Health Researcher, and Systems Leader at Johns Hopkins

🌐 Website:

https://dremilyboss.com

Show Information

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Transcript

SPEAKER_02 0:10

Welcome to Mom's Brain is a Coffee Sting, the only podcast clinically proven to raise your blood pressure and your dopamine. I'm Kayla, Millennial Mom, current chaos coordinator of two spoil giants who think budget is a TikTok sound. Today we're talking with Dr. Emily Boss, a nationally recognized pediatric auntie, ear, nose, and throat surgeon, public health researcher, and a systems leader at John Hopkins to discuss some of the most common pediatric health concerns families face today. Well, let's jump on in. Thank you for joining us today, Dr. Emily Boss. Why don't you go ahead and introduce yourself and tell the world a little bit about yourself?

SPEAKER_01 0:56

It is great to be here, Kayla. Thank you for having me. So I'm Emily Boss. I am a pediatric ENT surgeon at Johns Hopkins. I've lived in Baltimore since 2008. I had moved here for what I thought was going to be a quick stint. And it turns out that that's been a lot of my adult and professional life. So I am also sort of a non-traditional physician career. I am a researcher, and the research I do is on how patients and physicians communicate with each other and make decisions for surgery. And we our lab does this cool thing where we audio record with people's consent. We audio record a consultation and um and then we get to go and analyze all the communication during the consult and um and sort of see what worked and how people engaged and talked to each other. And then we uh interview parents who are mostly mothers afterwards. So that is pretty cool. I'm also the mom of a 13-year-old girl. She just turned 13, and I have two awesome bonus children. One is a 16-year-old girl almost driving, and an 18-year-old boy who has just graduated from high school and is entering college.

SPEAKER_02 2:04

Round of applause. That's amazing. That's right. I love that. I have one that is uh 15 and a half and he just started driving. And then my my bonus daughter, she just we just watched her walk across the stage last week. So uh she graduated high school and she's off to college in August. So I it's uh you're in a whirlwind of life right now. I totally understand.

SPEAKER_01 2:30

Plus, you have a 13-year-old. I know. You know, I love 13. I know, I know, so I know it's not great for everybody. For uh for Lila, my daughter, it's it has been great. But I I will look at all of them and I just am still so amazed that they're like thinking human beings, right? With real feelings and opinions and um and life stories. So so it's it's it's really cool to watch.

SPEAKER_02 2:53

Absolutely. And it's so wonderful because you know, you touched a little bit about your research, and I know you've said that conversation in exam rooms shapes care, like and how care is given. So, what do you mean by that and why is that conversation in an exam room so important?

SPEAKER_01 3:12

Yeah, so this is a a figure that I love. Like when I I'm a surgeon, so I do I do do a lot of surgery or perform a lot of surgery, which are these are procedures, but um, in an average physician's life, you know, you'll see 150,000 or 200,000 patients. And so each one of those different patient encounters is an individual visit, right? So um, so I like to think about the visit, which is that that human conversation and the encounter between between two people where somebody is seeking uh health care and you know somebody is helping provide it. That I like to think of that that as procedures as the most important procedure that we do. And so um well, what what I've sort of learned along the way, both in practice and from research, is just how much of the downstream care is influenced by just what's said, and it might be as short as five or or or 10 minutes. Um and then also that's sort of where trust ends up being built, both um interpersonally, like between two people, but also in overall health and healthcare. So um I can't I can give an example like my my daughter um is 13, but when when I was at a school event, I was talking to one of the other teachers, and my daughter came home from school the next day and she's like, Mom, you knew you knew my math teacher because you saw her daughter a decade ago or 10 years ago, and you told her something. I said, Did I do okay? Like, how's she doing? And she said, Oh, well, she you said something like, I like operating, but your kid doesn't need anything, which is something I say all the time. I'll say, I like operating, but your kid doesn't need surgery if I if surgery is not indicated. But um, it's just was such a poignant moment to hear from my own daughter uh a line that I had said to a patient more than a decade ago. So you realize how that really shapes um how people think about healthcare as a whole and then also healthcare for their children.

SPEAKER_02 5:13

Yeah, and you are, you know, you have both both best of both worlds, where you are the physician and you are a mother. And has your parenting influenced the way you care for patients and you communicate with the families?

SPEAKER_01 5:28

Uh it definitely does. And I before I had children, I I actually I really didn't love when when parents would ask if I had my own children, I felt really insufficient if I didn't and like I wasn't being as good of a doctor. But I I do think you start to you start to experience care from both sides of the table, especially for me as a doctor for four children. I speak so much to mothers who are like me. Um so I I uh I remember when my daughter was let's call it two and a half, she she was really cranky for about 24 hours. And I just thought she was being a cranky toddler and she had hot jammies. And then of course, by the time I took her temperature and realized she had like 104 degree temperature, it was really febrile. And then I started going through all my self-guilt and blame, like, oh, she's she's had this terrible fever for a day. I didn't recognize it. I just sort of thought this was childhood. And um, and then I went into doctor mode where I started, and 104 is really high, right? That's that is a true fever. And so I started sort of going through all of the worst case scenarios that you would see with such a high fever, like leukemia and juvenile remature arthritis and all these crazy things. And I I called my pediatrician and I was I I and I expressed my concern and he just kind of stopped me and says, It's really hard to see your own child sick. And it just was like this moment where my brain turned into then from Dr. Brain into mom brain, and you know, I was able to relax and take a take a beat, but it you know, sort of taught me a lot about having that empathy and being able to express empathy and validate parents and and their concerns.

SPEAKER_02 7:13

Absolutely. I remember when my son, he was about six and a half, seven months old, um, and he had to have surgery because his tear ducts weren't open. And we didn't, I didn't, he's my first child. I didn't know anything about that. Um, but I guess like they can get like salt pocket buildups and it can actually erode tissue.

SPEAKER_01 7:32

Um swollen and goopy too, right? Yes.

SPEAKER_02 7:36

Yeah. And so, you know, we went through all the doctors and everything like that, and the pediatrician was like, hey, there's a really good ENT I'm gonna set you up with. He works with children, you'll love him. He works at a Cleveland clinic. I said, okay, cool. So we drove up to Cleveland, and this guy, I I I was 21, and I think this guy was like 26. That's what he looked like, right? He looked so young. And my pediatrician, he had been a pediatrician for like all the kids in my family. So he's older, you know. I'm like, why did he do me this way? Right, right. So, you know, one of the first things I said to this guy was, like, do you have kids? And he said, No. And my mom was like, That doesn't matter. And I said, Well, it kind of does because this is my most valuable thing. Like, I can't imagine my life without it. And he he doesn't know what that feels like. So it kind of does. And, you know, so he tells me, like, this is kind of what I'm looking at and what we're seeing. This is how we can, you know, verify for sure what's going on. Um, and but he was so nice because he was like, I can also get a senior doctor who's in the practice to come in. And, you know, I won't, I won't give him any of the information. I'll just give him the file if you'd like for that too. I and of course, me being a young mom, I was like, Yeah, thank you. You know, that'd be great. And this guy ended up operating on my son and he was wonderful. He's seen my son through kindergarten and everything, because my son had some vision problems afterwards. Um, but he was so wonderful. And like when my son ended up needing like his tonsils and adenoids removed, and like he had a like a lymph node problem and everything like that, he actually caught it. Um, and I I remember when he had his first child, his like demeanor like completely like switched. We'd been probably seeing him for like three years, and his demeanor kind of like switched. He was very more like way more interactive with like the children. Not that he was ever like cold or mean or anything, but you could just see like a spark in his eye, and he would like touch their feet or something like that. And I was like, now he got it, you know, like it made me feel like he gets it because he has one. So it I totally understand what you're saying because you have it on the both both ends where you can worry about it on both ends because your mind is gonna go. Worst case scenario, like I think a lot of moms do, but you know so much more. Um, but at the same time, you can take that and apply that to your patients and really provide that comfort and compassion that moms are looking for when they come to see you. And I think that's amazing and it provides that trust. And your research really is focusing heavily on trust and healthcare. And why do you think trust between families and healthcare providers seems to be eroding? And how can we actively rebuild it?

SPEAKER_01 10:36

It's it's just so hard to be a patient or a parent in the healthcare system as it exists. And uh, I'm by the way, I mean, I work a lot on healthcare improvement. It's really hard to affect change. And so um, you know, I sort of certainly see both perspectives, but uh it is so hard to navigate getting to places, right? Finding appointments, understanding who you should see, right? It you know, who's the at what office? What do you need? Right? There's um, you know, what are your options? Do you even have options to see more than one person or or go to more than one place? So and I'd say, so one is complexity of the healthcare system, two is there's just so much noise, right? There's just so much information everywhere from your friends, your friends of friends who have had a, you know, I'm sure you have a friend who's had their child who's had their tonsils out or who's had a lacrimal depth problem, and they'll tell you their experience, which, you know, like and then you'll have these patient forums, which by the way, I when I have a problem, I I mean I cannot help myself. I will join the patient forums, right? And participate because there's something that's so rewarding about learning from other people's experiences with disease and how they navigate it. It doesn't always mean that they're telling you correct science or you know, like a medicine as it is. So sometimes one voice is louder than it it should be. And there's even noise from like our own parents, right? The people or our our spouses, like the people that are are the closest to us, will sometimes have really differing opinions for for how we parent or how we choose to receive care or or make decisions. And so so I think that all those different sources of information, they just they just they just raise raise tension. The other thing is is we're being taught more and more to question, like you know, qu question what's going on. So I'll give you an example. When I was pregnant myself, I was a I mean, the the pregnancy forums are just like endless, right? I'm sure if you've seen these these internet forums, I mean you they really like it's really hard not to read them. And over and over again, you hear from people who are very specific about their birth plans and do not let somebody give pain medication. And if they try to do a C-section, then that you know, tell them they're trying to make money and get or go home early, right? Like, don't let them like make sure all these things happen. And in fact, that's just it's just sort of seeding this element of of uh of trust of like don't don't trust everyone. The intentions are wrong. And I I want to say that nobody has bad intentions. I'm sure sometimes those intentions exist, even if they're implicit or hidden, but um, but a lot of times those those you know, those inklings aren't right, right? Like people need C-sections if if labor is stalled and and the baby's in in danger, right? So um, so so I guess that's that's how I think trust is becoming more and more at risk. And I do continue to believe that interpersonal communication is such a key for rebuilding trust. Like literal sounds cheesy, but the whole one patient at a time. I think that AI, ironically, and and the world wide web and in the internet, they actually have the ironic potential of being able to humanize medicine more because they're gonna allow us to have more accurate, um, you know, guideline-based care. So it just gives us more quick, quicker information and helps us test some of our concerns. But I had a couple patients of of kids who have chronic disease. I've seen these kids for for 10 years at least, and the kids are sick. And and I've I've done things along the way, and you know, some things have made a difference and some have not. And I I looked at the for some reason I saw these moms in the same visit. They knew each other. They requested this and I said, Why do you trust me? Like after all of this, uh what do why do you trust healthcare? You your kids have been to so many visits, and they just said, like, look, at least with you, you give us the information and you talk to us uh directly and you include us in a decision. So I don't feel like uh I don't feel like you're making a decision for me. So I really do believe that these elements of how we communicate with our patients is a way to rebuild trust. I don't, I definitely don't have all of the answers and have most certainly been wrong on many occasions or have been biased by my own experience or, you know, and my my experience parenting or as a physician, but uh but just that transparency and the disclosure that all those things exist, I think that helps to rebuild trust.

SPEAKER_02 15:07

I totally agree with you. When I was pregnant with my son, um, my nephew, one of my nephews, is six months older than my son. Um, so of course, me and my sister-in-laws, we all use the same OBTYN and had the same like hospital we went to and everything like that for labor and delivery. Um, but it was wonderful because we were seeing the same doctor at around the same time. And then my nephew, when he was born, I was actually in the room with my brother and my sister-in-law, and he was breach and he was having uh like a hard time like actually getting him to flip. Um, and my doctor or stayed completely calm, you know, and he was kind of like explaining everything he was getting ready to do and why he was doing it. And, you know, like my nephew, he actually has a tiny little scar that goes up right here um because of like where his head hit the pelvis or something like that. Um, but you know, they he's so good and he was so calm and it was wonderful. And then it he he always practices at like a teaching hospital. So they he always they always ask if you know one or two residents can I guess they're residents or maybe they're doctors and training, I don't know the difference. But anyway, they ask if they can be in there and assist and everything. And we're always like, yeah, you know, gotta learn somehow. So when I went to go have my son, you know, my son when he first came out, um, because I I had like MRSA and my labor had been, they actually had to keep stopping my labor for like 40 days. So this was the last, they were like, We're not stopping it anymore. This is he's he's coming, you know. Um so when my son first came out, uh, there were some issues. So my doctor, of course, was right there and he was working and he kind of let the residents finish taking care of me. Well, they stitched me up with my placenta in and attached. And so when my when the pediatric doctor came in um and was, you know, evaluating my son and everything like that, and do what was it, um the test thing that they do for the babies and making sure his lungs were clear. My doctor came back over and he's like looking at everything and he's like goes to feel my belly, and he's like, No. And he's he's like, run it down for me. What all did we do here? And I'm like, I I don't know. Because I thought he was talking to me. I'm like, I'm just here. I was like, you know, I've I had a baby, I guess. And he's like, no, no, honey, not you. He's like, I'm asking them, you know, what what all did they do here? So they were like, oh, you know, we put in this tennis stitch and we cleaned this. And he's like, Yeah, did anybody take the placent out? And you could just see the look on their faces. And the nurse was like, just shaking her head. And I was like, This is me. They gotta learn somehow. So he was like, So this is what's about to happen, and you know, explained to me like they're gonna have to cut, and you know, and it was not just not a pleasant experience, but at the same time, it wasn't done with any intent. Right. You know, they were kind of and I found out like it was actually like the third day that one of them was in that rotation, because I guess they have to do different rotations before they pick a specialty. Um, it was the third day they had been on labor and delivery. So, you know, very new. You know everything that the books say, you know, but when you have to go put it in practice, and I'm like, they were you could tell that that hospital was so worried. They kept sending everybody in to ask me so many questions, and like people from like admin kept coming down, and I'm like, I'm I'm good, guys. Like it was, it was in not intentional, you know, like and that's seriously how I feel is because they didn't do it out of spite. I would ever say I can't trust a doctor because this one time this thing happened. No, they were they were trying to remember this is what we do, this is how we do it. It was chaotic, you know. I get it. Um and as long as my son was healthy, honestly, that's what I cared about. And you know what my doctor did? He made sure my son stayed healthy until the pediatric doctor got in there to take over. That's what I cared about. So if you have to make sure I stopped bleeding, that's fine.

SPEAKER_01 19:53

So in many ways, that it sounds like these are medical students, um, because that that would that would make sense if they were doing a lot of different rotations. But yes, in many ways, you would trust that doctor more because they said this is they could say in front of you something happened that wasn't supposed to, right? Rather than acting like, hey, oh, this is just business as usual. We're just going to redo a little stitch, right? Like so that I think about transparency again and that disclosure of something this happens. I'm sorry it was you, and we're gonna take care of you and your your child, and right like that, in many ways, even that disclosure of the error probably made you have more faith in that doctor.

SPEAKER_02 20:33

Exactly. And the fact that he was so open and he was like, you know, this is what we're gonna do. It's not gonna be pleasant, you know. He's like, Do you mind it? And he literally asked, Do you mind if they still stay in the room? And I'm like, absolutely. You know, why, you know, they're never gonna forget this. Like, why would I want them to not see? Exactly right. I just wanted to make sure, you know. I'm like, yeah, no, let them learn, you know. And and it I love him and we continue to use him throughout the family, people getting pregnant because that's just how he is. And he, you know, he's always very open. If you had a question about can I take Tylenol? Can I take ibuprofen? Can, you know, he would be like, you know, this, this, you know, whatever. And some of it he would even tell you if it came from personal bias, you know, like I didn't like when my wife was pregnant, I didn't like her doing this. Um, and it can be because, you know, it can detach a placenta or blah, blah, blah. And when I'm I was 19 when I was pregnant, I had an idea what a placenta was, but I wasn't actually when I was pregnant, I didn't realize how critical that was to keeping your baby alive and thriving. And he was so kind and patient that it ended up being so funny that he taught me all about this placenta that it was so funny that they left it in. And I couldn't help but laugh at the irony in my mind. Mom could not help but laugh at mine. Because my mom, of course, was explaining it to me, but I I wanted to hear it from my Obi, you know. Like I'm I'm like, yeah, my mom knows sure, but I want to make sure the information hasn't changed in 20 something years since she's had a baby. You know? And it's just so f funny because, like you said, like patient care and trust can be built where when mistakes are made. You know, but and it comes down to, like you said, the communication. You know, as long as you're open and you have that communication. And and like I said, he even asked, Do you mind if they still stay in the room? I get that. Some people might have might not want them in there. Me, I I want them to learn, you know.

SPEAKER_01 22:50

I think what you said also about the all the administrators coming down. I mean, that um I mean the truth is is that we're in a really litigious society and um and so there is this this fear of being you know blamed or s sued. I don't you usually if there's no bad outcome that that would be really unlikely. But um, but so I hope every patient can hear your story um and that wonderful, actually that wonderful demeanor and relationship you have with that surgeon.

SPEAKER_02 23:20

Yes. Um, and so to get back to some questions, what do you think are some common communication mistakes that parents make during medical appointments that can actually prevent them from getting the information they need?

SPEAKER_01 23:34

Yeah, so uh a couple things. I just saw somebody today. So sometimes parents um don't know, don't know what to present, right? So if you came to see me because your child was not sleeping well at night and was making noise and snoring, if I'll say, how long has this been going on? And you know, they might say forever or right. Like so sometimes the timeline is really vague. Um, if there have been other treatments or other surgeries, they're not exactly sure what it was. So it's not that you need to know, but it definitely will help your child if you are um, you know, if you have some idea of an actual timeline, what makes things better or worse, like is something that's been tried and and about when, you know, was it a last week, was it last month, or was it two years ago, right? Like so having some understanding of of what's what's gone on and how severe it is, like that, that definitely helps. Um, I think that helps helps direct care quite a bit.

SPEAKER_02 24:39

Absolutely. And we all know that sleep is so important, but with children, it can be more important. It well, maybe not more important, but it definitely aids in their development. How can these sleep issues affect a child's behavior, learning, emotional regulation, and just overall health?

SPEAKER_01 25:01

Yeah, this is the lesser-known issue with sleep. So we treat something that's called no, no patient or mom should know this term, but it's called sleep-disordered breathing, which is a fancy way of saying anything from snoring to sleep apnea, where kids are really pausing in their breathing at night. You know, the breathing actually pauses and they have to have a catch-up breath. And during those pauses, sometimes the blood oxygen level can dip or they can be holding on to the gas that we want to be breathing out, and that and that can um that can cause problems. So people know that snoring or these pauses can be abnormal, but what they don't necessarily know is that it the that disruption in sleep can disrupt so many other things. So, yes, it can make kids very tired and cranky during the day or difficult to wake up, but it can also make uh it can be related to why kids wet their bed at night beyond when they're supposed to be potty trained. And it can also present as symptoms that are uh commonly associated with like ADHD behavior, so difficulty paying attention in school, hyperactive behavi behavior or fidgeting or just general learning delays. And those are difficult to quantify sometimes, but usually moms know their kids, right? So they they uh they know what's going on. I will always tell families uh if there's something to treat, like, can I promise you that if we treat the sleep apnea that these behavior problems will go away overnight? No, I cannot. But um, but we know that they're related to each other. And so so that that well-being and the effect on learning is really more common than we think.

SPEAKER_02 26:41

Ah, yeah. And snoring in children is often really dismissed as like harmless or oh, it's so cute, they're snoring, you know. Um, when should parents actually be concerned? And what are some signs that might indicate something more serious is happening, like maybe sleep apnea?

SPEAKER_01 27:01

So um I I will tell you that so many parents will blame themselves for when they think that they didn't recognize something or they waited too long. So I want everybody, if you're listening to this, to stop blaming yourself because usually uh even if it takes a second to to assess, usually you know when it's time or to express a concern or when there's a problem. Some snoring can be normal and it can be temporary and kids can outgrow it. Uh, like a lot of two and three-year-olds will have some some degree of mouth breathing or heavy breathing at night, or will snore when they're sick. And um, it's problematic when kids are so restless in their sleep. Like people will describe the children being like sundials so that their child will literally move uh around the bed with the head in every single position because they can't get situated, or they'll arch their neck. Uh, they will, again, a lot of people will hear the pauses, or they'll hear kind of grunting and gasping, or they'll know something's going on in school, like the child's not doing well in school, or um, or you know, just think things aren't quite right. I mean, and people prioritize different things about ch their children's behavior and um and sleep. So, but I will have, I mean, I I have a mom who said I've had multiple parents say, I am afraid my child is going to stop breathing at night. Like they will sit there and listen to their child, they'll take a video and and watch these very long pauses and breathing, and then you know, listen to these terrible noises that they'll make. So um, so just to say now, sometimes just to say that most of the time you know, sometimes there are households where parents are on one end of the household and child is on the other and the doors are closed, and then you actually wouldn't know. So sometimes in like closer fit households or or in situations where we share rooms or sleep in the same room or s or same bed, we're more likely to notice. Um, you know, common scenario is oh, we were on a business, we were on a family trip and we all shared a hotel room, and that's that's when I figured out how much my child was having problems. So there's all sorts of different signs. There is a way to test for sleep apnea, which is called a sleep study. And they're reliable tests, but they are done in sleep labs, somewhere like across between a hospital and a hotel. Uh not really a hotel, but but you you know, you'd have to go there overnight and some and child gets hooked up to a bunch of monitors, and some kids do great with it, and some it's they're very difficult to get. And there might be other reasons why they're they're difficult to get if you have other children and you know, childcare is difficult.

SPEAKER_02 29:38

So oh, I totally remember when my son was five doing a sleep study for him. Um it was fun, but you know, they were super nice. They had like fans because my son's always been a hot sleeper, so we always have to have like a fan. So they had like fans. He was allowed to bring his like favorite blanket and stuffy, and um, they let him bring his favorite pillow, and um he just he was always hard to fall asleep anyway, and then being in a strange place made it even worse. But then once he fell asleep, oh, he was just racking it up, and when he wasn't racking it up, he was flipping and flipping and flipping and flipping and flipping, and like I guess the one, the lead got like they had to go in and like untangle one of like the little lead cords from around his foot. Um and he woke up and was like, huh? And I was like, I'm here, it's okay. And dude went back to sleep and then kept continued flipping. But you know, it it's one of those things where it took a while, but it was so worth it. It took, I think it took us like five or six months to actually get the sleep study. Um, and not for a lack of his ENT not trying. Um, his pediatrician even signed off saying, Hey. Uh, and at that time we were actually seeing a therapist too, because my son had been diagnosed as ADHD with ODD at five. And the school was requiring him to be on medication. And I'm like, I don't want him on these, like I at first they wanted to put him on like Ritlin. And it was like a high dosage. And I'm like, I I don't want him to be on something that's such a high dosage that can really alter his brain if we don't know what else is happening, you know. And his ENT was very good about when I mentioned, you know, his snoring was getting worse and worse. And I thought it was because he had a cold. And I thought, you know, when I was younger, not everybody got their tonsils taken out. So your tonsils would get swollen when you would go to the doctors and stuff, and they would say, Oh, mom, if she snores a little more, it's fine. Her tonsils are just, you know, making a different sound. So that's what I figured it was. And they were like, Oh, um, no, that's not what this is, you know, and and they helped with the sleep study to figure out that he had the sleep apnea. And it it's it does take time, but it's worth it to get the proper treatment. And it's like now my son is 15, he's not medicated. Um yeah, he still has some issues. And we he we did do low dose medication for a little while, especially throughout elementary school. Um but as he's gotten older and he's learned more coping mechanisms and we've gone through more behavioral therapy and things like that. Um, he's been able to completely wean off of it for the last three years and not need it. And now he's to the point where he manages his own grades, he manages keeping up with his own schoolwork and things like that. So, like I said though, it it takes time, and it started with finding the right doctors, and then the right doctors had to find the right test, and then you had to wait to get into the test. And so I totally understand because you want to feel confident as a parent that you're making the right decision for your child, and sometimes when it takes that much time, you're you kind of want a quick fix because you want to help your kid right away. But I always like to look at it like uh I'm not educated in ears, nose, and throats. Um, I didn't go to school for that. I'm not educated in looking at the brain waves of a sleep study. I didn't go to school for that. Um, so I think that if somebody's telling me, hey, we should we could look at this, and in the long run, this could really benefit your child.

unknown 33:54

Yeah.

SPEAKER_02 33:55

You know, that it's better to have the open and honest communication. Like, yeah, we're not gonna fix this today.

SPEAKER_01 34:01

Right.

SPEAKER_02 34:02

But in the long run, we're gonna fix this.

SPEAKER_01 34:04

So I'll tell you the sleep study discussion, that could be a whole other episode if you ever want to have it, because I have a lot of thoughts here. But we've talked to a lot of moms and asked them their experience with sleep studies and how hard it was to get. And you'll have some parents who said, I'm so glad that I had it because I needed that information that, you know, it helped me know that we're doing the right thing, exactly what you just said. There are some children who absolutely, if they, you know, they may not be able to get them, but they really should have a baseline sleep study. That's anytime the story is a little iffy. So if there were real behavior concerns and you weren't sure that's the right time, children who have obesity, children who have syndromes, like Down syndrome, like those are these are children that at baseline, very young children, children under three, like the baseline should have a sleep study. But a lot will say also what you said, like I always knew this was a problem. Like my child's been snoring the whole time. I didn't need the sleep study to let me know, right? And and we also know that some kids get lost to follow-up after a sleep study is ordered, just for exactly what you said. It just takes a long time, and then it takes time to either get a read or get back in. And um, and so sometimes it will actually delay delay the treatment. But um, but there's definitely a time and place for it. And for a situation, if if a family needs the sleep study for that information, it's always the right call. I was gonna tell you one other thing. You said the reassurance. I recently saw a patient, this is after surgery, we'd done um the removal of an adenoids. I talked to the mother, actually, she watched me. I said, I'm gonna write this down. I'm gonna tell people about what you just said. So she was so nervous when I saw her before surgery. Like I well, I was happy because I just heard him have the noise again because she was so sure she was doing the wrong thing. So I did the case and I came out and I was like, oh, there was so much tissue in there. I'm glad we did this. I really think it's gonna make a difference. And that relief, like she said, and she said to me, You just gave me a gift, right? Just that understanding that the findings were there and that the choice was the right one, and right, that she hadn't put her child at unnecessary harm was so it's so so important that they're like really knowing go going in with the right confidence that you're making the right choice for your child, it's just can't be overstated.

SPEAKER_02 36:30

Yes, absolutely. And speaking of that, you've studied both appropriate and unnecessary surgery and things like having the right testing done and surgeries and seeing the right providers can definitely give you the confidence that you are making the right decision. But at the end of the day, when we're parents and we're saying, hey, yeah, you can put a scaffold to my baby, at the at what at the 12th hour, you really start thinking, oh my gosh, did I do everything right? And you know, sometimes maybe there is an unnecessary unnecessary surgery. I know, for example, a friend who let their six-year-old get a nose job. Not for any medical reason like a deviated septum just because the six-year-old didn't like how bulbous their nose was. That to me wasn't unnecessary surgery for a six-year-old. Um I'm not the parent, but I would have said, if hey, if there was a deviated septum, I could have understood it. There's not. And she just likes to like be in TRs and dance around stages, don't get it. So that's how I look at unnecessary surgeries. Now I know you as a medical provider, you look at necessary and unnecessary a little differently. What have you learned about why some children receive treatments they may not actually need?

SPEAKER_01 37:53

I think um necessity is in it's so different for every family. So there are some situations where you know the child needs treatment. If your child breaks their arm on the playground, right, and their arm is broken in two, they actually have to have surgery to fix their arm, right? Or they something has to be done so that their arm gets fixed, so that it's less of a decision of is this, is this necessary? If somebody has really bad diabetes and their their sugar, their glucose level is just out of control, they need to have insulin, right? They need to have treatment. But there are so many situations where there are these gray areas, and I work in one of them where so much of what we do is elective, you know, based like it's your choice based on how bad the problem is, how long it's been going on for, and this is the key. What is the most important to you? So, like in the case of sleep problems, like we were discussing earlier, one family might say, I am really worried about my child failing in school. I'm worried that my child's gonna stop breathing at night. I'm shaking my child because I'm so scared for them. Another family might say, I can't have my kid take pain medication. I don't want to watch my kid in pain, or I will do anything to avoid my child going under anesthesia and or you know, or having a procedure, you know, we're some will even say we're really, we really would like to wait if it's an option. So um, so that's where I think like necessary surgery, a lot of times, yes, there are clinical guidelines, right? So in the case of if someone really had a cosmetic nose surgery, I I can't even understand how that that happens at age six, but that is that's probably in the unnecessary category, right? Just like you said, but um, but so many things, like if they if there are indications for it, it's really it's necessary if it's the right decision for the the right child, you know, at the right time.

SPEAKER_02 39:45

Yes. And what is one question that you would say every parent should ask during a medical appointment?

SPEAKER_01 39:53

They should ask, what would what would you do if it was your child? Okay, I'll just I will say that that is one of my favorite questions and my favorite new question. Um, in medical school, there was a there was a line of teaching that said, you shouldn't, as a doctor, you shouldn't be treating somebody like they're your child. You should be treating the the person in front of you based on who they are, which there's truth for that. But what that question does is it immediately forces somebody to pause and step into your shoes. I really try to take your perspective and sort of reduces that distance that you may have between patient knowledge and doctor knowledge, right? Like it just sort of gets to you both as people. So um, when I go to see my own doctor, I'm like, if we were in a decision-making vacuum, what would you tell me to do? Right. I really want to know unequivocally. Like, don't don't tell me what you think you want, you what you think I want to hear. I really want to know what you would do if this were you or what you think I should do.

SPEAKER_02 40:50

So yeah, I I I always love to ask my own doctor. I always love to be asked, well, what would you do if you're me? And she she always goes, Well, I can't tell you what to do. I'm like, but that's not what I asked.

SPEAKER_00 41:03

Right.

SPEAKER_02 41:04

I asked, if you were me, what would you do? And I'm like, so we're not gonna play semantics because I didn't say you were me and you were telling me what to do. But acting like she's wonderful.

SPEAKER_01 41:17

Kayla, I wish everyone were as direct as you. And if anybody is listening that can actually, you know, really set really ask those questions of of of really driving home that engagement, you know, what what should what should I be doing, or what do you think? I think the most important thing is backing it up with a why. I do that more now, and I that's because I've been practice for two decades. There is there is a little little experience involved, but I will look at somebody if they say, What should I do? And I and I think taking everything we've we've just talked about and hearing what is important to you, this is what I would recommend and this is why. And then that that that also allows this moment to check my assumption, right? Did I make, did I, did I, did I read the room right? Which is always possible that I didn't, right? Like, and so so uh so really if if you as a mom can can reverse that language and really make sure that you have expressed what is the most important to you, what your what your biggest fears are, and let somebody tell you why that, you know, why why we can help or or or why that might be a a different line of thinking.

SPEAKER_02 42:27

Perfect. And I've got two more questions for you. This one is gonna be a fill-in-the-blank. Finish this sentence.

SPEAKER_01 42:34

The best healthcare decisions happen when the best healthcare decisions happen when the mother or when the mother and the patient uh say what is most important to them. Perfect. Love that.

SPEAKER_02 42:55

And you know, it it seems hard, right? Because a lot of the times parents can feel like what is what sort I'm looking for. They can feel like intimidated by doctors. Um, and sometimes doctors come in and they have such confidence and authority, and you're just like, oh, oh, oh, okay, okay, okay. Um, I think it's I've been a mom for a long time now. As time goes on, you kind of get a little bit more experience. Like you said, with your career, you've got more experience behind it. Same thing with parenting. You get a little more experience when you're dealing with different providers and doctors. And it it's a little easier to be like, hey, you know, that's not what the goal is here. Or that's not the direction we want to go in. You know, what are some other options? It it's easier to do that, you know, as time goes on. But I think it's also important it shouldn't matter if you have a newborn or a eight, 16, 17, 18 year old. As a parent, you Should still advocate for your child. And if you feel like you can't say, excuse me, I don't think we're understanding each other. Like I think maybe like we're missing something. This is what I want. Then you need to take somebody to the appointment with you who can articulate that for you. Um, and I think that that's really important because I do see that with a lot of young moms, um, just friends and family that they're like, oh no, but the the doctor knows, and I'm like, yeah, yeah, the doctor knows, but did the doctor know what you were actually saying?

unknown 44:34

Yeah.

SPEAKER_02 44:35

Because everything you just told me was not what you told me before you went to the doctors. So you didn't tell the doctor the right thing. So they didn't treat the right things. So how does that work?

SPEAKER_01 44:48

I can't say this is every, I can't say it's every dad, but I will say the number of times somebody will come in, they don't even look at me. They're like, okay, she said this, and then she said to ask this. Like they're they were like leading from they're reading from the list of of what's going on. And uh there's also a fact of people I'll walk in and maybe there's a and this isn't fair because a lot of dads are really engaged, and I'll walk in, I'll say, What's going on? They're like, nothing. And I say, Why are you why are you here? You know, why are you at the agenda? Like, don't know. Just a checkup, I guess. And so then and then I'll get a call later. So I think that's pretty funny. I was I wanted to say that my runner-up question for the the question that every parent should ask was going to be, what are my options? So you said it for me very well, but you usually there is more than one option.

SPEAKER_02 45:41

Yeah, and providers, they don't, no matter how confident a provider is when they walk into that room, they're there to provide care. So I think one of the biggest things we can put out to parents today is don't be afraid to ask, what are my options? Don't be afraid to articulate exactly what you are experiencing with your child or that your child is going through in the direction that you would like to be at, whether it's today, tomorrow, next week, or in years, whatever that may be. Um, because the provider can't treat what and give you the put you in the right direction if they don't know the right path. It's like getting somebody an antibiotic for strep throat when they have like bronchitis. It's not the same thing. You know, we treat these things differently. So I think that that's really important to to just get out there. But if every parent listening today could walk away with one piece of advice about trusting their instincts and partnering with their child's healthcare team, key word, partnering with, what would you want them to remember?

SPEAKER_01 46:48

You just said it for me. I think that's what I want that everyone to know is you can trust your instinct and you can trust medicine. And those don't have to oppose each other, right? You had such a beautiful story about your experience having a baby and even there being an error, right? Like you can trust when something is is off. You can trust yourself to say what you need to, what's most important, what you're scared about, like what you need to do for your child, and you can still respect and trust the institution of medicine and you know, like and and ask questions when you're not sure. So I all of that can happen in the same room.

SPEAKER_02 47:28

Absolutely. Well, where can the listeners find out more information about your research and just more information about you, what you've got going on?

SPEAKER_01 47:37

I'd love anybody to follow me on my website, dremilyboss.com. You can see a lot about our research lab, the boss lab, but all the work that we've done on communication and making decisions in medical and surgical care. Um, we I do a lot of advisory work with organizations and family organizations to try to help people communicate and make decisions for their kids.

SPEAKER_02 48:01

Perfect. And we'll make sure that we put that link in the show notes. So if anybody didn't catch that, dremily boss.com, it'll be in the show links. Just scroll down and you can click on it there. Well, thank you so much for joining us today. We really appreciate it.

SPEAKER_01 48:14

Kayla, thank you so much for having me.

SPEAKER_02 48:21

Well, that's it for today, you beautiful caffeinated disasters. If any of this resonated with you, hit that follow button. And if you would, please leave us a review. It really helps other tired moms and dads find the show. And if you want to become a supporter of the show or just keep us caffeinated so we can keep bringing the chaos every Tuesday, head over to our Buzz Prout page at mom's brain is a coffee stain.buzzprout.com. Even a couple bucks means the world and helps us keep the coffee and the show flowing. Now you can become a subscriber of the show and get access to new episodes two days early. And don't forget, check us out on social media. You can find us everywhere at mom's brain is a coffee stain. Or slide into our DMs. Email us your best no guilt hacks, cringiest mom moments, or episode requests at mom's brain is a coffee stain at outlook.com. And guys, head over to check out Dr. Boss's work on her website, dremily boss dot com. We will put the links in the show notes. Well, if you'll excuse me, I'm off to go clean the grill. That I told my husband I would do yesterday. Well, love y'all. Mean it. Go sift one for us, and we'll see you next Tuesday.