Transcript for
Responding to child anxiety in general practice

Narrator (00:02): Welcome to the Emerging Minds podcast.

Jocelyn Marsland (00:07): Hi, I’m Joss Marsland. And welcome to this episode of the Emerging Minds podcast. Today, I’ll be chatting with Dr. Dr Andrew Leech, who’s a GP based in Perth. Andrew holds a medical degree from the university of Notre Dame in Fremantle, attained the FRACGP fellowship in 2014, and completed the Child Health diploma through the University of Sydney. Andrew has an advisory role within the RACGP and Emerging Minds. He works as an educator for medical students and GP registrars, and is the host and creator of the Kids Health Network podcast.

(00:37): This year, Andrew was selected to be part of the WA health clinical advisory group task force, reviewing mental health care in children, a review that is still ongoing. You may remember Andrew. He spoke most recently with us pre COVID about bio psychosocial formulation and child mental health, and the key phases of a child mental health assessment. Today, Andrew joins us for a conversation about paediatric anxiety.

So hi, Andrew, and welcome back to the Emerging Minds podcast.

Dr Andrew Leech (01:04): Thanks Joss. Thanks for having me again.

Jocelyn Marsland (01:07): So, as I’ve said, you’re no stranger to emerging minds and certainly not the Emerging Minds podcast. But it has been just a little while since we last chatted. What’s it like being a GP in the time of COVID?

Dr Andrew Leech (01:19): It’s been interesting. It’s been challenging. I must admit being in Western Australia, we’re a little bit immune to it all in the sense that we don’t have as many long duration lockdowns or challenges with missing school and things like that. But are certainly still seeing the effects of COVID around children’s mental health and that’s made our workload a lot busier. And for some unknown reason, we are a lot busier, just people coming in a little bit more, maybe a bit more concerned about their health overall. So it has been a different period of time that’s for sure.

Jocelyn Marsland (01:50): Yes. And how about discussions with your colleagues that you might be in touch with in Sydney and Melbourne who have really been touched by the advent of the COVID pandemic?

Dr Andrew Leech (02:00): Yes, we’re certainly hearing out of those states that mental health in particular has been a concern for a lot of people, adults and children, and that’s completely understandable going through significant change in their life missing school and, and being at home. And for a lot of kids that’s challenging and losing that social interaction is very, very challenging. For some kids it works quite well being at home and having that one to one attention. And then I think I heard a report that NAPLAN scores were probably the best in the country in those states that went through lockdown, which is sort of strange in a way to hear. But yes, I certainly know that anxiety and mental health has been very difficult in GPS practises across the Eastern states. So from them, we’re here a lot of those sorts of challenges.

Jocelyn Marsland (02:45): So we’re here catching up to day to talk about paediatric anxiety, which feels very timely given what we’ve just discussed and what families have experienced over the last 18 months or more really. So we’re coming up to almost the two year mark since COVID became a thing. And it seems there is a very real increase in children presenting with anxiety related issues. Can you tell us a little bit about the prevalence of paediatric anxiety and also whether you think this can mainly be attributed to the COVID 19 pandemic? Or is that just one of a number of contributing factors?

Dr Andrew Leech (03:16): Yes, so I don’t think COVID has necessarily increased anxiety disorders. It’s impacted children in sense of anxiety being a little bit higher. It may not have increased the numbers though. And we’re yet to find out about that data anyway. And this may be fleeting. It might be anxiety as we’re experiencing these lockdowns and changes in our lifestyle and over time as we are released into more freedom, the anxiety settles. So time will tell what’s actually happening with data and numbers. And we’ve had anxiety long before COVID. It’s been recognised that it’s been a concern in children long before COVID. So, already it’s something that’s been looked at.

(03:56): And I was looking at the Young Minds Matter survey, and that was back in 2014. And they looked at data across all the age groups and found around 7%, 6.9% of children, were affected by anxiety disorders, such as social phobia, separation anxiety, generalised anxiety, and OCD. That’s not much when you look at it, 7%. It’s not that many. It equates to about the second, most common mental health disorder. But the most common in girls. And the number the one on their studies was ADHD actually, which I had never thought of as a mental health disorder, but that was their number one. And then anxiety came in second. It’s about 278,000 Australian children.

(04:35): So I guess when you look at the numbers it’s a lot of children that had a diagnosable mental health condition, such as anxiety. Now that’s across four- to 17-year-olds. As you look into older age groups, it definitely becomes more prevalent. And I guess that makes sense. So the teenagers, the 11 to 17 year olds, it goes up to 20% of teenagers. So it is much more significant and impacting those older age groups. And I think we can explain, plenty any of reasons why that might be happening. And I’m sure we’ll talk about that today.

Jocelyn Marsland (05:04): So it strikes me as quite a complex thing to discern between the behaviours and emotions that are just those normal parts of growing up, and those that might indicate that a child needs some further support. We all experience a range of emotions, including the not so enjoyable ones. Could you tell us a little bit about what guides you in this process when you’re working with children and families?

Dr Andrew Leech (05:24): Yes, that’s a key point, Joss, is that we all experience anxiety and I think that’s a key take home message today is, anxiety’s actually a really normal feeling, a normal emotion and something that we all experience from time to time. And I like to explain that to children and normalise it in a way and help them to feel comfortable to talk about it. Because just as with any other emotion, it’s something that helps us. If there’s something dangerous happening out there, we need anxiety to warn us not to do that thing or go near that thing. So it’s actually part of how we interact with the world.

(05:57): Now, in terms of recognising it as a concern in children, it might be that it becomes more persistent that the feelings become more persistent. They start to develop into more irrational fears around certain situations. Specific situations like going to school might become a really daunting process. Or even just going out to the shopping centres. Lots of crowds and people, might become really daunting and occur time and time again. So we start to look at patterns of those sorts of feelings and behaviours in terms of working out if it is an anxiety disorder or if it’s just that day to day experience of anxiety that we all have when we are worried about a situation.

Jocelyn Marsland (06:34): And it’s such an interesting cohort as well, that birth through to 12. There’s so many different stages of development through that period of time and quick succession as well. Can you tell us a little bit about how these presentations might differ between, say an infant to a toddler and from a toddler to a primary school aged child?

Dr Andrew Leech (06:53): Yes, I can. Across the board, there’s probably some similarities. But definitely through age groups, you would notice differences as well. And I guess if the GPS listening, it’s important to recognise some of those early signs in those young kids that come in when we are doing those immunizations, for example, those early age groups. Just checking in on parents and children who might be having a bit of a hard time.

(07:17): So in the infants it’s probably more around the behaviour of that child. And I’ve got a couple of younger kids that I see that do really struggle to be left alone, and that impacts bonding. So they’re crying often. They don’t like to be left on their own for sleep. They’re really attached to mum or dad and may then affect feeding and that connection with the parent. And look, I’m really wary of over-diagnosing and over-labelling children. And we like to let things just have some time to see if they self-settle because quite often it’s a phase and it’s a period of time that’s difficult.

(07:52): And with infants many parents go through challenging times with infants where children just do not settle and cry all night and all that, and that’s quite normal. But if it is persistent, it affects the whole family, and I’ve had many families really, really struggling through that period of time with no sleep and difficulty settling and a really, really unsettled child.

(08:13): So you might start to think about anxiety in that setting and would also have a chat to mum or dad around their mental health as well. And we know that they’re intimately linked, the child and parents’ mental health. So if a child’s not settling, perhaps the mother or father is also having a hard time or there might be something difficult going on in their lives. So take the two together, the two stories and symptoms and feelings and emotions, and then try and put it together in terms of working out is there a problem here? Is there a mental health disorder happening?

So I think with the infant it can be quite vague and my answer’s not that clear cut. There’s no key symptom that would be linked to anxiety disorders. But certainly, the most common would be that unsettled infant and the infant that has difficulty separating from a caregiver.

(08:59): And then moving through to toddlers, probably quite similar. The unsettled toddler, the toddler that has, the key word that we’re using at the moment is emotional regulation. So it’s quite a buzzword. The toddler that has difficulty with emotional regulation. Now that’s pretty much every toddler. But the one that really, really struggles with…parents come in and say, “Frequent, epic meltdowns where they really cannot regulate their own feelings easily.”

(09:25): So, that might be the toddler that’s being left at a daycare centre that just can’t separate from their parent. They are very clingy, very attached, very emotional. And a parent often has to end up staying with them. Through to the toddler that cannot, does not, understand the word “No.” And falls in a heap and screams and kicks and all that sort of thing. Again, this is quite normal behaviour for a toddler. Is it persistent though? Is it happening regularly and frequently and across perhaps weeks to months and not really something that is sorting itself out over time? Maybe then we become a bit concerned. Is it affecting the parents’ mental health? Once again, it affects the whole family. And again, we’d want to ask some of those questions.

(10:10): There are also toddlers do often have fears and fears of nighttime in particular. Fears of dark, fears of losing their family, fears of losing their parents. And I certainly see that quite often. And it might be something that’s a phase and we just have to follow it up. Or it might be an anxiety disorder that’s emerging in that toddler.

With primary school children, so moving up to the older group, it’s much more varied in what they might show. And it’s probably more now moving into those diagnosable anxiety conditions, such as OCD, such as separation anxiety disorder, and generalised anxiety disorder, which are the most common in that age group. The child with obsessive compulsive disorder might really struggle with routine and break of routine. They’re particularly obsessed about having everything lined up in order.

(11:01): I’ve got a couple of kids who struggle with sensations. So sand in their shoes or dirty feet or dirty environments that leads them to having panic, a feeling of unease. And children with separation anxiety disorder basically cannot separate from caregivers. They can’t be dropped off at school. They have to be with their parent as much as possible because they really genuinely feel that that parent is going to never come back. So, that’s probably a brief summary across the life spans. Hopefully I’ve answered that question.

Jocelyn Marsland (11:34): No, that’s great. So it sounds a lot like the regularity of all of this occurring is such a major factor as well.

Dr Andrew Leech (11:40): Yes, that’s right. So it’s the pervasiveness. How much it impacts that child’s world and ability to function in that world. So such as going to school or sleeping or bonding with their parent. The persistence. So how persistent it is. Is it happening every day? Is it happening every few hours? And then the duration. So is it going for more than a few weeks? Or is it just going for a short period of time and it’s pretty much explanatory around their age group. It’s something that we’d see in a toddler normally, like a meltdown. Or is it going over weeks and weeks and months and months, and it’s just not settling?

Jocelyn Marsland (12:17): So you mentioned earlier, GPS are really the first port of call on a number of different primary health related issues that families might be experiencing. And also the kind of routine checkups that babies have et cetera. So you really are seeing families in all their shapes and forms from a very early age, right through. When it comes to paediatric anxiety, what guides you in making a decision around when a child actually needs further support? So involving a developmental paediatrician or a specialist.

Dr Andrew Leech (12:49): Yes, I’m quite passionate about this in the sense that GPS are at the forefront of helping families deal with not just emotions, but mental health disorders as a whole. And I think we get a reasonable amount of training in mental health that at medical school and GP school. But in terms of dealing with families and children, it’s fairly limited. So GPS may lack a bit of confidence in seeing children presenting in this way and not really know where to turn to next. But I think we’re good at it. And we can listen and we can talk to families, even if we don’t know what to do next.

(13:23): And the other benefit of being a GP is that we can follow families up over time. So we might not know the answers in the first instance, but we can see them again and check in on them and make sure they’re okay. And we call that holding the family. So we can really just keep that follow up going. And in itself that is therapeutic to families. Someone’s actually listening to them. Someone’s actually getting their story down and checking in on them over time.

(13:45): And as I said before, anxiety may ease over time. It might be all they need is just a little bit of support and tweaking rather than a full intervention. If that family continues to come back and report difficulties across school, across home, across the family unit, and those challenges are becoming not sustainable, but if the family’s not coping at all, then I might start to think about what we could do next. And I have a number of things I will do myself with the family, which I’m happy to talk about a bit later, that might just buy some time.

(14:19): At the moment, and we were talking about COVID before, at the moment, since COVID, one of the biggest problems is actually getting the help we need. So developmental paediatricians in Western Australia, very difficult to get in. I’ve had families saying they’re ringing 30 paediatricians to try and get an appointment and still not be able to get an appointment. So there’s a real limitation on getting the help we might need quickly. And it’s important that families remain patient and try and do things that help in the meantime.

(14:46): Psychologists might be a better point of call to start with, maybe a little bit more accessible. So if there is a criteria met for an anxiety disorder, we could use a mental health treatment plan to involve a psychologist or an occupational therapist. And occupational therapists work really well as well, especially for the younger children. So we could involve either and collaborate to create a bit of a team to help with that family.

(15:09): If it may not be as clear cut as that, and we just need some local support, then I draw on the child health nurses. They can be really useful. Then we’ve also got some other baby units around in Western Australia. I know across all states, there are units that help with admission for a period of time, if there is a mental health diagnosis, in particularly more severe end for the mother. And so that would help. Or there are also some sleep units around, both public and private, which can support around the sleep side of things. And they can do day admissions or four, five-day admissions, which can be really helpful while we’re waiting for more longer term support.

Jocelyn Marsland (15:50): I really love that concept of holding the family. It strikes me as really so important, navigating that whole process, especially if you are having those wait times for the specialist support.

Dr Andrew Leech (16:02): Yes. That’s an Emerging Minds concept that came up when we did some of these modules. So they could be proud of creating that term and I’ve used it many times. So I find it explains exactly what GPS do, we hold families.

Jocelyn Marsland (16:15): Absolutely. So we’ve chatted a bit about why the prevalence of paediatric anxiety might be increasing and also some of the signs to be looking out for in children. And I feel like you’ve touched a little on what I’m about to ask, but could we take it a little bit deeper and just talk a little bit about some ways to support and treat children who are experiencing anxiety?

Dr Andrew Leech (16:36): I might need to backtrack a little bit as well. With the signs and symptoms with children, that they are often very different to what we see in adults in terms of anxiety. And so you have to be a little bit more open to thinking about anxiety in children that present with physical symptoms. And more often than not, they are presenting with physical symptoms.

(17:00): So I had a child the other day, they presented with chest pain. And the main thing I’m thinking about first is, is this something to do with their heart or their lungs? And screening those things first. But as we did that, we started to open up that this child’s actually suffering from anxiety around different parts of going to school. And it takes those questions to figure it out, because the child doesn’t know. They don’t know their worries leading to chest pain. But the more common ones are tummy pains and headaches and those physical feelings of being a bit breathless, being a bit tight in the chest or having muscle aches and feeling a bit sick. They’re the more common symptoms in children, I would say in terms of presenting with anxiety. So GPS just have to think broadly.

(17:42): And then assessing those children. Well, make sure it’s definitely not medical and I guess that’s the first step, and we are good at this. Examine them, check them over, make sure there’s nothing going on. But use open ended questions and I’ll put it back to the child. “Is there something at your school that might be upsetting you or worrying you or leading to this pain that you’re experiencing?” And children are pretty good at saying, “Well, yes, actually there’s this difficult child that I’ve been interacting with or I don’t like my teacher or I hate going to school.” They’re pretty good at explaining those sorts of concepts without actually recognising the link between the physical symptom and the worry.

So what was the question? I’ve probably gone off track now. Supporting children and treating children. So before I said, tweaking the way the child is, for their world. So I look at the key concepts of things like sleep, diet, their interest in school, their interactions with their family and friends, their social media use and their family situation. So I might start with just trying to explore those areas.

(18:48): So sleep, for example, if a child’s not sleeping properly, they’re going to have big emotions and difficult emotions, especially if it continues over time, it’s not going to help their overall mental health. So this is an area that I would explore really early on and try to manage as best as possible with sleep hygiene. Really just having a good wind down routine. One important area of this is to make sure they’re not using technology after dinner. So we set a timeframe of say a couple of hours. There are good studies now to show one to two hours of no tech before sleep improves the sleep quality of the child. And that includes iPads, TVs, and phones and all of that.

Jocelyn Marsland (19:28): It’s probably so true of adults as well.

Dr Andrew Leech (19:32): Yes, yes, yes. We could all take this advice. And that helps the melatonin, which is that hormone that helps us feel sleepy. That helps that to produce more if we’re not using the screens. So we start with that using a really good wind down. We might have meditation, they might do a massage or just playing with Lego or drawing or really quiet activities helps to calm the mind before bed. And then reading and going to bed in that relaxed state helps sleep. If they’re struggling, sometimes we look at things like additional melatonin, medication prescribed, but that’s up to the GP to work out depending on the extent that sleep’s been difficult. So small tweaks with sleep.

(20:12): Diet is the same. I usually ask those breakfast, lunch, dinner, morning, tea, afternoon tea, what are they eating? And there’s often something that can help. A lot of kids aren’t eating breakfast. So I would suggest a good, healthy breakfast. A great way to start the day, to help build those good chemicals in the brain we need healthy nutrients and diet.

(20:31): Looking at diet and then those other things like are they spending hours on the weekend playing computer games or are they on their phone using social media as they get older? These things are common and expected and helpful for kids that need that time out. But overuse may trigger off anxiety and worry and fast brain activity. So can we cut back on that somehow? Can we limit the use of those things? Can we spend more time outdoors? And often enough kids just aren’t getting outside enough and need to go outside to wind down. So it’s a great way to regulate emotions, to spend time outside playing.

(21:09): So there are a few ways I might manage it in the first instance in a GP level, GP setting, as well as along the way, supporting parents. So mum and dad as well with their own mental health. But I guess as I said before, if those things are just not shaking, they’re so persistent that nothing we do necessarily is helping and we know that it’s impacting their learning and their ability to progress, then we need the referral onto those support services.

Jocelyn Marsland (21:36): Yes. Great. Thank you. Has me thinking about parents during those very long lockdowns in the Eastern states and how they were able to manage screen time and television time and be able to get to the great outdoors as well. Must have been very difficult.

Dr Andrew Leech (21:51): Very difficult. Yes. And totally understandable. You really just can’t avoid it. And I know at schools, even now, even without lockdowns, screen time is huge. Kids spend all day on the iPads, so it’s unavoidable and we can’t be too hard on parents, just doing what they can to get through. And for some parents it means having the child watching TV while they just take a break. And I completely understand that.

Jocelyn Marsland (22:17): Through all of this, of course, you’re not just working with the child themselves. The relationship with the child’s parents and carers is a really essential part of the process too. How do you go about having these discussions with parents in a sensitive and helpful way? And in ways that ensure the child is involved?

Dr Andrew Leech (22:33): That’s a really good question. And this can be one of the hardest parts of being a GP, interacting with everyone when you are already a little bit time poor and extremely busy, in a sensitive way. Being able to manage the family as a whole. I guess that idea of follow up and just touching base with them. Just let asking them if they’re okay and letting them know that you’re there for them. If a child’s there for a standard check-up and I’ve noticed that there might be something going on, it would be, “Look, do you want to come back and talk to me in a little bit more detail on your own?” Get the parents back for a separate appointment so that we can chat more freely without the child listening in on all those detailed parts of the discussion.

(23:14): I’m wary of children listening. And I don’t want them to feel like something’s wrong with them. I don’t want them to feel like, “Oh my goodness, there’s all this going on. What’s wrong with me? I didn’t realise I was in this much trouble.” In fact, it’s quite the opposite. I want children to recognise that, “Hey, I’ve picked up that this is going on and I hear you and I validate you.” And it’s a good point for parents as well to know it’s okay to talk about these things in general terms. You’ve got big emotions, got big feelings, you’ve got worries going on. I get it now. I understand what’s going on. And we’ve figured out that it’s this issue that it’s because you’ve had to move house or it’s because your grandparent died or it’s because you’re being bullied at school. There’s a difficult person at school. Or you’re not really not liking or connecting with school. So, just the fact that we’ve validated those things is enough for children, I think, to be understood and listened to.

And then from there if there’s more detail, like the parent wants to talk about some stuff that’s going on at home, there’s separation issues or there’s some really big things going on, there’s some big arguments, then I get them to write it down or come back as a separate session.

(24:23): In terms of talking to children about anxiety, it depends on the age group. So the younger age group, I might just get them to draw how they’re feeling or to label their feelings as a colour, or to talk about their anxiety in their own words. I might put out some ideas. Is it worry that you’re feeling? Or is it being scared that you’re feeling. Or is it nothing? Are we just reading too much into this?

And then for the older kids, we can talk a little bit more about anxiety itself. If they’re experiencing stomach aches or headaches, do you think this might be your mind that sending those worries to your tummy? Do you think there’s a bit of a mismatch going on? Is it something going on at school that we need to talk about? So it might be open questions, it might be normal things a little bit. And then validating the child, getting the parent back if we think it’s a bit more complicated or complex, and doing those regular follows.

Jocelyn Marsland (25:15): Yes. Sure. And do you ever experience any resistance from parents around children’s mental health, anxiety, and that kind of thing?

Dr Andrew Leech (25:23): Yes, like I said before, I think we don’t want children to feel like there’s something wrong with them. We want them to be supported and embraced rather than made to feel like, well, you’re different to everyone else because you’ve got an anxiety disorder. So in sense of that, parents are often a bit cautious about how we talk about these things and I completely get that. I think it’s important we don’t overreact. But we don’t want to miss it either. So it’s a fine balance between getting them the help they need when they need it and not doing too much too soon.

(25:56): Involving a psychologist, it’s not a small thing. We have to do that big referral with mental health care plan, which is about 30 questions around their emotions and the screening questions around how well they’re feeling. It more works towards the unwell model rather than the things that they’re actually good at and passionate about and doing well at. So it works towards their disabilities rather than their abilities. And I love to touch base on their abilities as we go through this, and what is actually working for them. So I guess there is resistance but with a little bit of gentle support and working through it over time, I think parents are pretty understanding these days that psychologists can be helpful tools. And that it does provide a lot of support for them as well.

Jocelyn Marsland (26:42): Yes. Thank you. So, as we’re chatting through this, it really is making me think about the GPS and families in Victoria and New South Wales, particularly when they’ve endured months long lockdowns and the huge impact of those restrictions on everyday routines and the usual activities that family might be getting up to together. So now we’re in the state and earlier we’re across the country, we’re moving to opening up and that comes with its own excitement, but it also comes with worries as well. What is your advice for GPS working in this space when they’re chatting with parents about things like the transition back to school and living with COVID in the community?

Dr Andrew Leech (27:19): I think it’s hard because I am in a state that has not had to endure such a hard time. But I think GPs are pretty good at this already. And given they’ve gone through it in their own lives, they’re the ones that are living there, a lot of GPs have school aged children, so they can absolutely relate to what parents are going through and bring their own story to it.

(27:40): But getting back to normality, I think that’s really important for kids. Getting back to routine, getting back to seeing their friends, going to school and getting in that learning mode again. I think it will take time to adjust and GPs and families probably need to be patient and just say, “Look, let’s just see how things go and just take it easy and do it a step at a time, a day at a time, to getting back to that normal life.” And not jump onto the bandwagon too soon. If there has been some difficulties going back to school, because I assume that that’s going to be the case.

(28:09): It’s a little bit overwhelming. Wow. I’ve been out of school for six months and now suddenly I’m going back to all these people. It’s a big jump and it’s a big step. I would expect that some kids will struggle with that and find that quite daunting. I would personally find that hard if I’d been home, working from home for six months and then suddenly had to go back to a busy office. I would find that hard too. So we just tread carefully, go gently, do things in their own time. It might be doing things in small steps and building them back into school gradually and letting the teachers know that they are quite sensitive and finding it quite challenging.

(28:44): If it’s prolonged, if it seems to be more around catching coronavirus because it’s everywhere, you can’t avoid the media around this topic. And if it’s around germs and it’s developed into something a bit bigger, it still might need that psychological intervention regardless. But I imagine just as it is here, over there getting a psychologist is probably going to be a delay and a wait. So probably an early referral would be warranted if that’s something that they thought was going on.

Jocelyn Marsland (29:13): So I’d just like to pick up on a point that you made earlier on in our conversation, which was just around training and information on children’s mental health. Being good whilst you’re going through your training, but then there not being that much out there once you’re qualified and are out working with families.

(29:30): So Andrew, the last time you joined us on the Emerging Minds podcast, you were here to chat about our online course, which is called A GP Framework for Child Mental Health Assessment for Children, age five to 12, in which you consulted with us on. And we’ve now just released a version which focuses on infancy and early childhood up to five years, which you were also part of creating. What I’m interested in is I’d like to talk about some of the key takeaways from these courses that might support GPS in this work. And also if you have any other recommendations for GPs want to upscale in this area.

Dr Andrew Leech (30:02): Well, I definitely recommend doing these courses. I’ve done them myself after even helping to contribute to them. I find them really helpful. The great thing about them is they’re based around quite real, realistic cases, which have been videoed and acted out with children. And those cases are cases you will see in general practise probably every week. The unsettled infant, for example, is one we’ve already touched on today. So these are realistic cases that you can work from and gain insight into. And then also some tips and strategies around how to interact with those parents and families and manage them using some question as prompts. I strongly recommend doing these courses.

(30:45): Just in general terms, there is a resource for parents, it’s called The Brave Programme and it’s free, it’s accessible. And if you’re waiting for some help from a psychologist, that might be a good breach that GPs can recommend to parents. And it’s for children. So the child completes the course. It’s cognitive behavioural therapy. It’s evidence based and it’s pretty straightforward to use. And I think it was the University of Queensland that brought this out. I always recommend The Brave Programme, especially for the mild to moderate anxiety cases that we just need something to help us in the meantime.

(31:20): Some schools also have counsellors and psychologists just that can be useful. Or even chaplains. And it may be as simple as just having that person, that regular contact for the child while we’re waiting. Because I know that this wait time is a little bit difficult at the moment. We need as much as we can to help us in that gap in between.

(31:37): The other website that’s quite good is Beyond Blue. For anxiety, they’ve got some step rise approaches to dealing with anxiety. They call it the step ladder. So just taking steps to get back to that normality again, especially coming out of lockdown. So Beyond Blue has some really good stuff on there. And also the Raising Children’s Network is another really good resource. So if GPs are wondering what they could recommend to parents while they’re waiting, have a look at those websites.

Jocelyn Marsland (32:05): That’s great. And what we’ll do is include those as links on the website for our listeners.

Dr Andrew Leech (32:07): Thanks, Joss.

Jocelyn Marsland (32:07): Well, thank you so much, Andrew, for bringing your insights around child anxiety or paediatric anxiety to us today. It’s been a really fascinating conversation and really appreciate your time.

Narrator (32:18): Visit our website at www.emergingminds.com.au to access a range of resources to assist your practise. Brought to you by the National Workforce Centre for Child Mental Health. Led by Emerging Minds, the National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health, under the National Support for Child and Youth Mental Health program.