Welcome back to ParentData. I am very excited to be joined today by Kelly Fradin, who wrote a new book called Advanced Parenting: Advice for Helping Kids Through Diagnoses, Differences, and Mental Health Challenges. I think this book is a must-read for any parent struggling with a complicated parenting problem. And as Kelly describes in this conversation, it’s also a book for every parent since all of us face the challenges of advocating for our kids at one point or another.
Her book is full of tools and resources that will help you manage the stress and navigate the business of care. And we’re going to cover some of her top tips in today’s conversation. You can order her book Advanced Parenting and check out her website at drkellyfradin.com for more, and now for today’s interview.
Emily Oster:
So, I am thrilled that Kelly Fradin has joined me here to talk about her new book Advanced Parenting. And before we get into it, I would love you to just introduce yourself. Tell us who you are.
Kelly Fradin:
Hi. So I am a pediatrician in New York City and the mother of two kids. I have a five and a nine-year-old. And in my career, I’ve done a lot of different things. The academic medical center, I took care of medically complex children and their healthy siblings.
Then, I did some work with the Public Health Department, like a safety net for children with chronic conditions in the South Bronx. And now, I’m in private practice at a place called the Atria Institute. So I’ve kind of taken care of families in all sorts of different settings, and as a child, I had my own challenges too.
Emily Oster:
Amazing. So the title of this book is Advanced Parenting: Advice for Helping Kids Through Diagnoses, Differences, and Mental Health Challenges. And I thought what’s interesting about writing a book like this is effectively you are writing a book that you hope people will not read. I mean, given that what you mean by advanced in the title, we’re all hoping to achieve beginner parenting.
But of course, on the flip side, if people do need the book, it’s incredibly important. I think it’s an extremely useful book, and I’ve actually tried to send my advanced copy to several people, but then I needed to keep it. But I wonder if, in light of that, you could talk a little bit about why you chose to write this book and maybe a little bit about how your experience drove it, either your personal experience or your professional experience.
Kelly Fradin:
Yes. Well, what I would say is that part of why I called it Advanced Parenting is because I wanted the title to be at least somewhat positive. Because yes, when your children have challenges and diagnoses and difficulties, it’s hard. But it’s also a universal part of being a parent that, at some point, your child is going to have something that you’re at least going to wonder, “Should I get professional help for this or not?” Maybe they just have a difficult temperament, and you’re not sure if there’s an underlying developmental delay or diagnosis there or maybe this sleep problem that isn’t responding to the beginner parenting book tips.
Emily Oster:
That’s like my book. I’m like the beginner parenting book. Okay, yes.
Kelly Fradin:
You’ve read all of your books, and you’re still having troubles and not able to figure things out, then maybe there’s another thing there. And how are you going to pick the right specialist to see and communicate with them about it and be confident in becoming an advocate for your child?
So I don’t think it should be viewed as such a rare scenario that you need these skills because I think most parents, at some point, they have to gain their confidence in their voice as a parent to advocate for their child’s needs, whether it’s in a school setting or a medical setting. And so that’s why I think that the book is really for everybody.
Emily Oster:
That’s awesome. So I actually think you’re right in line with that. Individual families are going to read this book in ways that work best for them, and some people are going to read all the way through and some people are going to sort of pick out parts. And for anyone reading it, there will be pieces that really resonate like, “Oh, that’s something I could use. That’s a tool I could use.” And it really is like a book full of tools. I wanted to pull out sort of a few pieces that I thought for me were kind of the most general lessons. So the first one is from the chapter called, What Matters Most, and I’m actually just going to read the first paragraph of the chapter, which says this.
“So when I…” You’re talking about yourself, “Was first diagnosed with cancer at age four, my parents tearfully sat me down. They explained my diagnosis and told me a bit about what would come procedures, chemotherapy, and radiation. But as a four-year-old, only one thing mattered to me amidst this very serious and stressful conversation. I grew and asked, ‘But I can still play, right?'” And then, you go on from there in the chapter to talk about how to approach the question of what matters and how to think about what matters to your kid as a separate piece of what matters to you, and that being itself important. And I would love to just walk a little bit through how you think about some of the tools in that chapter.
Kelly Fradin:
Yes, it’s interesting to talk to you about this in particular because I know, in Family Firm, you talk a lot about choosing what’s important to your family and thinking about your values. And when your family is confronting a challenge, it’s even more important to have that big picture, what matters to you, conversation, and goals because the decisions carry a lot more weight. And often, when a parent and a doctor are deciding what to do, they’re centering around sort of the obvious stuff that adults value.
“We want to make sure the kid’s doing really well in school and getting all their sleep, and we’re thinking about their long-term health.” But for a child, often there are other things, whether it’s their friendships or their extracurricular activities like their sports teams or their ability to have sort of free time that they care about deeply. And as a parent, when you’re being sort of the intermediary between your child and the healthcare team or the educational team, you have to also remember to protect your child’s top priority items.
And that might not be such an obvious thing when you’re thinking about all these really big important things like yes, their long-term health matters, but also their mental health matters. And if they don’t have the activities that they value so deeply and that are developmentally appropriate for them to be focused on sports and independence and relationships with their peers, that might have other consequences down the line if you’re not thinking about those priorities. So that’s why I encourage parents to remember their children’s what matters to them.
Emily Oster:
Yeah. And I think it’s to take a sort of, in some ways, slightly less fraught example than a serious medical diagnosis. Even in settings, and I hear this from parents, where people are coming up against an issue at school, a kid who is struggling in school or where there’s a problem with homework completion, whatever it is, where they’re trying to work with the school to kind of fix that problem, people can get extremely focused on limiting all of the other things their kid does to kind of focus in on that problem. That’s the salient issue.
Let’s spend all of our resources making sure that we’re doing all of these things to kind of fix this one problem or to prioritize this one problem. But forgetting that, actually, for the kid, there are a bunch of other things like their soccer team or play dates or being in the play or whatever, which also matter. And it’s not that you necessarily have to do that, but there is a balance there. And particularly, when we’re worried about our kids, we can get so deep into the one area that we’re most anxious about and think, “I am going to put all my focus on fixing that,” and these other things go to the wayside. But actually, for the long-term, those are super important as well.
Kelly Fradin:
Yes. Yeah. And with littler kids too, I find it comes up all the time with, say, they’re getting early intervention services, PT, and OT for some developmental issues that are noted, and then all of a sudden, we’re not letting them nap anymore because their schedule is so full and we just can’t fit in the preschool and the play dates and the nap. And it’s really like that is a priority for your child that we still have to protect. It’s just another example for the younger kids.
Emily Oster:
Yeah, completely. All right, so we sort of think about priorities, and then the second thing I want to talk about is this chapter on educating yourself. So in the newsletter actually talk a lot, as you know, about data and using data in parenting decisions. And a thing that comes up sort of all the time is what do I do when the data is incomplete, and where do I look for answers? And sometimes, when the question is like, “Do I need to use cloth diapers?” The answer is like, “Who cares?”
It doesn’t… Yes, there’s no good data on that, or maybe that question has a lot of complication, but actually, in the end, it really doesn’t matter too much, and some of it’s just about your feelings about laundry. But this sort of incomplete data piece comes up way more in these complicated settings because the challenges of your particular kid, medical, emotional, educational, whatever, are going to be very specific. Even within a kind of category of diagnosis, not everything is exactly the same.
And so people are finding themselves having to do the research on their own. And I’d love you to talk a little bit about sort of how you think about approaching that incomplete landscape, maybe particularly when it’s something medical where it’s hard to get as deep into the literature as one would have to be an expert in all of the range of the ways things are treated.
Kelly Fradin:
Yes. So, in general, I do recommend that when parents are educating themselves on their child’s condition, they start with resources that are recommended by their child’s care team, whether it’s the teachers or the doctors or whatever. Start with the gold standard resources because those are likely to give you very good data that is accurate. But what a lot of parents will feel is that it might not be as specific or as detailed about their child as they want. And so often, after you get through all that, you still want more. And so if you’re in that situation, it’s very easy to start Googling. And obviously Google is great in some ways.
In this respect, it can take you off the beaten path relatively quickly, and you can find yourself on blogs where you’re digesting people’s opinions rather than data that is based on the experience of many and vetted by experts and verified and fact-checked. So you just have to be very cautious when you make that transition. So things as simple as looking to see who is the author of what you’re reading? Is there a date on it? Because a lot of these resources don’t even have a date that it was published, so you don’t know how recent it is.
And then, if it’s something that you only find on one source like somebody’s blog, then it makes you doubt the authenticity a little more that… Most good information about your child’s health should be verified by a second source. And if it’s not, it’s maybe because it’s just somebody’s opinion. So I do think parents have to be careful about what sources they trust. But that said, I will say that there is a lot of positives about social media for connecting parents who are going through similar challenges. I’ve had patients locally find really great physical therapists or better pharmacies or better tutors for their children because they connect with other parents who are dealing with the same things on social media.
I think if you have something super rare, it’s incredibly liberating if you live in a town where no one has the same thing as you and you connect with somebody who also has a child with the exact same thing as your child, and you can really gain in addition to information or data support from that other parent and connect with them about their experience. So there’s good stuff out there too.
Emily Oster:
Even in as we call it beginner parenting, I think social media has this sort of double-edged sword of, on the one hand you can get a lot of pressure or confusing information or misinformation or things that are definitely not fact-checked or verified. But on the other hand, it’s awfully nice to connect in the middle of the night with the other people who are also awake with a child that will not stop crying and at least get a little bit of solidarity. So there’s this sort of… [inaudible] there’s this double edge.
I mean, I think one of the things that’s hard in this space is that when you are dealing with one of these challenges, you will be interacting with a lot of experts, people like you or people like kind of the educational experts at your kid’s school or medical experts. And there is an inherent knowledge gap between you and those people. And that’s not to say that the people that you are not smart or that you do not have the most information about your child, you do. On the other hand, you’re interacting with someone who has a huge amount of background medical knowledge or educational knowledge about this problem in general.
And so we think coming into those conversations can be quite daunting. And I’m curious. I often will sort of tell people, “You want to have a script? Use the information you got to develop some kind of script that at least will sort of hit the… and write it down in advance.” Because I think those conversations also be really… it’s a lot of information. It’s scary. I don’t know if there’s advice beyond to be prepared.
Kelly Fradin:
I think that it’s one of a parent’s most important jobs to go into these meetings and represent what their lived experience is to these experts. And generally speaking, I really hope parents aren’t intimidated in these situations because those experts are there to support them and to support their child. And so even though it can be intimidating with the positioning of these meetings and the jargon and all this stuff to remember that you are the expert on your child in the room, and you are the expert on how your child will react to whatever they’re suggesting. So your voice really matters. That’s the first thing. The next piece I’d say is that the preparation is a great idea because you don’t… how you present the story to these experts is going to affect the plan.
So if you were to leave out parts of what your child is experiencing or forget to mention things, it is possible that the plan might not be as good. So you want to try to be complete about what you’re seeing at home and what you’re experiencing and what your child’s history has been because while it is their job, the expert’s job, to ask the right questions, they might not think to ask everything because they don’t know. They can’t read your mind. And then the last bit is the questions, right, because you’re allowed to have as many questions as you want as a parent, and no question is off the limits. You’re allowed to just push back and ask and ask for what would another person recommend. Would all the doctors in your field agree with this decision, or is there an alternative plan?
I think that that question can be particularly useful because there are some conditions where the treatment is very standard, and a doctor can look you in the eyes and say, “Look, you go to 10 gastroenterologists in the city, they’ll all tell you the same thing about this.” But there are other conditions where the doctor will say, “Yeah, walk down the hall, and my partner might tell you something totally different.” And that will determine maybe whether or not you want to seek a second opinion or whether you want to spend a lot more time doing research. Because if it’s one of those things where everybody’s going to recommend the same thing, then maybe you just go with the plan and save yourself some angst.
Emily Oster:
Yeah. I was going to ask about the second opinion. So you think that the sort of circumstances in which a second opinion is appropriate is when you have a sense that this is not settled. There is not settled science about the path that one is on.
Kelly Fradin:
Yes. I think that’s the most important time to get a second opinion. That said, I think second opinions sometimes are about more than just the decision itself. It can also be about whether you feel like you have the right fit with the team you’re seeing and whether you feel like comfortable and confident in that person the way they treat you and your child. And that fit matters too, especially if it’s somebody you’re going to be working with for a long time. So, if you want to interview multiple doctors for that purpose, it’s something I support as well.
Emily Oster:
So the final thing I want to talk about is there’s a pretty extensive focus in this book on the holistic wellness of the family. So there’s a chapter on burnout, which includes the following amazing phrase, which you should put on a sticker. Which is, “You are really too important to your family to be neglected.” You also talk about the other siblings.
You talk about prioritizing independence, even for a child who is very ill. And this just struck me as a really important set of issues. I mean, maybe going back a little bit to what we talked about at the beginning, that there’s this kind of… we’re going to be sort of singularly focused on fixing this one problem without paying attention to the broader context of the family, the fixing of that one problem may create a lot of other problems, which then will need fixing later. I don’t know if that’s how you think about that.
Kelly Fradin:
Yes, it’s true that most challenges that we face are not that brief. Sometimes, you have appendicitis, and a week later, everything’s fine, and you move on with your life. But for the most part, these are more long-term situations. And so that’s why it’s important to plan for more of a marathon kind of than a sprint.
Emily Oster:
I mean, I think the other thing that happens with that, particularly for parents and maybe even more so for moms, is that when my kid is struggling with something, the idea of taking time for myself is… almost feels disgusting or at least feels very guilt-inducing. My kid is struggling with some serious thing, and here I am, having coffee with a friend or exercising.
I’m at a gym class. I could be doing more research. I could be investing more in this problem. And here I am just la-di-daing in my yoga class. I think some of the point here is even if the only thing that you cared about was fixing this one problem, you are going to be a more effective fixer if you have taken some care of yourself.
Kelly Fradin:
It’s so true. And I think many parents can remember the challenges of the newborn phase when you’re so, so sleep-deprived and how your brain does not work the way that it’s supposed to work, and your emotions are all over the place. And that same feeling can be induced when your child is facing a really big challenge, and you’re anxious about it, and you’re not sleeping, and you’re skipping your exercise class because going to all the different doctors. And I think in that moment, you’re right that people feel guilty about prioritizing themselves. They feel like they can’t ask other people for help because nobody can help the way they can.
But some of those assumptions are incorrect, right, that if you take a half-hour break from what you’re doing to go for a walk or to get some exercise or to take a nap, then you might come back and be more efficient with the rest of your day. Or other people in your life, whether it’s like a neighbor or a grandparent or a friend, they can help with your kids’ dinner and your kids might not like it as much. But your family will still be fed, and there are other people who can do some of the things that you have to do to make things go better. So, to not hesitate to ask for help, and to take those breaks that you need for your own well-being is something I encourage a lot.
Emily Oster:
Yeah, I think it’s a lesson, as you say, from sort of… it’s a lesson even in the beginner parenting stage of how to take care of yourself with a baby that sort of then carries over, and maybe you’ve forgotten because you had a break in the middle of that where things went okay.
And then got to come back to remembering what it’s like to have those demands as a newborn and those kind of feelings of being needed all the time and yet needing to take a break. Okay. So I think this book is great. If you had to sort of give people a large takeaway here, what would you like them… How would you like them to be different at the end of the book reading the book than the beginning?
Kelly Fradin:
Yes. I think one of the main goals of the book is to sort of normalize the fact that children have stuff that they’re dealing with. Not every child just has a very straightforward, healthy, easy go of it. And why I think that’s so important is because in my experience, when your child does have something, part of what makes it so hard is you feel like you’re very alone in it and that you’re very isolated from the normal and the average experience and the other parents in your community.
But I think the more aware we are that all the people in your community are dealing with stuff and they may or may not talk about it, but they all are dealing with stuff. We can all be more empathetic to the people in our lives, and we can think about how we can make things easier for our friends and family members and community members. And just remember that you aren’t alone when you’re facing these sorts of things.
Emily Oster:
You aren’t alone, and everybody’s dealing with something, even if it’s not a thing you see so visibly.
Kelly Fradin:
Mm-hmm.
Emily Oster:
That’s a good message. All right, thank you so much for joining me, everybody. The book is Advanced Parenting, and it is based on the timing of when we’ll release this. It will be out tomorrow.
Kelly Fradin:
Amazing. Thank you so much.
Emily Oster:
Thank you for coming. Thanks for listening. If you like what you heard, subscribe to ParentData in your favorite podcast app and rate and review the show in Apple Podcasts. You can subscribe to the whole newsletter for free at www.parentdata.org. Talk to you soon.
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