January 24, 2022
Ask Dr. Mom: Podcast Episode #135
Kristin talks with Dr. Elham Raker about telemedicine in times of COVID and offers parenting tips for mothers . Dr. Elham is the official “Ask Dr. Mom” who has leveraged her experience as a pediatrician to help parents navigate the “shoulds” of motherhood.
Welcome. You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting. Let’s chat!
Kristin: Hello, hello. This is Kristin with Ask the Doulas, and I’m joined today by Dr. Elham Raker, and she is known as Ask Dr. Mom. Welcome, Dr. Raker!
Dr. Raker: Hi. Thanks for having me.
Kristin: So I would love to hear about your journey as both a pediatrician and parent coach.
Dr. Raker: So as a pediatrician, I’ve been working for – gosh, I think close to 20 years. I got married right after I finished my training, and my husband lived in a different city. And I was following him. So he was also in medicine and doing his training, so we moved around quite a bit. And because of that, I really got to work in different environments. So I did urgent care, private practice, hospital setting, different types of inpatient settings, and lastly, I did a home healthcare. All of that was amazing. I loved all the different interactions, all the things I got to learn. What I really felt was missing was true connection with patients and parents. And especially in the office setting, we have such limited time. You know, there’s these, like, 10-minute visits, 15-minute visits at best, and sometimes, you know, we’re running late, and you’re waiting. And it just seemed really rushed. And I would come home just feeling burnt out, really, is the best word to explain it, and I know where a lot of people are going through that now for different reasons, but just feeling that, in the sense that it wasn’t satisfying. I wasn’t providing the best care that I felt that I could. And then I was coming home literally exhausted and then also missing out on my kids’ life. So it just wasn’t a win-win at all. I wanted to be able to do that. So pre-pandemic, I actually had this idea of starting a telemedicine practice, which really was more like, absolutely be there for urgent visits because, you know, you always – something always happens after hours, right? The baby hits his head or the earache comes up. Something always happens. So I knew that when my friends would call me, I would be able to at least walk them through what to do during the weekend so they wouldn’t have to go to urgent care or the emergency room. So that was something I wanted to provide. But also, I felt like parents were really looking for advice on Google or Facebook groups or other places that you never know what you’re going to get. So I wanted to be a more reliable resource, especially if you maybe didn’t have a friend that was a pediatrician and you needed to ask those questions. So that was how that aspect of Dr. Mom was initially born. And then during COVID, I decided that I really wanted to add a little bit more of the counseling and the coaching, which is something I truly enjoy. And I delved more deeply into parent coaching and, you know, the world of conscious parenting, which is fabulous and something I want to share with everybody. I think it’s going to help us build such strong connections with our kids and just make kids that become grownups who are going to do amazing things.
Kristin: So fill us in a bit more about, you know, what conscious parenting is and how we can apply it in our own families.
Dr. Raker: Conscious parenting is really – it really makes sense when you kind of take a step back. I think so much of what I was taught as a pediatrician, as a mom, from mom resources and other things that I did when my kids were younger just came from training or, like, this concept of, you know, we have to teach our kids that what they did was wrong by punishing them or giving them a consequence or something so that they don’t do it again. We kind of lose the concept of, kids are just learning. They really don’t know what’s wrong or right. And it’s not always by punishment that they’re going to necessarily learn that, right? Just like us, we all respond so much better to positive reinforcement than negative ones. So why would it be any different with our kids? So to me, it makes sense. There’s a lot of scientific research to support it, how the brain develops. And, you know, we know that your frontal cortex is not developed until, at best, 25 or 26. It could be even later. So we’re really having these expectations of our kids way before they’re ready to do what we’re asking them to do. And then I think another really important part of conscious parenting that, for me, was a little bit of a surprise is that all of us were parented, even if we had the best parents, something was missing. There was something that we didn’t get as children. And oftentimes, that comes up in moments when we get triggered in our own parenting. So when we feel the need to yell or get angry, that’s a clue that something is going on within ourselves, like an old trauma. So that was a huge revelation for me, being a mom that yelled a lot and going through, like, recovery of that. It’s important to learn that anger is not just something we can just make go away, right? It’s a signal. It’s a sign. It’s something going on. So just like our cues with our kids, their behavior is showing us that something’s going on, and it’s our job to figure out what. Same with our behavior, our anger, and our – you know, those are just signs of unmet needs that we have to figure out. So that was a lot of what we go through in the parenting course and parent coaching. It’s really about transforming yourself.
Kristin: That makes sense. And the coaching is individualized based on your particular clients’ needs, or do you have a set structure that everyone goes through?
Dr. Raker: I did a course through Jai Parenting, so they have a set course which is a 12-week course, and it’s amazing. And you get a lot of benefits from doing a course. But there’s also individual packages where you can just go through. Like, I have this particular issue going on, and I just need help with that. So there’s different ways to do it. I think what we have to remember about coaching, just like anything else, it’s really – parent coaching is parent-centric. It’s about you. So it’s not behavior modification for our kids, necessarily. That kind of happens naturally as we change ourselves, right?
Kristin: So changing habits, like time-outs, punishment, and just figuring out a new program for the family?
Dr. Raker: Yeah, and that’s actually a great topic, too, is punishment versus discipline versus consequence. I think that it can be confusing, but I do think they’re all very different things. Punishment doesn’t really have a place. There’s no benefit to it. Oftentimes it’s something that’s not even related to what the child is doing. Like, you threw all the toys on the floor. No more screen time for you. It just doesn’t make sense. And a lot of times, it’s more of a punishment for the parent because they use that screen time for their own time-outs.
Kristin: Right, to get work done.
Dr. Raker: Right. And it doesn’t kind of flow. And same with a time out. Their child is not going to all of a sudden come out of time out realizing that what they did was awful and they need to correct their behavior and they’ll never do it again. They’re just going to sit there and be mad and comply with whatever you need because they don’t want to be in time out, but they’re not really learning anything or gaining anything by that. So punishment doesn’t really work, and I think it severs the relationship. So anytime we want to think about what to do with our kids, I always think, you know, is whatever you’re thinking of doing going to help build your relationship with your child, build a connection, or separate the two of you? If it’s a separation, it’s probably not the right choice. Your child’s going to learn so much more from your love and attunement than trying to make a point with a punishment. A consequence can be something that happens, and we talk a lot about a natural consequence, which I’m a believer in. So, you know, if a child forgets his jacket after you reminded him and he’s cold, that’s a natural consequence, right? You can’t really do anything about that. You don’t have to do anything. You can be empathetic about it. You don’t have to be, like, cruel. I’m sorry that you’re cold. It’s not – you know, it doesn’t feel good, but next time, you’ll remember to bring your jacket. Or we’ll try to stay inside more because I know you’re cold. Right, you try to accommodate, but it’s a natural consequence. If a child forgets their homework or if a child forgets their lunch – I mean, if they called me and said, Mom, I’m starving, I’m not going to say, sorry, your fault; you’re going to starve. I’ll try to at least problem solve with them, right? Can you ask your teacher, is there someone you can borrow money from to buy lunch? You know, whatever it may be. Can you call the school and say, my child forgot their lunch. Is there anything – you know, whatever it is, you can help them, but it is a natural consequence. So it doesn’t have to be a harsh natural consequence, I guess, is what I’m trying to say.
Kristin: It makes sense. They’re problem solving and figuring out things on their own versus being coddled and – yeah. It makes sense. So how do you feel about rewards, then? Or not really bribing, but you know where I’m going.
Dr. Raker: Yeah. So rewards kind of goes along the same lines where we’re actually showing the child that our love is conditional. So that means if they do something, then they get the reward, as opposed to just being who they are and being loved for who they are. So that also is a system that doesn’t work well in the long term, and it takes away the internal motivation, which is what we’re really trying to promote, and provides an external motivation, which isn’t what we want in the long term.
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Kristin: Even with toddlers, it’s sort of that. If you have a newborn and you’re trying to focus your feeding time, then as doulas, we’ll sometimes try to distract the toddler or suggest they have a special basket with toys that comes out at that time. Would that be considered, you know, a reward and – I mean, how do you manage a situation like that, I guess?
Dr. Raker: No, that’s not a reward, because you’re not really rewarding them for their behavior. That’s just something special for them during a particular time. So I guess if you said, you behaved so well today, you get to go do the special box, right, or if you didn’t behave well or you did this, so you can’t have the special box today – that would be more along the lines of reward and punishment and being conditional. But if you say, here’s a special box just for a special time when I’m with the baby, I’ve see that and different people talk about that. I think I like that idea. It just makes the child feel special. But it’s not based on a condition of their behavior, right?
Kristin: Thanks for clearing that up.
Dr. Raker: Yeah. I think that’s the main difference.
Kristin: Yeah. I didn’t want to give incorrect advice, and so I’m glad that that works.
Dr. Raker: No, I think that’s great. Yeah, I really think that’s a great thing to do, and rotate the toys every so often and just make it fun for them. No, I think that’s just being creative, which we all need to do with toddlers, right?
Kristin: So let’s switch gears and talk a bit about your telemedicine practice and how things have changed within physician offices with COVID. I know you approached the telemedicine practice before COVID, but just how your practice can complement their physician visits, whether they’re in-person or telemedicine visits.
Dr. Raker: Yeah, I think that COVID really accelerated all of that, right? The concept of Zoom, I would say very few people had even heard of Zoom prior to COVID. So the idea of doing things online, telemedicine, just became the norm. So mostly I think people are just looking for convenience and the ease of being able to reach out to someone and talk to someone, which is great. You know, I love that about what we’ve all gone through and that we can all still be connected, even though we’re six feet apart, right? So there definitely have been some positives. So I think from the aspect of medicine, it’s being at home, especially if you have kids and you have more than one child. So, A, taking that child to the doctor is hard on its own, but then if you have two or three in tow, that’s really hard. And whether you have to find daycare for them or whatever it may be. And then I think the other thing is just the accessibility. So a lot of times it’s hard to get a doctor’s appointment. And the timing. You know, I really do think – I don’t know the solution 100%, but doctors’ visits – listen, and not that I think we can’t have doctor visits anymore. They’re obviously super important. But emergencies happen, so there’s no way for a doctor to not run behind. It’s just not feasible. Even in a normal visit, there could be an issue that comes up that takes more than ten minutes, and then you’re just behind. So there’s that concern of just trying to fit everything in. And I think parents, especially if they have a newborn or, you know, if it’s the first child, or maybe it’s a second child that’s just totally different than the first experience – they just need a little bit more handholding. That’s really where I think it can be a benefit.
Kristin: And how long are your visits? Are they ten minutes, or are they longer?
Dr. Raker: My standard visit is 15 minutes, but I can go longer without really throwing off my schedule. So I allow for that, and then I end up just chatting with the patients, to be honest. I don’t make it this big cut-off time. So it’s just nice to have that flexibility.
Kristin: Definitely. And then different timing. So you would be available potentially evenings or times that, say, a physician office would not be able to?
Dr. Raker: Yes. Yes, exactly, since I am, you know, working from home or from anywhere, it’s a lot easier for me to just log on if someone needs me. Like I said, oftentimes, there may be not something I can directly take care of, although I do think we’ll have more technology, like being able to look at ears at home or listen to lungs and things like that, but I can usually at least get you to stay home, you know, take care of it overnight, and then be able to see your physician in the morning. So it’s still nicer than going to urgent care or the ER, for the most part.
Kristin: Right, especially now with COVID. I mean, Michigan, we’re, like, the worst in cases, and there’s really nowhere to go. So the fact that there are telemedicine options if your child bumps their head and you don’t want to try to go to the ER at this point.
Dr. Raker: Yeah, and just to have that reassurance and that piece of mind. And, you know, emergencies – and thank God the emergency rooms are there when needed, but a lot of times, you can get through without it. You know, you know when it’s an emergency.
Kristin: Right. Of course.
Dr. Raker: But those in between times, hopefully I can help you stay away from it.
Kristin: And you have a download guide on telemedicine that talks about when emergencies and when to call your provider and so on. So tell us a bit about that and how our listeners can access your guide.
Dr. Raker: Yeah. So you can access it through – probably on my Instagram through Linktree will be the easiest when you subscribe. The guide is basically – it was really at the beginning of COVID when telemedicine was, like, the only thing we were doing. And it was just a way to kind of prepare for a visit, like what your doctor is going to know, what you can do at home. So what we do when you walk into the office, we take your temperature. We take your weight. Other vital signs, like your heart rate and breathing rate, which actually are all things you can do at home, right? It’s great to have a weight scale at home. Even for little kids, you can weigh yourself and then weigh together and do the math. Thermometer, of course. I feel like everyone has that now. And then you can just check your pulse and measure, you know, how fast your child is breathing. So all those things are important because if there’s something wrong, that’s an important thing to know. That’s why we call them vital signs. And then just having – I think parents, even in the office setting, I think it’s important to give as much history as possible. It really – there’s so much we can ascertain from a history. Like, people always ask me about telemedicine and how do you really get to diagnose anything or how do you know. Like, parents really know their kids best, and being able to know their level of concern helps, and the history of what’s been going on makes a huge difference. And then any medical history, right? So whether it’s family history or the child’s medical history, that’s all important. Allergies, medications, history of surgeries or hospitalizations, things like that. So those are kind of the standard things, and maybe you don’t think about those things when you go to your office because you’ve been going there since your baby was born, so they kind of know all of that, but those are just important things to think about any time you – even if you go to an urgent care or emergency room or a new doctor, those are the things that they’ll want to know. So that was kind of my prep of what to get ready when you get on a call. And, yeah, that was the main thing. I mean, the physical exam is really more about seeing the child and making sure they look okay and breathing okay, and the history just makes such a difference in how to make a decision at that point.
Kristin: Yeah, to get you up to speed on everything so you can really make a solid diagnosis and referrals. It makes sense. So how – I know you have a YouTube channel. How can our listeners find you? You have a blog. What are your most active channels?
Dr. Raker: Mostly, the easiest way is to go on Instagram, and that’s askdrmom_ on Instagram. And the Linktree has everything in there. When I publish a new blog, it’s in there. You can also access my blog through my website, and my YouTube channel is linked in there, and I kind of announce stuff on Instagram. I’m just the most active on Instagram, so if you have questions, it’s a good place to message me, also. If you’re not on Instagram, then you can find me on Facebook, and that way that also links to everything.
Kristin: We’ll include all of that in our show notes. Any last words of advice for our moms?
Dr. Raker: My last word of advice for moms is to trust yourself, which I know sounds like one of the hardest things to do, especially as a new mom. Like, I know nothing. How can I trust myself? But you really have something that’s really important, and that’s intuition. And a lot of the things that we’re talking about with conscious parenting, I think it just feels good. It feels good to connect with your child versus sending them to time out. I don’t think that ever felt good for any of us that used that method. So question things that don’t feel right to you, and find a trusted source to ask questions, whether it be your pediatrician – you know, hopefully, your pediatrician, and maybe another one or two sources that you trust, and ask them those questions. I always say, as long as you’re not harming your child, as long as there’s no danger to your child, do things the way that works for you and your child and your family. That’s the most important.
Kristin: Perfect. Thank you so much for your time today, Dr. Raker.
Dr. Raker: My pleasure!
Kristin: We really appreciate it.
Dr. Raker: Thanks for having me again.
Kristin: Have a great day!
Dr. Raker: You, too.
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