Fresh Take: Dr. Michael Milobsky

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0:27Amy Wilson:Hello, everyone, and welcome to Fresh Take from What Fresh Hell? Laughing in the face of motherhood. This is Margaret. And this is Amy. Today, we're talking to Dr. Michael Malabski. He is a board-certified pediatrician with 25 years experience practicing in Denver, Colorado. Dr. Malabski is a father of seven kids, ages 15 to 29, and he's also the grandfather of three. Dr. Malabski specializes in pediatric emergency and hospital medicine, adolescent mental health and addiction, and medically complex or special needs children. You can find his content on TikTok, Instagram, and on YouTube, as well as on his podcast, Your Kids Will Be Fine.

1:08Welcome, Dr. Mike. True pleasure to be here. I'm a big fan of What Fresh Hell and the podcast. Thank you. Well, why do parents today need to hear that more than ever? Because they do. Your kids will be fine. Why is that so hard for parents to accept these days? Yeah, that's kind of where the podcast came from, just my day-to-day experience. My pediatric career has crossed two eras, right? It really started in the pre-social media, pre-internet era. I think when I finished my residency and fellowship, we had a gateway computer that had a plug-in modem and could download a picture after eight minutes.

1:45That was it. And now my seventh child was born in 2010. And now I have parented and treated people in the age of information overload. And it is way harder. It's the hardest, I think, time ever to be a parent, to feel competent, to not have our anxiety overwhelm us because of the massive overload of information, which constantly sets us against one another and in doubt about what we know, what we don't know, parenting in the public forum. And I think that a generation of parents ago didn't suffer like this.

2:14Amy Wilson:I feel like this leads us into a first question that we have from one of our listeners, which is the famous phrase, if you hear hoofbeats, you think about horses, not about deceivers. That's the old kind of idea. But that as a parenting podcast and a parenting community online, we talk to a lot of people who they have done a ton of research. They are seeing something that concerns them in their kid. But then they're going to a medical professional who might be saying, okay, Dr. Google, mom, relax. And how do we, in this age of information, how do we be heard? And how do we also dismiss things that maybe are wrong?

2:53That's a fabulous question. I think the first thing is that it's unrealistic from a standpoint of what I do to think that people are not going to leverage AI and the information at their disposal to come with concerns and questions. It's a reality that is now part of who we are. And I don't have that expectation. I have that expectation. That's what parents are going to come to me with. So the next part of that answer is that all hinges on the relationship you have with the person that you've entrusted with the care of your kids. and then that leads into the whole discussion how that has been irreparably changed and eroded by the system in which we are all working and makes it harder to really leverage and engage in that relationship in the way it needs to be for me to be able to get you to say i hear what you're saying this enables and i acknowledge that this is good research and i hear why you're concerned here's what i'm going to retort to that and why someone who's done this for 25 years say Not all of this may apply here because of my vast experience in my training.

3:50So let's come to a shared decision-making on what the best steps are forward and outline those so then we can go with A and then B and then C. So you feel like your effort wasn't wasted because the stuff you looked up was probably valid. I mean, the truth is AI is becoming more and more precise and more and more reliable by the week. So we have to respect it and we have to trust it. We have to know that it has access to information that I haven't always thought of. But what I have access to is information on the ground. and having done this over and over and over and over and what we can ignore and what we shouldn't ignore and how it can change.

4:21But what all of that takes is time. As someone who has been a pediatrician in multiple settings and now owns a pediatric business, that is the problem. I am not afforded the ability to leverage that relationship and time to establish those kinds of things in a visit, especially with a complex situation because of the way insurance dictates how they compensate us, how I have to get paid to keep the lights on and keep the staff paid and how that then makes it harder and harder to devote that time when I have to see six people an hour because of the way our insurance companies have now decided to value my time to be able to give you what you need in that setting.

4:58And I know that I can't fix the system, so I'm leaning more into my concierge care truly because of response to this because I don't want to practice this way anymore as much as I still own my practice, I'm still here, But I find that I can develop these relationships and develop that kind of rapport when we are not limited by that. And then I can spend that time.

5:17Amy Wilson:We used to say in the restaurant business, greet them, feed them, and street them. And now doctors are greet them, treat them, and street them, right? Get them in, get them out. That's the number one thing. Right. And what's my alternative? My alternative is to say, I'd love to spend the time on this that I don't have. But we can maybe run a few tests, refer you to a subspecialist, and maybe make sure that we're not missing something. but that doesn't really check the boxes in the way that you were talking about. I have a follow-up question for that. As the parent of a medically complex kid, with excellent support, by the way, from not only that kid's pediatrician, but the other specialists, I always feel when I'm walking in to see somebody new that I have to walk this specific tightrope between seeming informed and not too well-informed and not that mom and not a nut and not annoying.

6:04And because you specialize in treating medically complex kids, who's a parent that you look forward to collaborating with and why? So I look forward to collaborating with someone who's really becoming the PhD expert in their kid, because that's what I need you to be. Because I can be what I can be, but I can't know everything. I can quarterback and access your subspecialty teams, and I can access you. And that's who I love working with, someone who really is the PhD in their kid. because as you know, even with the same diagnosis, no two of these kids are ever even the same. And that's what I value the most is someone who's really taken that time.

6:39I don't judge people for their level of concern, their worry. There's a lot of anxiety and worry. And I, you know, part of being someone who takes care of these kids, you have to recognize that and be able to work with that and understand that that person is coming from a totally different set of conditions than someone who didn't have to walk this path with a very young, fragile and complicated child.

6:58Amy Wilson:But on the other side of that now, I have a family member who's a brand spanking new pediatrician, second year resident, definitely feeling some of the pressure of the information overload that involves a lot of misinformation, vaccine hesitancy, people worrying about the vitamin K shot and different aspects of people coming in and saying, listen, you may be a doctor, but I've got a thousand people on Facebook telling me that that vitamin K does this. And you, as you said, maybe have five minutes to explain to me blood clotting in children and the consequences of it. I think a lot of this started after the pandemic.

7:41Well, for those of us who practice pre-pandemic, it was around, but it was low level. It wasn't pervasive. It was a fringy kind of kooky wing of everybody's clinical experience. And now it's central in almost every visit. I think the brand speaking new pediatrician is the most vulnerable in the situation because they don't have the benefit of doing it long enough to be able. So they're Googling too. I can look you in the eye and say, I've been doing this for so long. Let me tell you what I see and what you don't want to see. And I'm believable. For some reason, we've been doing this for five minutes and pediatric residency used to be long enough.

8:11It needs to be two years longer now because of this. Pediatric residency really should be five years now, or at least four, because of the need to develop this part of ourselves before we face this onslaught.

8:22Amy Wilson:So from a long-practicing pediatrician, are vaccines a good idea for children? The absolute truth is, and this has been supported over and over again by every single time they study this and test this on populations of children around the world for the last 20 to 30 years, now going on studies involving tens of millions of children from every part of the globe, is that vaccines are the single most important and beneficial advance in human history in the health and well-being and longevity of our children, full stop, period. There's been nothing greater in human achievement as vaccines have been in preserving, improving, and upgrading childhood and human life.

9:04A hundred years ago, every single family knew a family who had one or two kids die regularly. And I defy you to walk down your street and knock on every door in your neighborhood and find out how many people had a child die of anything. Not that terrible, tragic things don't happen and people get into accidents, but that is not the norm now. And that is overwhelmingly due to our success in eliminating vaccine-preventable disease, both bacterial and viral from our childhood experience. And we've been so good at it that we forgot what it's done. And people now think or overly romanticize what it used to be like because they weren't there and think that we don't need them.

9:42On our podcast, we like to say, solved it at the end of every episode. Solved it. Usually we have not come down on a very clear answer, but that was an extremely clear answer and one we certainly agree with.

9:52Amy Wilson:And I do think it's valuable because I also, and we say this all the time, we feel for you. I get it. You are getting a lot of information. It's not because you're a dummy. It's not because you're a loser. It's overwhelming. I mean, I have a very trusted pediatrician in my family. And I asked, I said, I'm going to ask this because I'm hearing a lot of things. Are vaccines safe? And she walked me through and had the time because she was a family member for 45 minutes. Listen, nothing ever doesn't harm anybody, but we're on a scale. And I'm sympathetic to people who have questions. but I also think it's worth repeating as often as possible that from a doctor's point of view, vaccines are working.

10:34Correct. There's no question that reactions and things can happen, but those numbers and the way people perceive them, especially because of the social media internet is so warped and so not part of reality. The number of years I've been working and the number of children that I see conservatively probably ended up a couple million doses of vaccine conservatively myself. I have at least a network in Denver alone of at least five to seven colleagues who are exactly my age, have been working exactly as long as I have, who have handed out exact same number of vaccines I have. So collectively, let's put it conservatively, 10 million doses of vaccines of every stripe between five long practicing pediatricians in a single city.

11:17And not a single one of us, all of us work six days a week, at least 12 hours a day. for the last 25 years. I've never even heard of a single patient ever show up with a vaccine injury or a major negative side effect, major negative medical issue because of the vaccine. Yes, they happen. We know they happen. But think about the numbers just in that little, to get a sense of how rare that actually is. We're talking to Dr. Michael Malabski. When we get back, we're going to share our listeners' most burning questions for a pediatrician with decades of experience. After an afternoon at the pool, my mom's skin needs a hydration reset.

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14:26How about a creamy mocha frappuccino drink or a sweet vanilla? Smooth caramel, maybe. Or white chocolate mocha. Whichever you choose, delicious coffee awaits. Find Starbucks Frappuccino drinks wherever you buy your groceries. Dr. Mike, a lot of our listeners asked versions of this question, but let's go with picky eaters as an example. So Jessica wrote in and she said, I'm a child of the 80s and 90s. Back then, we ate what was for dinner. We weren't given an option. Now there's picky eating everywhere. Where are we creating the parents of today? Are we creating picky eating by tolerating it more or is something more indifferent happening?

15:05I think we're interpreting normal child behavior in much more excessive ways because of our overexposure. And then our anxiety gets triggered and then we are taking normal behavior and pathologizing it.

15:17Amy Wilson:Say more about that. So we're talking about it more between ourselves? Yeah, just do a quick search on Instagram of toddler and childhood picky eating. You're overwhelmed. And then combine that with our innate wiring. As a parent, we are, for better or for worse, wired to focus on our offspring taking in enough calories so they don't die. So it's all just coalescing into we are hyper-reacting to things. And because of the nature of toddlers, especially toddlers in preschool, they react to that. And then we create now this dance of the eating, the response, the response to the response because of their normal oppositionality and Sour Patch Kid personalities that just go along with being that.

16:05And we are hyper-focused on all the negative stuff because our brains, as you guys know, all people are wired to hyper-focus on the negative because that's a survival part of our deep emotional brain. We hyper-focused on what we feel are a threat.

16:17Amy Wilson:What's that term, Emma? You use it sometimes on the podcast. Negative reaction bias. Negative reaction bias. There you go. We've definitely talked about it. Parenting is now overwhelmed by that because of our, that is now triggered a thousand times a day by social media. That's so interesting. And my Instagram feed is full right now because like you look at it once for 10 seconds and welcome to your new news channel. Yes. Right. And the machine learns. Yeah. I'm getting a lot right now of Japanese toddlers in a high chair being served a bento box of like actually squid and seaweed and radish for their lunch and eating it all.

16:52And by the way, is that realistic in Ohio? No. In Colorado? No. And so, yes, picky eating is normal. There are evidence-based and well-described ways to approach it as a parent, to navigate that phase so it ends sooner and your child becomes a more reliable and broad-based eater on their own. There's lots of books now. There are people who devote whole social media channels to it. But this excessive focus on it and this perception that it's now this epidemic that didn't exist before, is more a function of our parenting culture than the reality of any difference in children.

17:28Amy Wilson:A similar question on a different topic is neurodiversity. Yes. Lots of talk right now about the explosion of autism. I have a kid on the spectrum. I have another kid on the spectrum in my immediate family. I do sometimes think like, huh, is it coming from somewhere? It seems anecdotally to me, we have twice as many kids on the spectrum as the generation before. Is there something in the water? Are we noticing this more? Is it more information? It's B and C, to put it shortly. When were you guys in elementary and middle school? 80s. 70s and 80s for me. Yeah, right. All those kids that were in the special class at the end of the hall that were called emotionally disturbed or mentally disturbed, 98 % of them were actually autistic.

18:13We just didn't have a term for what that was because we had a very narrow view. And through decades of research in neurobiology, neuroscience, cognitive psychology, behavioral psychology, we have learned that autism, which is a genetically variable with four different main kind of like phenotypic site kinds that are all expressed differently, are actually all autism and not this one narrow form that we used to talk about in the 70s and 80s and even into the 90s. And you combine that with universal screening, it hasn't been that long that it's become standard in my office that I now apply a sensitive parental checklist at the 18-month and the two-year visit.

18:49So I'm screening now much more heavily and I'm picking things up a lot sooner than I would have 10, 15 years ago. Do you find that parents are coming in with a concern about my kids not meeting milestones? Is there more of a concern about that? A lot of times, especially new parents, they miss that a lot because they have nothing to compare it to. And that's why we screen and that's why we talk about it. A lot of times it's a child who's perfectly healthy and developmentally appropriate, does a couple of one or two quirky things that are on a list somewhere online. And the parents come in thinking their child's actually autistic, but they're not.

19:18My oldest kid used to crawl with one knee on the floor and one foot on the floor. I had that. My seventh child was an army crawler. Or the elbows. Right. And I think you are right. Back in our grandmother's day, would have been like, yeah, he crawls funny. It was time to worry about this. Now shut up and peel the potatoes and whatever. And parenting has now become, compared to our own, at least my parents as baby boomers who raised Gen X parents, parenting has become much more of an intensive endeavor, both for the good, but sometimes for the bad. My parents would have been arrested in this world.

19:52Amy Wilson:Oh, all of our parents. All of the scars from the riding in the back of the car. My husband grew up in Texas. They would drive back and forth to Dallas in the back of a pickup truck, open pickup truck, kids in the back. Or hanging out the back of the third row of the station wagon waving at the front door. Yeah, yeah. Those were the good old days. They weren't so good. But there was also a lot of emotional neglect. There was a lot of invalidation of your valid feelings. I mean, there's a lot of stuff that parents today are exemplary at because they've more information. But yet it has also, sometimes this need to intensive parent, the cup has overrun a bit in certain areas too.

20:29Amy Wilson:I think that's right. My grandmother, we have very, very long generations irish family my grandmother who was born in 1901 was the youngest of 13 kids only eight of them i think made it past the age of 10 made it to adulthood right so yeah everyone had their graveyard in the backyard of the kids that didn't get right i remember doing my genetic outline with some very like eager beaver phd and she's like and what did those kids die of i'm like cholera, I think. I don't know. It was 1915 in New York City. They didn't know either. They didn't know. It could have been leukemia. What do they know? Polio killed a lot of people.

21:05Diphtheria killed a lot of people. Right. So we vaccinate, but we forget because no one has them anymore. And honestly, very few people practicing in the hospital in the ER. Almost no kids get meningitis anymore because of our vaccine. Bacteria meningitis used to be a clear and present threat to your child's life that we were worried about all the time.

21:24Amy Wilson:I remember that from my childhood. That wasn't long ago. That is not the case, except for newborns and other vulnerable kids and kids who are medically complicated for other reasons. But it's just the average kid, because of how we protect them, it's just not something we worry about as much. We rarely see it. Here's a burning question that I was like, this is a good question. The question that we can ask the pediatrician. So if you're a parent to older kids, as both of us are, during their yearly check up, the parents leave the room, as we should. And the pediatrician asks the kids some questions that they might not want their mom in the room to hear.