Ep. 45 - When Your Child's Stomach Hurts — and It Might Be More Than a Stomach Bug

That familiar Monday morning stomachache might be telling you something. Dr. Andrew Rosen and Dr. David Gross sit down with pediatrician Dr. Celina Moore to explore what it really means when a child's emotions show up in their body — and how families can respond before things escalate.

Dr. Moore walks through how she approaches the classic school day stomachache: ruling out medical causes, recognizing patterns, and then asking the bigger questions about stress, separation, and fear. She explains why so many kids simply don't have the words for what they're feeling yet — and why that makes the physical symptoms worth listening to just as carefully as any other sign of illness.

The conversation also travels far beyond the exam room. Dr. Moore shares her ongoing work in Ghana through the Acoma M Tosso Foundation, which she founded with her husband — returning year after year to the same villages to build trust, address children's health needs, and tackle the deeper barriers that keep kids from getting care. She reflects on compassion, clinician burnout, and what keeps her connected to this work across two continents.

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Transcript

SPEAKER_02 0:04

Hi, I'm Dr. Andrew Rosen. I'm an psychologist. And I'm Dr. David Gross and I'm a psychiatrist. And we are two shrink center mic.

SPEAKER_01 0:13

Thank you for being here today. Today is going to be our uh special podcast because we have a guest. And uh our guest is Dr. Selena Moore, who is a pediatrician who has joined as a consultant for the Children's Center for Psychiatry, Psychology and Related Services. And she's going to be our consulting psychology pediatrician who will be evaluating and sometimes prescribing treatment for children starting at the age of almost zero and up to age 18. So I'd like to introduce Dr. Moore and ask her to tell a little bit about herself.

SPEAKER_00 0:52

I'm so happy to be here. Not just here physically right now, but it's just like being with these great minds and this great place where we can help kids. So my name is Selena Moore, and I'm a general pediatrician, and I have been working here in South Florida for over 20 years in all things being kids. And I have recently joined the center, the Children's Center for Anxiety, to really help kids who are struggling. We all know that there's this epidemic of mental health in kids, and we could always go into the causes of that. But the real thing is how can we help them? And any little part that I can play in that, I'm really proud to do that.

SPEAKER_02 1:39

You know, it's our pleasure to have you, and I thank you for taking time out from uh a busy day and leaving the parents behind of the kids. Um what I've been most impressed with is your passionate interest in the behavioral aspects of pediatrics, which is unusual. I mean, many pediatricians will end up putting their kids on uh psychostimulants for ADHD, et cetera. But your interest in all aspects of the emotional, behavioral uh aspects of childhood is wonderful. And that's why we're so happy to have you join us. Can you tell us how you got interested in the behavioral aspects of pediatrics?

SPEAKER_00 2:17

Well, you know, when you're in the medical field and you're going through medical school and you're looking at all of these symptoms, you know, like fever or cough or um runny nose or stomachache, we often gloss over the fact that behavior is a symptom. And because behavior is often viewed as being good or bad, acceptable or not acceptable, we look at the negative aspects of, you know, behavior as something that someone else is doing wrong, right? The child is bad, right? Or the parents are wrong. When really it's just a symptom like fever. And you look for the causes of the symptom. And then once you find the causes of the symptom, you can either do a quick fix or you can, you know, do more supportive care, like fluids and rest in the terms of fever, right? But more of supporting the child as a whole, you know, including the family and the parents, while they either grow out of this or we can modify the behavior in more acceptable ways.

SPEAKER_01 3:24

One of the things that I always think about is uh what's the most common reason why a young child, when they're in school, goes to the nurse's office. And, you know, uh I I guess the predominant percentage is uh a stomach ache, right? And so the child goes to the nurse's office, and whatever happens at the nurse's office, hopefully that child's tummy feels better and and it doesn't happen again. But very often that tummy ache is a symptom of uh anxiety or fear or stress about being away from home, being in an environment such as the school where there's strangers and there's authority figures, et cetera. So I'm sure you get plenty of calls for tummy aches from uh parents who will say, well, you know, Johnny has been in the nurse's office for a tummy ache a lot. What would your response be to something like that as a pediatrician?

SPEAKER_00 4:21

So as a general pediatrician, we try to exclude the medical part first, right? Is there does a child have an ulcer or a stomach bug or something that will be self-limited and you know, we can have certain measures that we can help them through this. But when we start seeing patterns, and a lot of being about being a pediatrician is looking, like zooming out and looking at patterns, when we start seeing patterns of belly aches Monday through Friday, or, you know, vague headaches and things that when you do an appropriate workup, yields nothing in terms of something physical going on, then you need to dive a little bit more deeply and find out what why they're complaining of a stomach ache. And the stomach ache is not fabricated, the stomach ache is real, but what's causing that stomach ache? And a lot of times, depending on the age of the child and their insight, they don't know. They can't tell you, like an adult will tell you, Well, I d I'm afraid I'm gonna get yelled at, or I'm afraid that, you know, when I get home, something bad's gonna happen, or whatever it is. They they don't have that insight. And so a lot of it is supporting them until they understand emotions and words and put those two together, because that also is developmentally a developmental milestone that a child needs to get to of understanding the emotion and adding the language to that to be able to explain themselves.

SPEAKER_02 5:48

You know, in this day and age, uh, unfortunately, mental health issues remain to have that stigma attached to it. And I would imagine that because of your openness to the presence of, you know, anxiety, depression, or behavioral problems in the kids that you see, uh, it allows the parents perhaps to be more comfortable in talking to you about it. Because I'm sure a lot of parents are reluctant to say, um, my my kid needs to see a mental health practitioner because immediately that means, you know, that kid is uh sick, uh crazy, you know, not as good as the other kids. And so it I suppose it gives you an advantage in that. When when do you make a decision that you need to go beyond the pediatric practice and refer to a mental health professional for problems?

SPEAKER_00 6:35

So I know what I know, right? I know my limitations, and I do know that I can have quite a bit of impact in the, you know, beneficial impact in mental health issues with children. So, you know, whether it is um listening, that's what the nurse does. She gives the kid ice chips and she listens to them, right? So, you know, whether it's the listening, acknowledging, that's half the battle right there. And and giving a kid and a family hope that we will get through this, you know, and I will help you with this. When I refer out is if I am um wary of maybe something bigger going on that a child psychiatrist might be need to intervene. If we have a very strong family history of uh you know, different mental illnesses, that this might be the initial presentation and this will not be the end of it. Depends on the age of the child as well. But common things are common, and um, a lot of kids have more of a situational transient anxiety based on you know their environment and equipping them with tools is it goes a pretty long way.

SPEAKER_01 7:48

One of the things that I'm excited about in terms of you being at the practice uh is that as a pediatrician who has a special interest in emotional and behavioral problems, you're in a better position uh to end up having an impact compared to the uh situation where the referral is to a child psychiatrist. It's it's kind of like it's much more of an extreme referral in the in the eyes of uh, I think, of parents and and most people. So that area, that interface between normal kinds of issues that children have, the stomach ache, the anxiety, the I don't want to go to school today, may not require anybody having to say, well, your child needs to see a child psychiatrist. That that's a big red flag for most people and scary and more likely to want to be avoided and denied. But with you as the as a pediatrician, you're in a position, I think, much better to ameliorate situations that aren't so extreme. And so the the target audience is much larger, and I think you can have a greater impact on a much larger population before they get to see uh such severe problems.

SPEAKER_00 9:06

Yeah, I'm never gonna knock a good child psychiatrist. You guys help me out so much, but um I agree that a lot can be handled um by a general pediatrician. Another advantage is that I can look at the child holistically. And what I mean by holistically is look at not just the symptoms of the behavior, but also what we call the differential diagnosis of what else could this be, and then look at the pillars of the child's life and making sure that they are strong and intact, that the foundation is good. If we have a child who has horrible sleep habits, they are not going to have a stable outcome with their depression, for example, or their anxiety, because lack of sleep is only gonna complicate things. Or if they um are in a situation where the diet is lacking, whether it's not enough in terms of calories or the wrong types of foods, then we're gonna see behaviors from that as well. So being able to look at the child as a whole. And another great place is also have being in an environment where I've got some great psychologists that are much more skilled than I am in being able to navigate the family dynamics because the kids don't exist in a vacuum. The whole family needs uh needs to be carried through this.

SPEAKER_02 10:27

But you mean you touched on the key issue, which is being a good listener. You know, whether you pediatrics or psychology or psychiatry, that's half the battle. Yeah. And and and maintaining that uh uh connection with the individual is critical. One of the things that that I see is as an adult psychiatrist is when somebody comes to see me, I have the advantage of having a track record. So if I see, you know, Joe Schmo or Jane Schmoe and they're depressed, and this is the sixth depression in the last 15 years, it tells me something about the biology or the family situation or the life situation that created it. But you get to see a kind of de novo disorders, you know, some a kid who comes in for the first time with school phobia. Uh, and and I would imagine the toughest thing is to try to differentiate how much of this is just a phase and a life situation from how much of this could be an ongoing difficulty that the child has. And again, my advantage is that I've got that that past history, and now you've got to be, I guess it's a more pressure on you to figure out how much of this is serious or not.

SPEAKER_00 11:33

We are really, as pediatricians, the front line. We really are, and it's a very unique position to be in, and it's sometimes a little bit um I don't want to say scary, but I I look at it with a lot of respect because you know, you have to look at all of the possibilities that are out there and be able to give reassurance to the family that this is a phase or not a phase. This is but we do a lot as pediatricians in the realm of anticipatory guidance. We expect this outcome. If this doesn't happen, then we're gonna look at this. And we're not going to go down that scary what-if tree very early on because there are too many branches in that tree. So we're going to follow this route and then we're going to follow the trunk, and then where the branches fall, you know, break branch off, then we're going to go to the most probable one. And if that's not where this child is headed, we backtrack a little bit and go up another, you know, in my little tree analogy.

SPEAKER_02 12:31

Um but then you're dealing with the Dr. Googles uh who get on the website and the parents find out, say this, that, and the other thing, and they go down that what if tree.

SPEAKER_00 12:40

They're they're already in the canopy. I'm in the part where you can actually start climbing. But um, you know, experience has, you know, is very helpful to be able to see all the, be able to understand all the players involved, the players being all everything in the child's life. Um, and and one of the most frustrating things as a student doctor and as a resident physician and as a new pediatrician earlier in my career was when I had people with more gray hair than than I did say things like, oh, well, I just know. I'm like, how do you know? Right? I wanted that experience. And I really um I have it now. But um, in in the beginning, it was very frustrating to me when I had people who were my mentors just telling me, like, I just know because I've seen this 800 times.

SPEAKER_02 13:29

Right. Well, you know, the uh the the new parents are anxious to begin with. They are. And I just remember when my my first child was born, um, and my wife tells the story all the time. Uh when he was, I think, three or four weeks old, he developed a rash. It was in the summer in in New Haven, Connecticut. Brought up, we had an old-fashioned pediatrician who had a herringbone jacket with uh leather patches on his elbows and almost smoked a pipe, did his own urinalyses. But uh Carter Stilson, what's his name? Wonderful, wonderful guy. But my wife brought our son with this rash, and he looks at my son, examines him, looks at my wife, and said, What are you doing to my my kid? And my my wife shrunk down the chair.

SPEAKER_01 14:10

Bundling him up.

SPEAKER_02 14:11

He's got prickly heat, you know, overdressing him for the weather. But at but new parents are really anxious. I'm sure now with the internet, they just get on the internet all the time to try to assuage their anxiety.

SPEAKER_01 14:23

It must be a good thing for you and the parents, though, because you have a lot of data points and you meet them early, early on. So they have a relationship with you and they start to trust you.

SPEAKER_00 14:35

Yes.

SPEAKER_01 14:36

And if you say something, you're not a stranger.

SPEAKER_00 14:38

Right.

SPEAKER_01 14:38

That's gotta be so valuable.

SPEAKER_00 14:40

Right. That that is that's super helpful. And especially when they're on their second or third kid, they, you know, I spend a lot of time in the beginning of a repent, you know, doctor-patient relationship with expectations and communication and anecdotes and all of the stuff that's kind of like the dating phase of the doctor-patient relationship. I don't mean that in a creepy way at all. That could totally come out weird. But but in a getting to know you phase. Um, and that way I can see where their sticking points are and they can understand, you know, I have once had a mom who I had called on a Saturday because I was just thinking of their child. And I'm like, huh, I wonder if this is what's going on, you know, in the course of the of the health of the child. And the mother had, you know, quite a bit of anxiety that I called her on a Saturday afternoon because she's like, well, if you're worried about it, then I must be worried about it. Because you get to know the personality of the person taking care of your kids. And, you know, if they're an alarmist, then it's very easy for the parents to be an alarmist.

SPEAKER_02 15:43

That's a that's a good point because I think I'm thinking about how long it takes us as mental health professionals to develop that trust. You know, and and and for you, it's just kind of natural because the parents need to have somebody who's an expert who's going to be there and the advocate for them and their child. But for us, many people come in being anxious about what's going on with them in the first place. We're strangers, and it may take months before that trust is developed.

SPEAKER_01 16:07

And the only person that maybe has said anything to that parent about their child may be the teacher or the school counselor bringing up the concept of maybe there's some sort of emotional issue going on. So to hear it there and then not know what to do with it, where are they gonna go to find out more? Well, they can go to a stranger or TikTok or you. And so, you know, you have that trust built up. So you, you know, your situation is so valuable in early identification, yeah, as opposed to early denial.

SPEAKER_00 16:37

Right, exactly.

SPEAKER_01 16:38

Huge.

SPEAKER_00 16:39

Yeah. There's a river somewhere, right?

SPEAKER_01 16:42

Right, in Egypt. Speaking of which, one of the things I've learned about you, yeah, that's a good segue, we didn't realize. I thought the same thing when you said river. And Egypt, it's a Nile, and that's a river in Egypt. And I'd like you to tell a little bit about what you do in a in an area not too far from Egypt.

SPEAKER_00 17:01

So um I see how far back to go. When I was about four, four or five years old, and my grandmother asked me what I wanted to be when I grew up, and I said, I either want to be a pediatrician in Sub-Saharan Africa, because I knew those words uh at that time, um, or a waitress. Those were my two career choices at that age. Um, and I've kind of planned my life to eventually go to Sub-Saharan Africa and become a pediatrician there. And about eight years ago, um I actually started doing that. You know, the my children were in a place that they could be, um, I didn't have to worry about them all the time. They were in high school and college, and I had a little bit more flexibility in my schedule. And I started going there first with the issue with the idea of wanting to help, wanting to make a difference, wanting to fulfill this lifelong dream that I've had. Um, a parentheses here, my parents met in Sub-Saharan Africa. So that's where that idea came from, and that's where their love story began. And so that's why that area of the world really um attracted me a lot, because as a young child, we had all the books and the art and the music and the, you know, the colorful outfits and everything from that part of the world. So as a very young child, I thought I was actually part African. But um now I realize that it's just where my my heart was. And so um my husband and I went and we went, um, he is not a physician, but we went on a medical outreach and he did his part in the non-medical part of it. And then we decided that we could actually do this. We could start a foundation and we can plan these trips and we can actually make a difference. And there's been, you know, there's a there's a learning curve, and there's a, you know, I could talk about this forever, but um, I think one of the important things to look at is, you know, there are barriers to care everywhere. My practice is in West Palm Beach. I've practiced in Boca Ratone for many, many years. And we don't realize that there are also barriers to care here. The ones in Ghana, which is where we go, are a lot more obvious. And um, a lot, they have a huge sequela, you know, life or death type of outcomes because those barriers are so big. And what we've what our what our project does, what our foundation does, is that we go twice a year, we bring volunteers with us, and we go to the same villages over and over and over again, establishing rapport, following long-term um, you know, the healthcare needs of these villages. And then as a pediatrician, and my special interest is in the health of children, is helping them not only physically with, you know, the recurrent malaria that they might be exposed to, or the anemia because of their nutritional deficits, or just, you know, infectious agents that could take their life before the age of five, but also getting them academically um up to par so that then they can dream big and they can do what they can do. And it's um, I mean, I'm gonna start crying because this is really my happy place. And I encourage anybody who ever had a dream at the age of four, whether it was being a waitress or a pediatrician in sub-Saharan Africa, just to do it.

SPEAKER_02 20:24

What's the name of your foundation?

SPEAKER_00 20:26

It's called Akoma Ntosso Foundation, and it means linked hearts, and it's uh Ghanaian adinkra, which is like a symbol that um almost like uh, you know, I just did this with my hands, but like a heart, you think you see the symbol of heart, you can think of love, and you can think, you know, you know, all those things. They have a whole bunch of symbols there called adinkras, and they each have, you know, the word that it is, and then the deeper meaning. So basically the meaning of the this adinkra of Komantoso is um it's a an understanding across communities. So we are an international foundation, so we are uh nonprofit here in the United States and a nonprofit in Ghana. So half of our volunteers usually come from the Guinean population in the area, whether they are um doctors or nurses or student doctors or just do-gooders, that they just want to help underserved areas. And so that's what we do.

SPEAKER_02 21:23

But people continue your work after you leave for that particular visit.

SPEAKER_00 21:27

Yes, we have established a network there of people in the healthcare field who are um placed there by the Ghanaian government. They're, you know, they're kind of their posts, whether they are nurse midwives or um nurses who deal with um, you know, vaccine promotions or whatever it is in the in the area, that they are plugged into these communities where if there is one of our children that we sponsor um who falls ill, or if there is um Someone in need that they relay that information back to us while we're uh stateside and then we help them, you know. The internet is a wonderful thing. You know, things out there.

SPEAKER_01 22:11

One of the things that um we hear about is compassion burnout amongst physicians and mental health people. And I mean, I frequently hear people talk about being tired of giving. And I think it affects one way or the other, it affects the quality of care that exists in the United States in our area, where professionals are kind of tired of giving of themselves. You have something exponentially greater in terms of the desire to give. And so I'm I'm curious as to how that affects your everyday giving. It must be it must make it even more joyful.

SPEAKER_00 22:58

You know, they say that love multiplies. So I think that's what it is.

SPEAKER_01 23:03

Wonderful. That's wonderful, very special.

SPEAKER_02 23:05

Well, you know, I I I've heard repeatedly from internists um and other ph specialists that it's it's if they don't get burned out by giving, they go but get burned up by the obstacles to their ability to give. You know, the the physician who has to see so many patients in a day that they can't spend the time with them and do the job they're supposed to do. And I would imagine that you get refreshed every time you head off to Ghana to do your thing there because it makes it a lot easier than I mean, one of the reasons why we did this podcast is because you have to keep kind of reinventing yourself in a long career. But also it it's a good balance with some of the work that we do in our offices as well. But unfortunately, in in in healthcare in our country, there's so many obstacles to providing the kind of care where we want to provide, whether it be the electronic medical records that are, you know, migraine headaches repeatedly, or the numbers of patients we have to see, or the prior authorizations for medications or insurance forms, or all the limitations on care, it it's really difficult. So being able to find ways of giving back, I think, are terribly important.

unknown 24:10

Right.

SPEAKER_00 24:10

I mean, it's not easy over there. And I um I do I do struggle sometimes when I'm there that I just can't do enough, or why does this have to be this way, or the injustice of it all. But um, I think that I had mentioned earlier barriers to care in, you know, in the United States, and that is the healthcare system, is one of the greatest barriers to care, is the system itself. And it is horribly frustrating, it is demoralizing, it is I'm having more colleagues leaving the profession that I love because of that. And it's it's really, really sad. And we have to be creative in our outlets. My creativity just takes me halfway around the world.

SPEAKER_01 24:57

Well, we're very, very um blessed to have you join the practice because I think what you're going to add, aside from what we talked about before, in terms of the easier bridge for parents and kids to access um mental health care, uh that's a huge part. But also I I think the the the enthusiasm and the love of what you do will definitely add to our programs because we have we've been blessed with lucky clinicians, like a great staff, and I'm sure they'll just add to it tremendously. So thank you for coming on board.

unknown 25:32

Thank you.

SPEAKER_02 25:33

I'm uh appreciative as well, and uh look forward to our working together. And I know we have when we have our clinical meeting once a week, it's been a pleasure having your input and having you part of that. And both uh Andy and I have this decided a long time ago that surrounding ourselves with younger people, as you can see, many of the clinicians in our group are young, it it helps. It helps get helps you continue to learn because we're still learning, and also helps you to be a mentor to them.

SPEAKER_01 25:59

So now that I'm gonna it really makes a difference.

SPEAKER_00 26:04

Well, that's one of the reasons why I still teach at the medical school, because they will ask me a question that at one point in my career I knew, but I had to access it again, and some things have changed. So um I really enjoy both being a preceptor and you know being at the medical school.

SPEAKER_02 26:20

So thank you very much for being here. And uh I'm Dr. David Gross, psychiatrist.

SPEAKER_01 26:25

And I'm Dr. Andrew Rosen, psychologist, and um says two shrinks in a mic, and we'll see you next time. Bye-bye. Thank you. The Two Shrinks in a Mike podcast is for informational and entertainment purposes only. The views expressed are those of the hosts and guests and do not constitute medical, legal, or professional advice.

SPEAKER_02 26:48

Please always consult a qualified healthcare provider before making any medical or wellness decisions. Our content is not a substitute for professional medical guidance, even though our mothers tell us we have the best advice possible.