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Interviewer: It's a situation that no parent ever wants to deal with, but their teen has run away. Once you have located your teen and got them back home, what do you do next? How can you make sure to resolve whatever is going on and why they ran away in the first place?

To help us understand the situation and what steps to take next, we're joined by Amanda McNabb. She is the quality improvement and training manager at the Community Crisis Intervention and Support Services with Huntsman Mental Health Institute.

Amanda, it is a situation that really I think most parents fear sometimes. And when it happens, what do you tell parents, and what is the first step that they should do when they get their kid back?

Amanda: Usually, when a parent is dealing with a situation in which a teenager has run away, one of the things that we really suggest is having another support system with them. So maybe having a mediator, a family friend, somebody who can come in and help keep the emotions that are going on at a minimum so that the conversation can happen about why.

A lot of families will then just say, "Don't do it again. This isn't good. Now you're going to be in trouble." And they don't really focus on what was the reason behind the idea of running away for that teenager.

Interviewer: What are some of the common reasons that they would run away? I mean, I know that every family is different, but with all the amount of people that you interact with, there have got to be some common threads.

Amanda: Absolutely. And those common threads can run from just a teenager who doesn't like the rules in the house and wants to have some extra freedom or things like that. It may be that they're dealing with a lot of pressures and feel like between school and home and friends and everything else that's going on, they just can't handle it and need to get out of the situation.

There may be some concerns about gender identity or feeling accepted for who they are. And that may be another reason that a teenager might leave the home or leave the situation.

The teenager also could be dealing with mental health, depression, anxiety, maybe thoughts about suicide. And the idea of running away is the first step towards "What do I do with my mental health itself?"

Interviewer: So Step 1, get a mediator, get someone in between, calm down some of the, I'm sure, very high-intensity emotions that are happening in that situation. What are some strategies and next steps that we can share with parents who are trying to help identify what is going on with their teen or with their home situation and where can they go next?

Amanda: I think in the beginning, as you said, being able to calm down and really bring those emotions back down to where everybody can actually communicate with one another.

When we're in a high emotional situation, we're not often listening to the other person. We're not having a true conversation. We're always thinking about, "How am I going to respond?" Or with teenagers, it's, "Okay, how am I going to hold this person to consequences for their actions and their behavior?" And instead, we really want to focus more on, "Okay, what is going on in this situation? How can I try to see their perspective?"

With teenagers, and really adults, we each have our own perspective on the situation, which doesn't always match up with somebody else. So we want to focus in on really being able to use those reflective listening skills and those active listening skills to communicate and say, "Tell me more about what's been going on," so that we can come to a positive conclusion and hopefully make things better.

Sometimes with that piece, we really will say to families and parents, "Call the crisis line." We are here not just for suicide or major mental health concerns. We are here for crisis.

And when a family has a teenager who's run away, I define that as a crisis. That is something that is creating a lot of discord and emotional upheaval for a family. And so we're here to try to walk you through those next steps or be able to intervene and say, "Maybe we need to do a mental health assessment on the individuals involved to make sure that everybody is in a safe place to have those conversations."

Interviewer: So with a service like the crisis line with the Huntsman Mental Health Institute, for some people, this might be the first time they are reaching out to a service like this. What can they expect when they call that phone number?

Amanda: When they call, usually, you will get ahold of one of our certified crisis workers who will then just ask, "How can I help you today? What is going on that made you call in?"

And once we've started to define what's happening, what's the situation, what is the actual need in the moment, and sometimes that need is just, "I need to vent. I need to talk about what's going on," or it could be, "I have questions about what resources are available to me," then we can start to collaborate together with the caller and say, "Okay, here's what may be available. Here's what may be an option."

And it doesn't always have to be the parent. It can also be the teenager. The teenager is always welcome to give us a call or use our SafeUT app or anything like that to reach out to one of our crisis workers and say, "I'm struggling with what's going on. I need help." And hopefully, they get a warm reception and are able to feel comfortable talking about some of those issues that maybe they haven't been able to bring up with other people before.

Interviewer: Now, who is the crisis line for and does it cost anything?

Amanda: The crisis line is for anybody and everybody. It is free to the consumer. We are here 24/7. Same with our SafeUT app, which is just a texting way of getting hold of the crisis workers. And it really is for parents, teenagers, anybody who's seeking that extra help.

Interviewer: So for a parent who is dealing with a runaway and it's time to figure out what's going on and heal together, what is the number to get in contact with the crisis line?

Amanda: Parents can reach us at 1-800-273-TALK, or the national number at 988.

Interviewer: Just 988?

Amanda: That's all it is.

Parents often wonder if their baby is lazy. I have parents use that term all the time. If their child isn't doing everything they think they're supposed to be doing, the parent labels their child as lazy.

For example, I have parents telling me a lot that their 12-month-old is lazy because they're not walking. Your child isn't lazy. Walking can start any time from 9 months until 18 months.

Parents will tell me their child is lazy because they want to be fed. If your child is under 18 months old and still learning how to use utensils, that's not lazy. They're just still learning. If they're 4 and they want you to feed them, that's not laziness. It's them being manipulating and trying to get you to do what they want.

Parents will also ask me about why their child isn't talking. They think that their 18-month-old should be saying sentences and instead only says about five words. Well, the biggest language explosion happens between 18 months and 3 years old. By 18 months, they should be saying four words, in addition to mama and dada. Boys tend to talk later than girls too. Not sure why, but that tends to be what I see. Girls tend to be more social. Boys tend to develop their motor skills faster.

I get the opposite too. Some parents think their children are developing completely normally when, in fact, they're behind on motor or speech milestones. This is one reason we do the autism screening at 18 and 24 months, to catch those kids that are behind and determine: Is this expressive speech delay? Are there not enough opportunities for motor development? Is there a concern for autism? Does the child have a different diagnosis that requires evaluation by specialists?

Now, I'll end with this as a heads-up. There was a recent article published in the "Journal of Pediatrics" outlining about how developmental guidelines for the first five years of life needed updating, and the Centers for Disease Control just adopted these new guidelines.

It will take a little while for everyone to catch up with these new guidelines when pediatricians do their screening evaluations at well-child visits. But we have a general good idea of where your child should be. As pediatricians, we are really good at figuring out if your child is on track developmentally, or if they need to see a specialist for a speech or motor developmental delay.

If you are concerned about a specific developmental issue with your child, be sure to discuss it with your child's pediatrician.

Interviewer: You've noticed a change in your teenager's mood. They're angry, moody, defiant, irritable, and in addition, their school performance or maybe interest in other activity is significantly decreased. You're worried about depression. Is it okay to talk to them about it, or could it cause more harm than good?

Dr. Thomas Conover is a psychologist at University of Utah Health, and what is your advice for parents about how to talk to their teens about these tough topics? Or should they even talk to them about them?

Dr. Conover: Communication is a real key. It certainly is protective and helpful for parents to communicate and inquire with their teen as to what's going on and how they're feeling. And that's something that I think most parents strive for but may struggle with. How do I talk to my teen? What do I talk to my teen about? Is it okay to ask? I would advance to say that it's always okay to ask your child about how they're doing. You seem really sad lately. Is there something bothering you? Is there any way I can help?

Interviewer: No. I mean you probably have to dig a little bit sometimes, huh?

Dr. Conover: You may. I think that there's value in setting an example and leaving the door open by saying those two things. In terms of setting an example, certainly communicating openly oneself is important. Right? So I've talked about various areas of function that a parent might look at for a teen child and use to try to evaluate how serious a problem that they're suspecting maybe. But a parent can show that those things are important themself. Right? A parent can demonstrate that being engage with social activity and self-care and physical activity, you know, which boosts mood, all of those things are important. So a parent may set the stage in their own family by doing those things.

It's always okay to ask your child about how you're they're doing. And even though a lot of times teens may seem outwardly like they don't want someone to ask, I think most of the time people who are struggling even in a small way do want someone to ask. I think it's helpful not to badger. I think if you're met with that initial no on a first inquiry, it's good for a parent to perhaps say, "Well, okay. You know, I hear that you're saying that there's nothing about it that you want to talk about. But just know that I'd be happy to talk to you if you do . . . if you change your mind about that, if you do want to talk about."

I think that's a tough one. It's a tough balance to strike, because I think if a parent is a concerned at all about their child and they try to make that initial ask, first off that's a hard thing to do. You know, you might be thinking about it all day or all week and then, finally on Friday you say, "Oh, we're sitting at dinner and my kid's actually home with me. I'm going to ask." And then, the first thing that they snap back with this, "No. Everything's fine." And the parent might feel kind of rejected by that and, you know, they might respond by shutting down. Right? Going like, "Oh, well, okay. I guess I shouldn't have asked."

I wouldn't advocate for that black and white of a response, nor would I advocate for a parent then saying, "Well, no, I know something must be wrong. I've been watching you all this time, and you just aren't acting yourself. You need to talk to me right now." You know, in most cases, that's not going to be the best approach either. It's, I think, always appropriate to ask and it's always appropriate to maybe give a little space and a little time for the teen to be able to absorb the question and respond. Now, that would be with the exception of a true emergency, and those emergencies do include threats or acts of self-harm or threats or acts of a suicidal nature or serious aggression.

Dr. Gellner: Bringing up health concerns with anyone close to you can be a challenge, but when it comes to parents bringing up concerns that their child may be overweight, it can be even trickier.

Announcer: Keep your kids healthy and happy. You are now entering the "Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Parents often ask during a visit, "So how's my child's weight?" Sometimes it's just fine. Sometimes they think their child is just fine, but their child is actually overweight and that gets us into a whole different conversation. As a pediatrician, it's my job to tell you and your child the facts about their health. And while I don't sugarcoat it, if your child is overweight, I do find that there is a very tactful way to discuss it and turn what could be a degrading self-esteem harming and accusatory conversation into more talking about, yes, your child is overweight. Let's talk about what they like to eat, how active they are, your family genetics, and how we can make sure your child gets to a healthy weight.

You've probably heard me talk about childhood obesity a lot on The Scope. It's an area that I focus a lot of time on in my clinic. I've gotten pretty good at talking to families and kids about weight. There are so many factors involved when talking to a family about their child's weight. Are the parents overweight? Are there cultural or ethnic considerations that need to be kept in mind? Can the family afford to feed their child healthy foods, or are they struggling just to buy ramen noodles? Is their child such a picky eater that it becomes a battle and the parents just end up giving their child whatever they will eat?

When I talk to a child and their family about weight concerns, I spend a lot of time with them and try to come up with solutions that work for their home situation and their child. There isn't a good cookie cutter fix for childhood obesity. Not only is it hard to get some kids to eat healthy and be active, but there is a huge self-esteem component when a child weighs more than their friends.

Telling a child they are overweight can really bring them down if you do it wrong. If you say, let me show you how you're growing. This graph shows that your weight is more than it should be for your height. So let's talk about what you're eating. Do you like fruits and vegetables? Are you drinking soda or juice a lot? What do you like to do for fun? And let's make a plan together to get your body healthy.

I've been doing visits with kids specifically to talk about their weight for years, and every patient I talk to leaves with a smile and a plan on how to be healthy and they feel empowered that they can do it. They are in charge of their body. They follow up with me regularly, and we see how we can make them successful in getting their weight where it should be. Sometimes it doesn't work, the kids aren't motivated, and the parents just drop the subject. However, for the most part, kids really want to be a normal size, not overweight, and they're open about having this delicate conversation if you bring it to their level and provide positive encouragement.

So if you're concerned that your child may be overweight and you don't know how to bring it up with your child, talk to your pediatrician. We understand how kids think and can help start that conversation in a positive way.

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Dr. Gellner: Parents come in frequently with concerns about their child's eyesight. Some kids like to read in the dark with just a flashlight. I was one of them. But does reading in dim light really affect your child's vision?

Announcer: Remember that one thing, that one person told you, that one time, about what you should or shouldn't do with raising your kids? Find out if it's true or not. This is "Debunking Old Wives Tales" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Yes. I was one of those kids who my parents constantly had to tell me to get my nose out of a book even long after it was supposed to be bedtime and my parents would find me with just the little bedside lamp or flashlight. Kind of like kids with the electronics these days, it was hard to get me to stop reading. It's no surprise that one of the biggest concerns I hear from parents is that the kids are reading in the dark and they want me, the doctor, to tell their child that reading without a lot of light is bad for their eyes. Well, at that point, I have to tell the parents that reading in low light damaging a child's eyes is actually an old wives' tale. Yep, that's not true.

Now what is true is that the lower the light level, the harder it is for one's eyes to focus. That can cause short-term problems with eye fatigue. Eye fatigue is basically when your eyes have to work harder to do their job no matter what the situation. You can have a lot of bright light, but if you're staring at a computer screen all day, you're going to get the same eye fatigue. This can also cause dry eyes because you don't blink as much as you should. But dryness doesn't damage the eyeball itself in cases like this. So if your kid likes to read in dim light, I'd encourage them to use better lighting more to help the eye fatigue, but I'd just be happy that your child is reading and not on a video screen or watching TV all the time.

Speaking of eyes and screen time, what about those kids who like to sit too close to a TV? While you may want to get their vision checked to make sure they don't need glasses to see clearer, sitting too close to the TV won't hurt a child's eyes either. Just be sure to limit screen time to two hours or less per day for the most part. Not only will it help with eye fatigue, but it will also make sure that your kids are doing something other than just vegging out.

If you have concerns about your child's vision for any reason, your pediatrician can do a quick screening test to determine if they need to be seen by an eye specialist.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Dr. Stoesser: Hi, my name is Kirsten Stoesser, and I am a family medicine physician. A question that a lot of new parents have is whether or not they need to supplement breastfeeding with formula. In most cases, this is not necessary but in some cases it can be helpful.

One of the times where we recommend that somebody supplement with formula is if the baby is not gaining weight appropriately, especially in those first few days to the first week. If we see that a baby has lost more than 10% of its birth weight and is not able to gain that back adequately enough and quickly enough with breastfeeding, then we will recommend to do supplementation with formula.

This doesn't mean, though, that you have to do a bottle feeding. There are actually some ingenious ways to be able to administer formula. One of my favorite ways is what's called the "Supplemental Nursing System," or the SNS system, and this involves sort of a drip line. There's a line that's taped over the mother's shoulder and then this line comes down and is taped across the breast and the nipple.

So a baby can still breastfeed and even if they're not getting much while breastfeeding, they are getting the formula that drips in and baby is still getting practice with breastfeeding so they're not losing that skill and mothers are still getting the stimulation at the breast, which helps to promote further breast milk production. Usually, when babies do the SNS system, they just need to do this for a few days and then they're able to catch up the growth and the weight that they need and are able to go back to breastfeeding.

There are different ways to supplement. Sometimes it can be because the baby's not getting enough nutrition, and sometimes it's because the mother's not producing enough milk. And so if the mother's not producing enough milk, having ongoing stimulation at the breast is important. So in addition to having the baby feed, one thing that I'll recommend to moms to do is to get a breast pump and after baby feeds to actually pump for five to ten minutes on both sides so that the breasts are getting adequate stimulation.

Another thing that's really important is for the mom to get plenty of sleep, which I know is hard, to make sure that she's eating regular meals, to drink plenty of fluids and to try to relax as much as possible. Another thing I'll recommend is that sometimes if just even one feed in the middle of the night, if somebody else can do that feeding, they can do a bottle feeding with either formula or with pumped breast milk, then that can allow mom to get a few hours more of uninterrupted sleep and sometimes that can help with breast milk production during the day because mom's not as exhausted.

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