Postpartum Depression

You’ve spent the last nine months preparing for your new bundle of joy. Juggling work or other kids. Keeping up with your daily responsibilities all while managing the extras that come with growing another human. It’s a lot to take in. Now you’ve brought home your baby. By all accounts, you are supposed to be gloriously happy. And you ARE happy. But sometimes things are just not right after giving birth. Sometimes you can’t shake the anxiety or underlying sadness. How do you navigate when your expectations and reality don’t line up? Fifteen percent of women experience postpartum depression. Are you one of them?

The Reality

Childbirth (and pregnancy!) is not all rainbows and unicorns. Sometimes things go wrong. Miscarriages are common and often not discussed. And there is an ever-growing list of things that you should and should not do while pregnant. We live with the illusion that if we do everything right, if we can control all the variables, we can protect ourselves and our babies. But if you are struggling, you are not alone. In fact, you’re in good company. Up to 80% of moms experience baby blues. And 15% will experience more severe symptoms of postpartum depression.

Signs of Postpartum Depression

  1. Feelings of significant anxiety or sadness that are interfering with your ability to take care of yourself or your family
  2. Crying more than usual or for no apparent reason (BTW, dads LOVE this one… I once started bawling my eyes out when my husband brought me home lunch a couple of weeks after bringing my firstborn home from the hospital.)
  3. Losing interest in things you normally love
  4. Thoughts of hurting yourself or your baby
  5. Feelings of anger or rage, feeling out of control
  6. Noticing that you are having trouble bonding or feeling connected to your baby

What is the difference between baby blues and postpartum depression?

Many women experience baby blues. As I mentioned above, nearly 80%! So more of us than not will have some feelings that don’t easily line up with what we are expecting? Lots of stuff goes into this. Sleep deprivation and pain do not help. And I’ve not yet met a new mom who doesn’t have at least a bit of both going on.

Baby blues often start within the first week of giving birth. They are mild enough that they don’t interfere with your ability to hold it all together. And they usually go away on their own within a week or two. Postpartum depression is more significant. It can start any time after childbirth and affects a mom’s ability to get through her day. A mom with postpartum depression may find herself utterly exhausted, but unable to sleep worrying that something might happen.

Who’s at Risk?

Postpartum depression can affect anyone. It doesn’t care about your race or socioeconomic status. It can hit anyone from anywhere. But there are some risk factors that make you more likely to experience it.

  1. History of postpartum depression with another child
  2. A personal history of anxiety, depression, or bipolar disorder (past or present)
  3. A family history of mental illness (anxiety, depression, or bipolar disorder in particular)
  4. Personal history of drug or alcohol abuse
  5. Lack of social support system
  6. A stressful event occurring during your pregnancy or shortly thereafter. This could include a family death, unexpected complications with the pregnancy or delivery, or loss of family income.

How can you know if you have a problem?

This is one of those things that is easier to tease out after the fact sometimes. While you’re experiencing it, it can be difficult to recognize. It is really easy to put on a happy face for the world and pretend everything is just fine. I know this because I’ve lived it.

My Story

My first pregnancy ended in an early miscarriage. I was a nervous wreck when I found out I was pregnant with my firstborn. I had finally started to relax and feel safe around 19 weeks when the contractions started. We were certain I was just overreacting so lots of water and extra rest. It didn’t get better. When I started timing them and realized that they were regular and frequent, I went to the hospital. I was in pre-term labor. IVs, magnesium, Terbutaline, Procardia, monitors. It was terrifying.

We made it through that hospitalization and several others before finally delivering a healthy baby girl at 37 weeks. It took around the clock medications, bed rest, and weekly perinatology visits. I put on a happy face for the doctors. But when I got home from the visits I would cry. I couldn’t think about the baby and I didn’t want to plan for her.

The experience took a toll on me. By the time I delivered my baby, I had no muscle strength.  I couldn’t sleep at night waiting for her to wake up. And during the day, I couldn’t stay awake. I’d used up all my leave during my pregnancy, so I had to return to work when she was just 4 weeks old. I chalked up all issues to normal new mom stuff. Months passed before I started to feel half-normal again. And eventually I found my new normal. But when I look back at those first few months, what I remember is the bone-deep fatigue, the anxiety of waiting for something else to go wrong. I needed help. But I didn’t recognize it. And I didn’t know how to ask for it.

Screening tests

Fast forward nearly 14 years and we have a much better understanding of postpartum depression and postpartum anxiety. And many pediatricians routinely screen for it when seeing parents with babies under 6 months of age. In my practice, we give a screening tool called an Edinburgh at the 2 week, 2 month, 4 month, and 6 month visits.

Sometimes when I walk into a room, everyone looks great.  Mom is put together and smiling and seems appropriate. And then I look over her Edinburgh screening and realize that she’s not ok. Which is when I will say that the screening tool looks like she may be struggling more than is necessary. And the tears start. Turns out I’m REALLY good at making people cry. It’s my super-talent. But good things come after that. Sometimes we have to reach the bottom before we can claw ourselves back out.

If you are reading this and it is resonating with you, ask questions. Talk to your doctor. Ask your pediatrician. If you’re a fan on online quizzes, you can insert your answers to this online Edinburgh Postnatal Depression Scale. Print out your results and use them to talk with your doctor.

Getting help

If you are having trouble, there is no shame in asking for help. And although you may be feeling alone, you most certainly are NOT. Talk to your OB/GYN. Ask your little one’s pediatrician. Your doctors can help direct you to the next best step. We need healthy moms for healthy babies. You are important, so take care of you.

Resources

For further reading, you can check out the following resources.

  1. National Institute of Mental Health:  Facts
  2. Mayo Clinic: Overview
  3. Office on Women’s Health: PPD
  4. See PPD: About PPD
  5. Postpartum Support International: PSI Online Support Meetings

It’s A Virus

“It’s a virus.” We all love this answer (NOT!). When your kid is sick for the up-teenth day and you are starting to feel the heat at work, what you really want when you bring your kid to the doctor is for it all to go away. We’ve all been there. It’s hard to keep everything together on a GOOD day. And throwing in a virus is not welcome. Read on for more on this frustrating diagnosis.

“So you don’t know what it is then.”

Well, not exactly.  There are gazillions of different viruses. And they are constantly shifting, changing, and mutating. (If you want a quick refresher course on what viruses are, you can read more about it in this Khan Academy introduction.

There are lots of tests to identify exactly WHICH virus. But here’s the thing. Tests are expensive. And many take days to come back. By the time you know your child’s cold was caused by a rhinovirus, they’re already improving. Health care costs are expensive. Most of the doctors I know work really hard to use your resources wisely.

It is much preferred to order expensive tests only when the answer has the potential for changing what we do and how we treat.

Being able to say which subtype of adenovirus your child has is not really all that helpful. Often, there are specific clues that will tell us the most likely culprit.  And many times, the big offenders change by season. But knowing you have a metapneumovirus instead of a coronavirus isn’t useful information. Neat. But not useful.

“So there’s nothing you can do?”

Not exactly. There is nothing we can do to make a virus go away sooner than it is going to go. There ARE things we can do to help our kiddos feel better. Tylenol (acetaminophen) and Motrin (ibuprofen) can help bring down fevers. Check with your doctor on proper dosing for your kid. Saline spray can help break up thick mucous in your child’s nose. Honey will help a cough. Warm liquids soothe a sore throat. Extra snuggles give reassurance. Check out my Cold and Flu Survival Guide for a list of items to keep on hand.

Sometimes time and patience is the best medicine. And sometimes doing “nothing” is the best thing you can do. I know it’s not what you want to hear. And I know it is small consolation, but I don’t like to say it either.

It’s your pediatrician’s job to tell you what you need to know, not what you want to hear.

And please understand that we desperately want your kiddo to feel better sooner too. But wants don’t always change reality and we can’t always have what we want. (Darn it, my parents were RIGHT!!)

“Can’t you just nip it in the bud?”

Nope, afraid not. I have nothing at my disposal to make a viral infection go away sooner. If your kiddo is in the first day or two of a virus, it is probably going to get worse. You don’t like it. I don’t like it. But that’s how it goes sometimes.

Antibiotics are not helpful for viruses. They help bacterial infections. And antibiotics are not without side effects. Rashes, upset stomach, diarrhea, vomiting. And if that’s not enough, we have resistance to antibiotics to contend with.

As parents (and pediatricians) we can give supportive care. Keeping your kiddo hydrated and comfortable is that best thing we can do.

“But Susy’s kid did this exact same thing and then it turned into an ear infection”

Our bodies work hard to fight off viruses. Most of the time, the infection fades away and we go back to our normal everyday lives. But sometimes we end up with what docs refer to as “secondary infections.”

Secondary infections are infections that grab hold while we’re already knocked down from something else. They’re not all bacterial. It’s completely possible to come down with a stomach bug while fighting off a cold.

But some secondary infection are bacterial. Ear infections and pneumonia are a couple that can be bacterial secondary infections. (Although both of these also have viral forms as well.)

Unfortunately, there is no way to predict which of our kids will go on to have a secondary infection. So if that fever is hanging on past 5 days or they were improving and now they’re sick again, get them checked out.

“I brought my kid to the doctor and they did nothing and said he had a virus.”

Sometimes value comes from ruling OUT and not ruling IN.  A diagnosis of a virus means that the ears aren’t infected. There is no strep throat. The lungs are clear and there is no pneumonia. There are no swollen organs.  There is no evidence of cancer.

It is easy to be worried as a parents. Many of us are parents too. Sometimes the doctor part of my brain has to talk down the parent part of my brain. I get it. But sometimes “doing nothing” is the absolute best thing to do.

What questions do YOU have about viruses?

 

Cold and Flu Survival Guide

It’s that time of year. Viruses and colds everywhere. This time of year can be a source of frustration with sick kids and hectic schedules. There is no way to make these unwelcome house guests exit your home any more quickly, but there are things we can do to make your kid more comfortable. Is your house stocked and ready for the season? Get prepared with your own personal cold and flu survival guide.

Tissues

When the noses start running, you are going to need these in your life. Make sure you’ve got an extra couple boxes stashed away in the event of a whole family virus-fest. Several sick kids, a sick spouse, and only 1 box of tissues isn’t going to be fun.

There are other options to replace the traditional kleenex if you are so inclined. Try a roll of the extra soft toilet paper to do the trick beautifully for less expense.  Or if you’re feeling experimental, you can try flannel handkerchiefs. Turns out, you can find these on Etsy in all kinds of pretty patterns. (I have flowers and robots…allergies at my house are NOT nice.) Or you can make them yourself if you are good with a sewing machine. (I am not.) Bonus points here for washing and re-using.

Vaseline

True, a tub of vaseline isn’t going to make your cold go away faster. But it WILL keep your nose and lips blissfully un-chapped. Once you start reaching for the tissues, dab a little of this on your nose and lips to prevent chafing. A little goes a long way. It doesn’t burn so kids won’t fight you.

Saline spray

This is the number 1 item to have in your house for cold and flu season. Grab a handful and stick them in a drawer somewhere. Saline does magical things to thick snot. It loosens mucous so that it drains more easily and you can blow it out more easily. But it also helps decrease inflammation in swollen tender nasal tissues.

A couple squirts in each nostril can really help you feel better. Saline is safe even in brand new babies. And you can use it as needed and every hour if necessary. But if you have an infant with a cold, go easy on the bulb suction. Using suction more than a couple of times a day can really irritate the sensitive tissue inside the nose and in some cases will make the congestion worse. Save the bulb suction for gobs of snot.

Considerations for saline..  1. generic saline is fine. 2. Label the saline container with the name of its user. (I understand that we’re family and all, but I don’t want to share boogies with my kids…) 3. If you’re having issues with the large tip working well with your little kid, you can try something like Simply Saline (link below)…  it can be found everywhere. And it has a tiny tip which works better for tiny nostrils. Warning to all though… apparently there is a form of this with eucalyptus which I purchased on accident once. Youngest daughter did not appreciate minty freshness on the inside of her already irritated nose… you’ve been warned.

Warm drinks

Hot tea with honey is great for soothing sore throats. The steam helps open up swollen nasal passages. And the warm liquids help soothe the throat and melt away mucous. Peppermint teas can especially help open things up. If your kiddo isn’t a tea drinker, you can also try apple cider or hot cocoa. The effects will be similar.

Honey

If your kiddo has an annoying cough and is over a year old, try some honey. A teaspoon of honey works better than most over the counter cough syrups without the medicine side effects. If you need more convincing, you can check out this study which was published in a 2012 Pediatrics publication. I love honey for my kids’ coughs. We don’t own a single cold medication.

Water

This should go without saying, but you need lots of fluids when you are sick. Blowing out gallons of snot is not good for keeping you hydrated. You will feel a lot better if you are hydrated. So bottoms up on that water.

Pedialyte

For little squirts who have upset tummies, pedialyte is the best for replacing fluids. It has less sugar than sports drinks. There are now many flavors to choose from and you can even get it in popsicle form.  Which makes anything more palatable.

Soups

There is something to be said for chicken noodle soup to help you feel better when you’re sick. The individual ingredients are not magical. But the combo definitely works. The salty chicken broth helps keep you hydrated. Warm soup going down the back of your throat soothes tickly throats and helps break down mucous in the back of your throat. Steam from the soup helps loosen mucous in your nasal passages. Granny was definitely right on this one. Soup does help you feel better when you’re not feeling well.

Heating pack/Ice pack

Last Christmas, I made my children fleece rice-filled heating packs. They are soft and fuzzy and you pop them in the microwave when you want them. They were a hit. Cold toes? Rice pack to the rescue. Chilled? Same. Just feel icky and need some comfort? You know the drill. Turns out, these are great for helping you feel better. True, they don’t make your virus go away any more quickly than it’s going to go. But they do provide comfort. And that’s what we need when we have a nasty virus.

By the same token, a cool pack can also help your kiddo feel better. My little squirt prefers a cold pack for a headache. Tylenol can also help, but she reaches for the cold pack as well.

A cozy blanket and extra hugs

Colds and flu (and other viruses) are going to happen. And we are probably not going to appreciate their presence when we do get them. Although they are certainly an inconvenience, they are also a reminder to slow it down and take care of ourselves. So curl up on the sofa with your kiddos and give them some extra snuggles. A little comfort goes a long way when your littles are sick

I hope that this cold and flu season treats your family kindly. Remember that most viruses can be treated at home. But if your little one seems much sicker than expected, they are having trouble breathing, funky rashes, or not keeping down fluids, get them checked out. If you’re not sure, call your doc for advise and next steps.

 

The Talk: how and when to get the conversation started

The Talk…it is a dreaded part of parenting for many. We spend a LOT of time worrying about how to introduce topics about sex and how our bodies work. But in reality, it doesn’t have to be a big deal. Our kids are curious and real questions deserve real (but age appropriate) answers. Keep reading for common sense ideas on starting and keeping the conversation going.

Start early

If you start talking about the body to your kids early, it is a whole lot easier than if you wait till they are older. Use the right words when talking about their parts. Penis and vulva are NOT bad words. Although they can be embarrassing to have yelled out by a toddler in the middle of Wal-Mart.

So use real words.  After all, do we rename our fingers and toes into cutesy words or phrases? No. And how confusing would that be? Keep it simple. The hardest part of this for many is to not treat those names as secret or somehow forbidden. We don’t have to whisper the word vagina when we say it. When we use words without embarrassment or shame we empower our kids to feel comfortable in their bodies.

Only answer the question asked

It is always best to answer questions simply. “Where do babies come from?” isn’t always an invitation for the ENTIRE story of how they get there. Sometimes that IS the question. But if you keep your answers simple and basic and remain open to questions, they will be happy to ask for more information if needed.

When my eldest daughter was barely 5, she was completely perplexed about how babies got out of a mom’s tummy. She had the understanding that they grew in the stomach, but no understanding at the time that there were different areas in a mom’s stomach region. To her, the stomach was food storage and that’s about it.

Her reasonable at the time question was that if a baby grew in the stomach, did it come out of the mouth? And how would that work? She was confused. I thought a second and answered very simply..  Nope, not the mouth. When babies are ready to be born, they come out of a hole next to the mom’s bottom.

She was not amused. “MOMMY!! I do NOT think a baby would like to be covered in pee or poo!!” was her response. “Well, they don’t come out of those holes” I responded.  She seemed satisfied by this answer and we moved onto other less dramatic car-ride conversation.

Until 2 weeks later when out of the blue she had another one for me. “Mom, I’ve been thinking, and I just don’t know WHAT hole you’re talking about!!” The answer to that one required some diagrams. Luckily you can search about anything on google.  But please do not do these searches in view of your children–sometimes you can’t predict what will come up.

It’s ok to give yourself time before fully answering

When kids ask us serious questions, they deserve serious and truthful answers. Sometimes we can answer them right away. But sometimes we need a couple of days to decide how we’re going to go about it.

It is totally OK to say “Hey that’s a really good question. Let me figure out how to explain it and get back with you.” Only you do actually have to get back with them. You’ve only bought yourself time to peruse the internet and Amazon.

Find some good resources

With so much information at our fingertips, it can be really difficult to sort through it all and find resources that help us without raising more questions. When Kid #1 asked what the word sex meant in 2nd grade, I was not ready. And a Tuesday night at 8 PM was not when that talk was going down. Insert stock phrase above, tuck in kid, and pull out laptop.

A few minutes later, I had resources on the way. A few days later, they were on my doorstep. But I didn’t like all the stuff I bought. I’m not weirded out by much, but some of the stuff meant for kids was downright creepy. Some gave WAY too much information. Others inserted morality into the discussion.

I’m all for morals. But when it is time to discuss how our bodies work, I do not need that in my books. That’s MY job. When having talks on bodies and parts, I just want information. Clear and concise.

Luckily, I stumbled on some gems that I am still recommending to my patients and still use with my kids. I don’t completely agree with the age ranges, but all 3 books in this series are great and you can always use the one you feel is most appropriate for what your kid can handle.

It’s Not the Stork! A book about girls, boys, babies, bodies, families, and friends by Robie Harris

This is a great introduction. It is intended for ages 4 and up which I think is appropriate. It uses real words and the illustrations are good. You can find it below on amazon or in person at another dedicated book store.

It’s So Amazing! A book about eggs, sperm, babies, and families by Robie Harris

This one is geared for ages 7 and up. It spends a lot of time detailing how our bodies work. I consider this book a book of “mechanics.”  What is a uterus, how do the ovaries work? What is a period? They touch on sex, but it isn’t the primary theme of the book.

It’s Perfectly Normal: Changing bodies, Growing up, Sex, and Sexual Health by Robie Harris

This one is geared for 9 and up. Although many 9 year olds may not be quite ready yet. But it is a wonderful resource to have available for your middle school kids on up. Definitely a lot of sexual health in this one. But all presented in a matter of fact and informative way.

Find a time to talk

Once you’re ready to have conversations, make a date with your kid. Go for a walk or head to a coffee shop. Warm drinks and baked treats always help. And if all else fails, grab their ear buds and go for a drive. Sometimes it’s easier for them (and you!) to talk and ask questions when they’re not looking you in the eyes. And they can’t escape if you’re driving!

Make sure to have follow-up conversations

This is not a one time event to mark off the parental to do list. It is the start of many great conversations to come. The more conversations you have, the easier it gets. As they ask questions and are met with honesty and real answers, the more comfortable they will be asking YOU and not the abyss of the internet or inaccuracies in school.

Feel free to add your tips for having these talks with your kids! We can all learn from each other. Any resources that you love? Feel free to share.