Over the past year I have learned about numerous new (or newish) initiatives focused on early childhood – literacy, mental health, and identifying and addressing toxic stresses. Evidence and experience increasingly point to the importance of the early years in shaping a child’s future – no surprise to pediatricians, who can and do play an important role in supporting this development. Yet, as children are clearly dependent on their caregivers to create and encourage the type of nurturing, caring, and stimulating environments that will help them grow to be healthy and happy adults, pediatricians also play a role in supporting parents during this time.
Up to one-fifth of mothers may experience significant symptoms of depression or anxiety during the first year of their baby’s life. Perinatal mood and anxiety disorders (PMADs, also known as postpartum depression) are incredibly common yet often hard to detect; cross all racial, ethnic, and socioeconomic barriers; and are often highly treatable.
As pediatricians, we see parents often during this first year of life, are trusted sources of care, and have strong connections in our communities. Caregivers with PMADs often struggle to engage and bond with their infants despite their strong desire to do so. This makes us a safe and ideal place for parents to seek help. However, as we all know, this is not as easy as it sounds. During a busy well visit with lots of things to discuss, it can be hard to take the time to truly elicit how a parent may be doing or feeling. On top of that, many parents are afraid to admit they aren’t doing well. As one social worker I know said, sharing her own story of her experiences with PMADs, “I could hardly do anything, but when I went to the pediatrician, I made myself shower, put on clean clothes and makeup, smiled and acted as all was well. It was the only time the whole month I was able to pull myself together.”
As pediatricians, there are a few things we can do. First, ask. Parents will rarely volunteer that they are struggling, but if we make a point to ask, they are more likely to feel comfortable sharing. Even if they don’t say anything right at that moment, they will start to hear the message that we are somewhere they can come for advice or help. Some practices use formal screening tools, such as the Edinburgh Postnatal Depression Scale.
Next, identify some resources in your community where you can refer families if concerns arise. This may be tricky, as access to these resources can be poor, but having a plan for what advice you will give to parents if concerns arise will make this process run more smoothly. Postpartum Support International is a good place to start. The website has access to local resources, references, and general information for families. Parents also can be referred back to their primary care providers or local mental health service providers. For parents who may be in very acute distress, knowing the local psychiatric and emergency department availability is important so you know where to send someone in a crisis. All of these things are easier researched and identified before you actually need them – perhaps a nurse or other allied health professional in the practice may want to take this on.
Lastly, educate your office staff on the prevalence, signs, and importance of PMADs. Parents who pull it together while in the exam room may be in the waiting room in tears before you see them, and an astute and caring practice team can alert you if they see anything out of the ordinary. A nurse taking calls for your practice may notice parents who have a high level of anxiety when they frequently call for low-level concerns and are hard to reassure. Pediatricians care for and support families in so many ways, across childhood. Special thought and attention to this vulnerable time for parents can have significant impact on a child’s long term health and development.
Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and immediate past president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at pdnews@frontlinemedcom.com.