Post on 13-Mar-2022
10/24/19
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Star%ng the Conversa%on
Integra/ngmaternalandinfantmentalhealth,infantdevelopmentandlacta/onsupport
Ihavenoconflictsofinteresttodisclose.
Star%ng the Conversa%on
• Presenta/on• Background–MILKStudy• Dyadicinterac/on• Observingbaby’sbehavior• Infantbehavioralstates• Infantdevelopment• Maternalmentalhealth• Contextoffamilyandcommunity
• Smalltablediscussions• Comebacktogethertoshare/psandknowledge
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Who am I and why am I here?
-ParentEducator/InfantSpecialist
-ChildLifeSpecialist
-Cer/fiedLacta/onCounselor(CLC)
-GraduateprograminInfantandEarlyChildhoodMentalHealth
-Cer/ficatefromPSIinPerinatalMoodDisorders:ComponentsofCare
-CurrentlytraininginBrazelton’sNewbornBehavioralObserva/on
-StudyCoordinatorfortheMILKStudy
MILK Study MothersandInfantsLinKedforHealthyGrowth
• ThegoaloftheMILKStudyistolearnmoreabouthowamother’snutri/onandherbreastmilkisrelatedtoherinfant'sgrowthandbodycomposi/oninthefirstmonthsoflife
• Thestudyis/wasconductedattheUniversityofMinnesotaoverthespanofthepast4years
• h\ps://cnbd.umn.edu/research/milk-study
MILK Study • Womenwererecruitedprenatallyandcompletedprenatalformsonline• VisitsattheUofMat1month,3months,and6monthspostpartum• Weightedfeeding• Infantanthropometrics• Maternalforms• Maternalheightandweight• Breastmilksample
• 2½-3hourlongstudyvisitsscheduledatthemother’sconvenience
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Inresearch,weobensay:“Thereisnodirectbenefittobeinginthisstudy”…..butmomputpantson……andgotoutofthehousewitha1montholdItseemedlikethereshouldbesomebenefitforher
MILKStudy
Sendherbackoutintoherworld• feelingsupported• withmoreinforma/on• connectedtoherbaby• feelingconfidentaboutadvoca/ngforherself• andaccessingtheresourcesinhercommunity.
MILKStudy
How each visit goes depends on:
• Rapportbetweenmeandtheparent(s)• Emo/onalavailabilityoftheparent• Healthandwellbeingofthemother• Healthandbehavioroftheinfant• Degreeofparent’sknowledgeaboutchilddevelopment• Importanceofwhatinforma/onatwhatage
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Thereisnosuchthingasababy,thereisababyandsomeone.
-D.Winnico\
CommunitySupport/Resources
FamilySupport
MaternalMentalHealth
InfantMentalHealth
DyadicRegula/on
InfantDevelopment
Newborn Period
“Fromaparent’sperspec/ve,thefirstmonthscanbeconsideredanorma/vecrisis,aperiodthatischaracterizedbyrapidchangeastheya\empttoestablisharela/onshipwiththeirnewinfant.”
(Nugentetal,NewbornBehavioralObserva/onsSystem,2007)
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Dyadic Interven%on/Interac%on
• Promotereflec/vefunc/oningwithmoms/parents• Talkaboutholdingthebaby’spointofview
How do/can we support this rela%onship?
• Providecaregivinginforma/oninanonjudgmentalwayandsuchthatparentsdevelopinsightintothemselvesandtheirinfants• Respondsympathe/callytotheconcernsorques/onsoftheparentsthroughoutthesession• Sharingobserva/onssetthestageforsuccessfulcommunica/onaroundtheobserva/onoftheinfant
Observing Baby’s Behavior
• No/cewhatyouareseeing• Commentonit• Askparentswhattheysee
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• Discusswiththeparentsthebaby’sstrengthsandchallenges• Iden/fythekindsofcaregivingstrategiestheybelievewillenhancetheinfant’sgrowthanddevelopment• Facilitatetheparents’effortstohelptheirinfantmeetthechallengesofthenextstageofdevelopment
Quiz
Whichofthefollowingaresignsofovers/mula/on?a.Paleorredskinb.Splayedfingersc.Yawningd. Turningorlookingawaye. Alloftheabove
Motherswhoaresensi/vetotheirnewinfants’cuestendtoengageinmorefrequentandposi/veinterac/onswiththeirinfants.Thiscontributestothedyadicroleofmothersandinfantsinperpetua/ngaposi/vecycleofreciprocalinterac/onsthroughoutinfancy,leadingtosecurea\achmentintothepreschoolyears(Bigelowetal.,2010).
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• Primarytaskoftheinfant–selfregula/on,beginsinthecontextofdyadicregula/on• Selfregula/onisdevelopedinthecontextofamutualrela/onship• Thisisthefounda/onofa\achment• Securea\achment
• Theparentissafe• Theparentprovidesregula/on• Theparentisresponsive
• Breaspeedingplaysanimportantroleintheearlya\achmentprocess,notinandofitself,butinthewaythatitcreatesthesitua/onobenidealforthatprocesstotakeplace.(Tamminen,1988)• Amother’sconsistent,predictableresponsetoherinfant’scueslaysthefounda/onfora\achmentandresponsivenessisbuiltintothebreaspeedingrela/onship.
Quiz
Howmanybehavioralstatesdoesaninfantmovethrough?a.3-Sleeping,alert,cryingb.4-Sleeping,drowsy,alert,cryingc.5-Deepsleep,lightsleep,drowsy,alert,cryingd.6-Deepsleep,lightsleep,drowsy,quietalert,ac/vealert,crying
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Infant Behavioral States • Deepsleep
• Lightsleep• Drowsyorsemi-alert• Quietalert• Ac/vealert• Crying
Behavioral States
ReplayedwithpermissionfromtheNewbornBehavioralObserva/ontrainingvideo
Sleep • Sleepingproblemsareoneofthemostcommondisturbancesofbehavioralregula/on• Theyarealsothecomplaintexpressedmostobenbyparentsofotherwisehealthyinfants
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Introduc/ontoInfantBrainDevelopment
Developmental Milestones Birth–4weeks:• Focusbestonobjects8-12inchesaway• Seebestwhenlightsarelow• Hasagraspreflex• Recognizesthevoicesoffamiliarpeople
4-8weeks:• Smiles• Makescooingsounds• Startperfec/ngtheirtrackingskills• Startstoan/cipatefeelings,interac/ons• Startstostudyownhandsandkickupfeet
Developmental Milestones 12-16weeks:• Startstorolloveroneway–tummytoback• Realizeshe/shehasanaffectontheworld• Reaches–inaccuratelyforobjects• Visionexpandsto4+feetby16weeksandacquiredepthpercep/on
16-20weeks:• Transfersobjectsfromonehandtoanother
20-24weeks:• Startstovocalize• Hand-eyecoordina/onisimproving• Separa/onismaybecomestressful
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”Serve and Return”
• h\ps://www.youtube.com/watch?v=KNrnZag17Ek
Maternal Mental Health
PMADsPerinatalMood(depressionandbipolar)Anxiety(GAD,panic,OCD,PTSD)Disorders
Quiz
ForhowlongaremothersatriskofdevelopingPMADs?
a. Fromonsetofpregnancyto6monthspostpartumb. Frombirthofbabyto6monthspostpartumc. Fromonsetofpregnancyto12monthspostpartumd. Frombirthofbabyto12monthspostpartum
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Quiz
Howmanywomensufferfrompostpartumdepression?a. 1in7b. 1in10c. 1in50d. 1in100
Prevalence
• Postpartumdepression–15%ofwomen• Perinatalanxiety–6%ofpregnantwomen&10%ofpostpartumwomen• PerinatalOCD–3-5%ofwomenaberdelivery• PTSD–9%ofwomenexperiencePTSDaberdelivery• Postpartumpsychosis–rare-.1-.2%ofwomenaberdeliveryAlwaysconsideredanemergency!
Quiz
Whatpercentageofdadsexperiencepostpartumdepression?a. 1in10b. 1in50c. 1in100d. 1in250
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How to start the discussion
h\ps://www.postpartum.net/wp-content/uploads/2019/05/PSI-Perinatal-Mental-Health-Discusion-Tool.pdf
Contributors/Predictors of PMADs
• Historyofdepression/anxiety• Prenataldepression/anxiety• Lackofsocialsupport–isola/on• Lifestress–financial,work,childcare• Babyblues• Maritaldissa/sfac/on
Why does parental mental health maOer? Remembertheconceptof“ServeandReturn”?S/llfacevideo:h\ps://www.youtube.com/watch?v=apzXGEbZht0
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Impact of PMADs
• Infantdevelopmentdependsonconnec/onwithparents• PMADscaninterferewithparent’semo/onalandphysicalavailability• Thelongeritlasts,themoreitcanaffectthetrajectoryofboththeinfant’sdevelopment,thewoman/man’sdevelopmentasaparent,andtheparent/infantrela/onship
Howdoespostpartumdepressionaffectamother’sabilitytoreadherinfant’scuesanddoesthatimpactthedura/onofbreaspeeding?
It takes a whole village to raise a child, but we need to remember it was the mother and father who had the baby, and they need our help, too.
JaneHonikman,FounderPostpartumSupportInterna/onal
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CommunitySupport/Resources
FamilySupport
MaternalMentalHealth
InfantMentalHealth
DyadicRegula/on
InfantDevelopment
Family • Whomakesupthisbaby’sfamily?• Whathistory/experiences/beliefsdotheybringtothebaby’sworld• Howcanobserva/onofthebaby’sbehavior/cueshelpusprovideadifferentperspec/ve
Culture
Healthcaresystemshave3socialarenas:• Professional=Scien/ficmedicine,indigenoushealing• Thisiswherewefitin
• Folk=Non-professionalhealingspecialists• Popular=Family,socialnetwork,community• Thisistherealminwhichmoredecisionsaboutcarearemade
Kleinman,1980
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Community Resources
• Post-Partummentalhealthsupport• Lacta/onsupport• ECFE• Communityclasses• WIC• Headstart/Earlyheadstart
Advocacy
• Providingresourceinforma/on• Suppor/ngmominadvoca/ngforherselfandherbaby• Withherpartner• Withherfamily• Inheremployment• Inhercommunity
FamilySupport
Infantmentalhealth
Maternalmentalhealth
Dyadicrela/onship
CommunitySupport
Infantdevelopment
Sleep(bothmom&baby)Table Discussion
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Resources • PostpartumSupportMN:h\ps://www.ppsupportmn.org/• PostpartumSupportInterna/onal:h\ps://postpartum.net• CenterontheDevelopingChild:• h\ps://developingchild.harvard.edu/• h\ps://developingchild.harvard.edu/resources/5-steps-for-brain-building-serve-and-return/
• h\ps://developingchild.harvard.edu/resources/maternal-depression-can-undermine-the-development-of-young-children/
• UniversityofMinnesotacourses:h\p://ceed.umn.edu/online-courses/• ZerotoThreewebsite:h\ps://www.zerotothree.org/
• Bigelow,A.E.,MacLean,K.,Proctor,J.,Mya\,T.,Gillis,R.&Power,M.(2010).Maternalsensi/vitythroughoutinfancy:Con/nuityandrela/ontoa\achmentsecurity.InfantBehaviorandDevelopment,33(1),50-60.• Carlson,E.(2016)Adevelopmentalperspec/ve:A\achment.Presenta/onforCPSY5501,Minneapolis,MN.• Galinsky,E.(1987)TheSixStagesofParenthood.PersusBooks.• Janson,J.,deWeerth,C.&Riksen-Walraven,M.(2008).Breaspeedingandthemother-infantrela/onship–Areview.DevelopmentalReview,28,503-521.• Kleinman,A.,Pa6entsandHealersintheContextofCulture:AnExplora6onoftheBorderlandbetweenAnthropology,Medicine,andPsychiatry,UofCalifPress.1980
References
• Lundqvist-Persson,C.(2001).Correla/onbetweenlevelofself-regula/oninthenewborninfantanddevelopmentalstatusattwoyearsofage.ActaPaediatrica,90(3),345-350.• MacKenzie,M.J.&McDonough,S.C.(2009).Transac/onsbetweenpercep/onandreality:Maternalbeliefsandinfantregulatorybehavior.InSameroff,A(Ed.),TheTransac6onalModelofDevelopment:HowChildrenandContextsShapeEachOther,(pp.35-54).Washington,D.C.:AmericanPsychologicalAssocia/on.• Nugent,J.K.,Keefer,C.H.,Minear,S.,Johnson,L.C.,Blanchard,Y.(2007)UnderstandingNewbornBehaviorandEarlyRela/onships,Bal/more,MD.• Peacock-Chambers,E.,Radesky,J.S.,Parker,S.E.,Zuckerman,B.,Lumeng,J.C.,Silverstein,M.(2017)InfantRegulatoryProblemsandObesityinEarlyChildhood.AcademicPediatrics,17(5),p.523-528.
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• Pearson,J.(2003)WorkingwithParentsofNewborns,FamilyInforma6onServices,MinneapolisMN• Stuebe,A.M.(2014)EnablingWomentoAchieveTheirBreaspeedingGoals,Obstetrics&Gynecology,123(3),March2014,p.643-652.• Stuebe,A.M.,Meltzer,S.,Propper,C.,Pearson,B.,Beiler,P.,Elam,M.,Walker,C.,Mills-Koonce,R.,Grewen,K.(2019)TheMood,MotherandInfantStudy:Associa/onsbetweenMaternalMoodinPregnancyandBreaspeedingOutcomes,BreasNeedingMedicine,14(8),h\ps:/doi.org/10.1089/bfm.2019.007• Tamminen,T.(1988).Theimpactofmother’sdepressiononhernursingexperiencesanda{tudesduringbreaspeeding.ActaPaediatricaScandinavica77,supp.344,87-94.• h\ps://jamanetwork.com/journals/jamapsychiatry/fullar/cle/1666651