Could Acetaminophen Use Contribute to Delayed Speech Among Girls?

New research suggests that pregnant women who take Tylenol “or its equivalent) may have daughters with delayed speech.

Pregnant women acquire all different types of fun ailments, leaving them with little choices on the medications they’re allowed to take. When I was pregnant with my first, I endured immense pain surrounding the tissues around my ribs, but there was nothing I could do. I knew I had to trudge through it until my rib cage finally bellowed enough to make room for my growing baby boy. Sometimes women will take an over-the-counter acetaminophen when they have a similar pain or feel sick. But new research suggests that pregnant women who take Tylenol “or its equivalent) may have daughters with delayed speech.
It seems like a strange connection, but according to the study, daughters of women who took acetaminophen while pregnant were more likely to have delayed onset of speech. The study, found in the journal European Psychiatry, surveyed 754 pregnant Swedish women between weeks eight and 13. The questionnaire asked how often the pregnant women took acetaminophen, and the participants were also asked to include urine samples throughout the weeks to detect the acetaminophen concentration.
The children from these pregnant women were then studied. All children in Sweden were given a developmental screening at 30 months. Those who did not say 30 words at this time were categorized as having a speech and language delay. About 10 percent of children in the study had delayed speech at 30 months, with boys being the more likely gender. Boys are often much more common to have a language delay compared to their counterparts. According to the study “girls born to mothers in the high-acetaminophen group were nearly six times more likely to have language delays than girls whose mothers had used none.” The more Tylenol or its equivalent that women took and the higher the levels found in their urine, the more evidence of  language delays in the daughters. Interestingly enough, boys of mothers who took acetaminophen were not more likely to have a speech delay.
The researchers theorized that “girls around 30 months tend to have higher vocabularies than boys – a well-recognized female advantage in early-childhood language development.” So, the study found that the intake of acetaminophen reduced this advantage. Digesting acetaminophen during the early stages of pregnancy may also be linked to ADHD. Yet it is commonplace for doctors and midwives alike to tell their patients that it is okay to take the over-the-counter drug while pregnant.
Although I didn’t take acetaminophen when I was pregnant with my son, he still ended up having a speech delay. And the second time around, when I was pregnant with my daughter, I didn’t take anything, either – yet her speech soared. And now I wonder, if I had taken the over-the-counter drug, would my daughter have been a late-talker like those in the study? It’s an interesting connection, that’s for sure.
So, remember to check with your obstetrician or midwife before taking anything that you question while pregnant. Take the time to do some research on your own, too. And if you’re having a reoccurring pain or other ailment, bring up this study to your care provider. It may not be a bad idea.

Reflections on the First 30 Days of Parenthood From Dads Who’ve Been There

We discussed fears, coping, breastfeeding, partnerships, and advice with five rad dads. While each have different stories, many sentiments remain the same.

Fatherhood is an amazing experience … but it doesn’t always start out that way. That’s as true for first-time dads as it is for first-time moms. The moment your child comes into the world, you’re responsible for the survival of a living, breathing, constantly excreting creature.
Between the jarring change to your everyday routine, the sleepless nights, and the nagging suspicion that you’ll never be even remotely as important as Mom, most new dads experience at least a few moments of “What the hell did I just do?!” in those first weeks.

Meet the dads

Parent Co. Studio recently spoke with five dads: Mike (five-year-old son and a new baby arriving any day), Andy (10-month-old daughter), Don (two-month-old son), Jon (five-year-old and two-year-old daughters), and Ben (13-month-old son).
We discussed fears, coping, breastfeeding, partnerships, and advice (tap a topic to jump). Here’s what we learned:

What was the most unexpected thing about becoming a new parent a.k.a. what freaked you out the most?

There’s a popular stereotype about dads being these big dumb oafs who are simply too lazy, too stupid, or both to worry about the myriad dangers facing their babies. (A Google search of “Don’t Leave Babies With Dad” yields 155 million results.)
The dads we spoke with, however, were not only hyper-aware of the sheer responsibility of their new role; they were worried about EVERYTHING. The temperature of the baby bottle, the security of the car seat, the minefield of that first bath, and, of course, the innumerable dangers out of their control all registered like a 7.0 earthquake on the Dad Richter Scale.
Each of these dads also cited the challenges of their limited role in those early days, especially if their partner is exclusively breastfeeding.
But the doubts and fears do eventually fade. One response perfectly illustrates the reason for the anxiety – and why it doesn’t last long:
ANDY: You ask yourself a million questions constantly in the beginning because you don’t want to screw the baby up, but the good news is, you go from knowing nothing to being relatively confident fairly quickly with a new baby.
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Parent Co. partnered with Babybay because they know the role of Dad is one you grow into.

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How did you cope with the crying and the sleep deprivation?

When you combine a wailing baby with the interrupted sleep that accompanies an infant’s constant feeding schedule, you tend to feel pretty crappy.
One of the dads we spoke to was lucky enough to have a unicorn baby – a rare, mythical creature who sleeps soundly from the get-go. This outlier dad wisely didn’t talk about his good fortune around his fellow fathers.
For the rest of the lot, sleep deprivation is very, very real. Yet it was also the one thing they’d been most prepared for in anticipation of their new baby. As a result, they either pushed through it like a marathoner whose feet start to ache around mile 11, or they leaned on their community and slept whenever they could find a couch and fit it in – even if only for 10 minutes here or there.
Jon: I think the sleep deprivation thing is a bit overblown … there was so much build up to it, so many people saying how terrible it was, that I didn’t think it was all that horrible by the time I got to it. Kind of like “Batman v Superman: Dawn of Justice.”
The crying was harder to handle for the new dads, which kicked their problem-solving, stress-reducing instincts into high gear because there is simply no worldly equivalent to that nails-on-the-chalkboard screech-howl:
Don: For the crying, I rely on my fitness and my breathing to help keep me calm and composed. Box breathing is a great technique to add to your daily routine. (Don is the owner of Bucktown Fit, a personal training business that specializes in physical and mental strength training.)
Ben: You learn very quickly what’s going to pacify your baby in that first month. Whatever works, just give it a whirl. Usually, it was the boob. The boob is the greatest pacifier ever.
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What was your role in the breastfeeding process during those first 30 days? How did that make you feel?

Due to the insane demands of breastfeeding, the dads felt a lot of pressure to make life a little bit easier for Mom.
They made themselves human gophers (“I’ll do it!”), they jumped at any opportunity to give the bottle, they took on all the household chores…. In short, these guys tried their darndest, tapping a level of empathy that would make even the most demanding psychologist proud.
They also struggled mightily in the process, experiencing feelings ranging from guilt and anxiety to a tinge of jealousy.
Mike: The hardest thing for me was trying to make myself feel useful. I had a difficult time connecting with my son, and I felt like the third wheel. I was there in a helper capacity as opposed to feeling that it was our family we just created.
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How did the baby change things between you and your partner? How did your perception of your partner change after seeing her as a mother?

As the saying goes, “having a baby changes everything” – for better and, at least temporarily, for worse.
While one of the dads met his partner just three months before she got pregnant (for these two, their love was never stronger than the 30 days of the new baby’s life), the rest of group weren’t so lucky. Relationships were tested, fights ensued, and roles shifted dramatically. One dad said it feels like they’re exclusively their son’s parents now.
At the same time, seeing their wives and partners give birth and step into the role of a new mother was an amazing experience for the new dads. Phrases like “awe-inspiring” and “life-changing” were used to describe that feeling, and many said it reminded them of falling in love with their spouse all over again.
Ben: Taking an A/B relationship and adding C – and C just happens to be something B grew in her body for nine months – your A/B relationship gets put to the side, and you have to accept that.
Mike: Your relationship is tested. You’re not doing the things that made you a couple, and the experiences that made you a couple are stripped away, so you’re bound to ask, “Is this gonna be okay?”
Jon: My wife’s instincts – she’s incredibly nurturing and warm – are so strong, and she’s also smart, hard-working, and competent. These are things that attracted me to her in the first place, but I realized after we had a baby that I couldn’t live without those attributes.
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What advice would you offer new dads for those first 30 days?

Mike: That vision you have of being a dad – of running errands and going to the park with your little guy or girl by your side – that takes a while to happen. Hang in there. Time is what makes the bond. By the time my son was a year, it was all dad, all the time.
Andy: Whenever you can, bring your child into your life instead of trying to completely bend your life to your child’s.
Don: Communicate with your wife/partner in a 100 percent open and honest manner from the start. You’re going to need to look out for each other more than you ever have.
Jon: Whether it’s changing diapers and swaddling or just preparing bottles, take pride in everything you learn. I was eager to prove that the stereotype of the helpless dad is lame, sexist and, in most cases, flat-out wrong.
Ben: The routine WILL become second-nature more quickly than you think. But be careful: Time speeds up when you settle into a routine. If you’re not careful, all the magical moments blend into one. Take it slow, enjoy every milestone, and break the routine when you can.
There’s a saying about becoming a new parent that goes something like this: Before you have your children, all your friends with kids tell you about how amazing it is. Then, when you finally do have a baby, those same friends say, “Don’t worry, it gets better.”
For many dads trudging through the muck and mire of those first 30 (or more) days of fatherhood, this saying may hit a little too close to home. If you’re in that boat, remember the words of the seasoned dads we spoke to. After all, each of them not only made it safely to the other shore, but they also made it there a little wiser – and were more than willing to share their wisdom.
While each of these guys has a vastly different background and story, they share many common sentiments about becoming a dad. Perhaps the most important of all:
It only gets better – much, much better.
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One Interesting Factor That Could Impact Future Family Size

Parents’ experiences with their preterm children may make them more hesitant to have more children.

Do you have kids? When are you having kids? How old are your kids?
In One and Only: The Freedom of Having an Only Child, and the Joy of Being One,” author Lauren Sandler points out how our questions about other people’s children are often asked as plurals. “Kids” not “kid” is the default assumption.
“If a kid has no siblings,” Sandler writes, “it’s assumed that there’s a hush-hush reason for it: that parents don’t like parenthood (because they are selfish), or they care about their status – work, money, materialism – more than their kid (because they are selfish), or they waited too long (because they are selfish).
A new study in the journal Pediatrics suggests that one of those reasons is that the child’s birth was traumatizing for parents. Whether or not a child is “first” or “only” depends in part on how early he was born.
Researchers at Finland’s National Institute for Health and Welfare (THL) identified all 230,308 recorded singleton infants born in Finland between January 1987 and September 1990 and interviewed those infants’ parents.
The study revealed that parents of infants born preterm were less likely to have subsequent children than parents whose born at term. Infants born “extremely” preterm (between 23 and 27 weeks) were the least likely to have a subsequent sibling, but even those born nearly at term (between 34 and 36 weeks) were less likely to have a subsequent sibling. The researchers concluded that for every 1,000 preterm births, there were 142 “missing siblings” from parents who would have been statistically likely to have more children.
A THL press release put the results in simple terms: “The more premature a child is born, the greater the probability that it will be the last child in the family.”
The researchers have not determined a cause for this lowered birth rate among parents of preterm infants, but speculate that the lowered rate “may reflect the crisis a premature birth may cause for the parents and its far-reaching impact. The birth of a premature infant is often a surprise, and can place the parents in a situation where their hopes and resources do not meet their expectations on parenting or the challenges during early childhood.”
In other words, parents’ experiences with their preterm children – which may include harrowing weeks or months in neonatal intensive care units as well as lifelong health problems – may make them more hesitant to have more children. The sole exception were parents whose children born preterm died within their first year. Those parents were actually more likely to have subsequent children.
In a December post to the Pediatrics’ blog, editor-in-chief Lewis First stresses that the issue will require further study before researchers can draw a causal link between preterm birth and the subsequent birth rate.
In the interim, however, we might want to consider the pain inflicted by probing questions about subsequent children. There’s no need to ask a family member when she’s planning to have more kids. Asking a stranger at the grocery store “Is he your first?” suggests, however innocently, that a parent ought to have a “second.” Instead of asking these kinds of close-ended questions about family planning and family size, we could all do better by asking open-ended questions about the kid who is actually right there in front of us.

This Is What Happened When I Said Yes to Every Offer of Postpartum Help That Came My Way

They say it takes a village to raise a child, but it’s rare that we actually trust our village to come through for us when we need them to. What if we did?

There’s a few things I need you to know before I begin.
I was in labor for three hours with my third child. Besides a few initial squawks upon arrival, she never cried the entire time we were in the hospital. Her first night, she slept a glorious four hours in a row.
I need you to know these things, because it’s important to note that not everything was terrible those first few months. With such a smooth beginning, I wasn’t expecting everything to fall apart. But a few days later it did, and I found myself trust-falling into my community.
My postpartum string of bad luck started with a slow recovery. The cramping and bleeding refused to slow down for weeks. With a hernia to boot, I could barely walk for weeks after delivery. Even lifting the car seat proved to be too much.
Ten days after delivery, I developed a bad ear infection that would last well over a month through multiple rounds of antibiotics and several different types of ear drops. I also got not one, but two stomach bugs, the latter of which landed me in urgent care with an IV hooked to my arm. At one point in the postpartum haze, I even shattered my iPhone.
The crowning moment, however, was when we totaled the minivan we had just bought before it even made it home to our driveway. A few days later, we all came down with colds – even the newborn – and I prayed that was our rock bottom.
At some point in this string of unfortunate events, I realized we couldn’t do this on our own. I decided that I would say “yes” to any offer of help that came my way.
My mom had already agreed to stay with us for the first several weeks after the baby was born. When she offered to take the kids in the morning and let my husband and I go back to sleep, the answer was a resounding “yes.”
We gladly devoured meals that were dropped on our doorstep. When a friend texted to say “do you need anything?” I asked if they could pick up a gallon of milk the next time they were at the store, or swing by and entertain my older kids for an hour. One friend even delivered my ballot to the courthouse on Election Day.
Shifting a few everyday tasks to other’s plates helped reduce my mental load tremendously. But as grateful as I was to receive the help, I felt uncomfortable admitting we needed it. In other times of stress, I had always met “Let me know if you need anything” with a “Thanks, but we’re doing good!” I worried I was inconveniencing my friends and family by actually accepting their offers of assistance. Our friends, however, seemed genuine in their desire to lend a hand.
It would have been easy enough to shut the door, feed the kids nothing but frozen fish sticks, and post cute baby pictures on Facebook that would make it look like everything was going wonderfully. But I knew pretending would only make things more difficult in the long run.
The months after my first two children were born, although not quite the tragicomedy we were currently living, had also been stressful. I struggled to adjust to motherhood, how to get my premature son to latch, and of course, with sleep deprivation. But more than anything, I was lonely in only the way that a new mother who is never alone can be.
Perhaps that is why, this time around, I was so desperate to accept any offers assistance. I ‘m sure I could have survived without friends cooking meals or family members stopping by to rock the baby. But what I needed most was not the cup of coffee that my friend was dropping off. Rather what I truly needed was the opportunity to connect with someone for a few minutes. Those brief moments of pleasantries reminded me that there was a world outside our own little turbulent bubble, and that we would eventually return to it.
They say it takes a village to raise a child, but it’s rare that we actually trust our village to come through for us when we need them to. There is no honor in doing everything on our own, and no shame in admitting that we can’t.
I now have a gigantic pile of Tupperware sitting in the back of my car. Every time I try to give it back to my friends they all reply the same way: “Oh it’s fine. I don’t need it back.” My own Tupperware drawer is pretty full as well. So when the newborn dust settles, I know exactly what I’m going to do with it – start feeding my own village. You never have to look too far to find a parent who could use an extra hand.

Making the Case for the Middle Name

A carefully selected middle name can discharge an obligation, preserve history, and appease in-laws all at the same time.

The question everybody asks soon-to-be parents after “Is it a boy or girl?” is “Do you have a name?” If they have picked a name and are willing to share it, the exchange goes something like this:
You ask the name. They hesitate, glancing lovingly at each other. Then one of them (usually the mother-to-be, because: labor) trots the two-piece title out like a brand new flavor of ice cream.
You pause, repeat the name aloud, and say how much you love it, after which they are compelled to explain how they chose it. It’s rarely a simple explanation either, so if you’re in a hurry, don’t even broach the subject.
The first name is usually an indulgent pick, maybe from a favorite movie or book, or after a childhood friend or an obscure British poet, or maybe it’s just a name the couple likes. But the middle name…the middle name is an entirely different story.
The middle name serves a purpose beyond semiotics (the study of sign and symbols), being that it’s not the primary signifier we identify with. It connects the prénom and surname, adding a layer of syllabic texture and intrigue.
A carefully selected middle name can discharge an obligation, preserve history, and appease in-laws all at the same time. It can carry the weight of tradition and fulfill the dying wishes of Great Grandma who always wanted a namesake, without sentencing your kid to a lifetime of answering to “Grizelda.”
The triad template we use today for names actually dates back to the Middle Ages, when Europeans were torn between giving children a family name or a saint’s name. The formula – given name first, baptismal name second, and surname third – emerged as a solution to this dilemma.
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After the American Revolution, immigrants arriving in this country continued the practice of three names. Since it was originally associated with royalty and aristocrats, giving a child a middle name was emblematic of aspiring to the upper class. The trend took off, and within 100 years, middle names were commonplace.
The first U.S. government document that had a space for a middle name was the World War I enlistment form. Other official forms followed suit, requiring at least a middle initial, which remains the standard format to this day.
The use of categorical religious middle names expanded to include family names – often maiden surnames – and soon, any name was acceptable. From a records-keeping standpoint in a country with a booming population, this additional differentiation was a welcome one.
The function of modern middle names continues to evolve, telling a story far more complex than, “I come from a long line of old ladies.” For parents, middle names can be the repository of a shared past, like NSYNC alum Chris Kilpatrick and his wife, Karly, who named their son Nash Dylan after the folk singer Bob Dylan, whom they listened to on their first date.
A middle name can be a reminder of unique circumstances surrounding the birth, as it was for the baseball fan who went into labor during a recent postseason game and named her son Logan Bauer, after Cleveland Indians pitcher, Trevor Bauer. Or it can be a grateful tribute, as it was when Jessica Braddock chose Dallas as her daughter’s middle name to honor the city’s incredible hospitality after Hurricane Harvey.
Middle names are often a means of compromise for parents who can’t seem to agree, as was the case with musicians Ashlee Simpson and Peter Wentz who named their son Bronx Mowgli after neither would concede to the other’s first choice. Though the middle name seems like a consolation prize if your goal was to be first, some parents prefer its understudy role and embrace the opportunity to flex their creative muscles. It’s like a braver, livelier, more whimsical version of your child’s permanent identity.
Another option is to use the middle name as a generational connection, passing down one specific name as an intangible keepsake. This works well for indecisive parents who have difficulties coming up with one name, let alone two.
My own family has done this with my middle name, Louise. While I wasn’t crazy about the name as a kid, as an adult, I cherish sharing something with my grandmothers, aunts, a niece, and now my daughter.
Parents-to-be are inundated with major decisions on every front – from feeding, to sleeping arrangements, to childcare, to finances. They need to find a good doctor, read up on the latest safety concerns, figure out how to install a car seat, and stock up on baby clothes, the right gear, and supplies.
On top of all this, they need to come up with a name that blends with the last, has meaning, carries tradition, and won’t lend itself to embarrassing nicknames in grade school.
No pressure, parents! Your kids can always go by their initials.
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Is My Baby Still Breathing? A Look at Postpartum Anxiety

When we’re suddenly responsible for tiny, helpless, precious humans, it makes sense we become anxious. But how much anxiety is too much?

Ask a new mom about her actions after giving birth, and you’ll hear a range of behaviors that would probably sound odd to most non-moms. Watching the baby’s breathing, checking the baby monitor dozens of times, keeping an eye on the front door for potential intruders. To new moms these actions are likely all too familiar. The anxiety that comes with motherhood is something many new moms feel but rarely discuss. And perinatal anxiety – that is, anxiety during pregnancy and the postpartum period – has received limited attention from researchers and health professionals, according to a 2017 review article in The British Journal of Psychiatry, despite the fact that it is highly prevalent. We are, after all, suddenly responsible for tiny, helpless, precious humans. Who wouldn’t be anxious? This can all lead a mom to wonder, how much anxiety is too much?

Protecting our babies: some physiological explanations

Entering pregnancy, mothers experience a ramping up of their stress systems in order to help them care for and protect their new little beings, explains Mary Kimmel, M.D., Assistant Professor and Medical Director of the Perinatal Psychiatry Inpatient Unit at the University of North Carolina, Chapel Hill, and mother of two. “The main hormone from the stress system is cortisol, and that actually increases across pregnancy to support the development of the baby, but it also functions in this role of trying to help mom find the right amount of stress or anxiety once the baby comes,” says Kimmel.
Researchers are working to understand how hormones and neurological reactions foster feelings of protectiveness. By using functional magnetic resonance imaging (fMRI) to observe brain activity in new parents, for instance, researchers at Yale University observed that when new parents heard their babies cry, the parents often experienced an anxious neural response in brain areas associated with obsessive-compulsive disorder (OCD) and with emotions such as empathy. As Anna Abramson and Dawn Rouse report in “The Postpartum Brain,” the researchers believe this neural response is evolutionary and primal: after childbirth, a period of high alert, or vigilant watch, was necessary in order for parents to protect their babies from all sorts of environmental dangers.
At the University of Denver’s Family and Child Neuroscience Lab, under Director Pilyoung Kim, Ph.D., researchers are studying the brain activity of first-time mothers for patterns that are linked to their anxiety or depressive symptoms. Researchers found greater connectivity between the amygdala (the brain’s almond-shaped masses of gray matter associated with emotional awareness) and frontal regions in the brain in mothers with higher levels of postpartum anxiety. “Heightened amygdala activity has been linked to greater fear responses or threat detection and anxiety symptoms,” explains Amy L. Anderson, doctoral candidate at the University of Denver. “Our finding of increased connectivity between the frontal regions (PFC) and amygdala potentially indicates that even in the absence of threat stimuli, mothers with higher levels of anxiety may still be activating regions of their brain that react to heightened emotions or anxious states.”

Defining postpartum anxiety

Defining postpartum anxiety can be difficult, explains Kimmel, since each woman is unique and some women worry more than others. “We all fall on a spectrum, in terms of our personality. It’s not good or bad where you fall, but wherever you fall, if you have no anxiety, that can be problem for you at certain times, and having too much anxiety can be a problem. That makes it harder to define postpartum anxiety. When is it a separate thing from how you are just working within the world?”
Sarah,* who has a 22-month-old daughter, believes she suffered from anxiety after her daughter was born although she never sought treatment. “I was really worried about keeping my daughter alive and her breathing. I kept the lights on in the house at night. I must have checked her breathing 20 times a night.” Sarah did not feel depressed, but she felt exhausted since checking her daughter’s breathing so often interrupted her own sleep. And she had no way of knowing whether checking her daughter’s breathing that often at night was normal. Only after her daughter grew older and less fragile did her worries dissipate and did Sarah come to believe she’d been suffering from anxiety. “When I compare myself to my peers who had newborns at the time, many women seem much calmer and less neurotic about their babies and their breathing,” she says.
Similarly, Katherine, who has a four-and-a-half-year-old daughter and 6-month-old son, worried about keeping her daughter alive. “I was constantly worried she was going to die,” adding that as a new mother, her lack of mastery over caring for babies left her feeling on edge all the time. “I couldn’t calm myself down when she cried. I had a visceral reaction to it.” Katherine’s anxiety about her baby caused her to become anxious about her own health. A psychologist by training, she recognized her anxiety was interrupting her life and causing her to not enjoy spending time with her daughter, which prompted her to seek treatment and medication.

The many forms of anxiety

About 85 percent of women experience some type of mood disturbances after having their babies, according to the Massachusetts General Hospital (MGH) Center for Women’s Mental Health. For the majority of these women, the disturbances are short-lived and mild. However, for about 10 to 15 percent, the disturbances develop into more severe symptoms of anxiety or depression.
Anxiety can be generalized or specific and affect a mom in a number of ways. A mom may suffer from constant worry, racing thoughts, sleep disturbances, or a feeling something bad will happen. The anxiety may get to a level where she never feels comfortable letting someone else take over, or it could be the other extreme: she is so anxious about doing something wrong she becomes paralyzed and unable to be left alone with her child. Specific anxieties include agoraphobia, literally “fear of the marketplace,” Postpartum Panic Disorder, or Postpartum Obsessive-Compulsive Disorder (OCD), a form of anxiety where moms experience obsessions, or intrusive, upsetting, often very frightening thoughts, and ritualistic behaviors or compulsions.
For Jennifer, mom of a two-and-a-half-year-old daughter, her obsession centered on harming her daughter while feeding her. “I was afraid to feed her because I was afraid to stab her,” says Jennifer. “I was afraid to hold a fork anywhere near her.”
Worries about harming their children are very common obsessions for new mothers, particularly in the postpartum period, says Kimmel. According to the non profit organization Postpartum Support International (PSI), these frightening obsessions are anxious in nature and have a very low risk of being acted on. “One mom’s example was the mom thought, ‘oh, my child can fit in the microwave, what a weird thought, oh my gosh, that’s horrible I was thinking about that,’ and she got stuck on that thought,” says Kimmel. “If you were worried about the microwave then you stop going into the kitchen, you can see how that can be negatively impactful.” Similar are obsessive thoughts about knives in the kitchen. “If you’re having that worry about knives in the kitchen, and that’s keeping you from cooking, and cooking is a thing you love, clearly, that’s gotten to a place that needs to be addressed,” she explains, adding that when a mom’s stress system over-responds – when the anxiety makes her feel uncomfortable, when it keeps her from being able to enjoy things, or when it keeps her from doing things she wants to do – that the woman should seek treatment.
But even Jennifer, who had a history of OCD, had difficulty talking about her thoughts. “I was so worried that if I told people what I was thinking that it would happen or that I wanted it to happen. I was afraid to talk about it because I was afraid they would call Child Protective Services on me.” Jennifer says she feels fortunate her longtime psychiatrist “picked” it out of her and can only imagine how many women, who do not have longstanding care and treatment, are suffering. “Even though I had a history of OCD, I did feel ashamed. How could I be a decent person and have these thoughts about my child?”

Anxiety with or without depression

Thanks to the media and to ongoing education, it may be fair to say many women know about postpartum depression (PPD), but many do not know they can suffer from postpartum anxiety alone, without depression. Anxiety is often subsumed under the umbrella term “postpartum depression,” which means recognizing you may be suffering from anxiety may be difficult if you are not feeling depressed. Plus, “little attention” has been given to postpartum anxiety by clinicians and researchers possibly because of the overlap between depression and anxiety symptoms, according to The MGH Center for Women’s Mental Health.
“Part of where it can be hard for some moms is they don’t recognize as being depressed be-cause they don’t feel depressed,” says Kimmel. “They don’t feel sad. They don’t feel like they’re not enjoying things, they just feel overwhelmed with worry.” She added that when moms are feeling really anxious and overwhelmed, they may begin to feel depressed, too. “That’s why it can be hard to piece the two apart because you can begin to feel a lot of the symptoms of depression, such as guilt and feeling hopeless, when you feel so anxious and worried.”
For Lisa,* who has a three-month-old daughter and was diagnosed with PPD, a lot of her PPD was anxiety-driven: she was on high alert, she would wake up in the middle of the night to stare at her daughter to ensure she was alive, and she had sudden fears she’d drop her daughter while carrying her. Then there were the socks. “When I put socks on my daughter, every time, I was scared I was going to pull one of her toes off,” she says, explaining she had such irrational fears, and she knew they were irrational, but she couldn’t stop them. Eventually, Lisa’s husband found her crying in the bathroom. “I couldn’t even explain why,” she says. “I was so overwhelmingly sad.”
But Jennifer, who had braced herself for PPD, was caught off-guard when she was met with anxiety. “I was bracing myself for possible PPD but never about panic attacks about my daughter and obtrusive thoughts about my daughter,” she says. “I’d read a lot about PPD, but the hospital never asked me the right questions. They didn’t notice I was panicking every time I was alone with my daughter.”

Getting treatment

Unlike PPD, a classic screening tool does not exist for postpartum anxiety. Instead, a combination of screening tools are used, such as the Edinburgh Postnatal Depression Scale (EPDS), used for PPD, and the Patient Health Questionnaire (PHQ-9), but these may not detect all symptoms, such as OCD symptoms, which are predominant. Accordingly, these tools may not identify all women with clinically relevant anxiety. “We’re still trying to figure out how to get at some of these diverse groups of symptoms that may be going on,” says Kimmel. Only recently, in 2014, did researchers in Western Australia develop the Perinatal Anxiety Screening Scale (PASS), a 31-item questionnaire – the first survey to date – to detect perinatal anxiety.
But even if women, themselves, recognize they are suffering, finding the right treatment can be difficult. Lisa, who suffered from PPD, was told by her daughter’s pediatrician that she needed to get help. But when Lisa contacted her prenatal care provider, she had to wait over two weeks to talk with a therapist, at which time she was told she had PPD. Lisa’s provider told her that she would be prescribed medication on the condition Lisa find a different provider for postpartum care and that the medication could take six to eight weeks to kick in. “I felt like no one was helping me from a medical perspective,” says Lisa. “So I got angry and channeled that anger to figure out how to help myself.” For Lisa, helping herself meant being honest about her feelings and talking about them: she decided to stop lying that having a baby was all wonderful. “The more I talked about it, people said, ‘oh, I felt that way, too.’ So why don’t more people talk about it?” she asks. “We don’t, as women and mothers, talk about it enough. We’re left feeling like something’s wrong with us.”
Moms need time to talk about their experiences so they can find and receive the support they need. “We’re moving towards this system of these really short [medical] appointments,” says Kimmel, “and we need to have time. These are hard things to talk about.” Kimmel suggests that a multidisciplinary approach – a team of people who can address the mom’s unique needs and background and offer the most effective support, whether that’s medication or therapy such as cognitive behavioral therapy or mindfulness – is important.
One resource is Postpartum Support International, which provides a network of volunteers in each of the 50 states to contact for support. Anyone may call its toll-free Warmline (1-800-944-4773) for basic information and resources. It hosts “Wednesday Chats for Moms” and “First Monday Chats for Dads,” free live phone sessions where parents can connect with other parents and talk to experts.
Thankfully, more steps are being taken to increase awareness and to address the many facets of maternal health. In 2015 the American College of Obstetricians and Gynecologists began recommending clinicians screen women at least once during the perinatal period for depression and anxiety symptoms. And in 2016, Congress passed groundbreaking legislation, enacted as part of the bipartisan 21st Century Cures Act in December 2016, to fund screening and treatment programs for maternal depression. Some states, like New Jersey, Illinois, and West Virginia, already require screening of new mothers for postpartum depression.
Steps are being taken. Still, many more need to be.
For information on additional perinatal mood disorders, visit Postpartum Support International.
*Names have been changed per requests not to be identified.

Her Own Curve

The type of growth that doctors measure is the kind that’s easy to see and track in a logical fashion. But it’s not the only information that matters.

This is a submission in our monthly contest. December’s theme is Growth. Enter your own here!
During my second pregnancy, all seems well for the first several weeks. Then one morning, it’s as if someone has flipped a switch that was buried deep in my immune system. I wake up with pains in my abdomen and an uneasy feeling I cannot shake.
Specialist appointments follow. “You’re measuring normally,” the OB-GYN verifies at an 18-week ultrasound – the last time I hear the word “normal” during this pregnancy. Lab tests quickly confirm what we’re dealing with: my body has elected to wage war on itself, focusing its wrath on my digestive system.
Despite an aggressive course of medication, my health deteriorates. The high-risk OB-GYN delicately broaches the topic of ending the pregnancy, which I refuse. Instead, I focus on what I need to do: take in enough nutrition so the baby can grow. My husband painstakingly prepares three-egg omelets for breakfast and brings protein-packed smoothies to my bedside, but eating remains an agonizing ordeal. The little girl growing inside me has to subsist on the most meager of rations.
When Lily is born at 31 weeks, she measures small for gestational age. “A little bit IUGR,” notes the doctor gently, referring to Intrauterine Growth Restriction, in which a baby does not grow to a normal weight during pregnancy. After 41 days in the neonatal intensive care unit, she’s discharged weighing four pounds – almost two pounds heavier than when she entered the world.
Lily is healthy. But her subsequent growth remains a concern that’s always on our minds. We follow the neonatologist’s advice and supplement breastfeeding with special, high-calorie formula. When Lily starts solid foods, she seems hesitant at first, turning her face away. This makes us nervous, so we start applauding and cheering manically whenever she takes a tiny bite, something we never did with our oldest child.
As Lily enters the toddler years, we continue to watch her like a hawk at meals. “One more bite, just one more bite,” I plead. In my head, the drumbeat continues: You must eat. You must eat. If you don’t eat, you will not grow, and we can’t have that. I can’t fail you again.
When Lily turns four and remains at the lowest percentiles on the growth chart, our pediatrician cheerily ships us off to the endocrinologist. I sit at the appointment with my child, a happy, bright preschooler who is blissfully unaware that everyone in the room is analyzing her from all angles, as if she’s a puzzle they want to solve. The lead doctor briefly discusses human growth hormone, and how it can be prescribed if lab work reveals any abnormalities. I feel my blood pressure rising.
I watch as my sweet girl endures the sharp poke of a needle, her eyes widening in hurt surprise. Next, a technician grasps my daughter’s wrist for an X-ray – a test that assesses growth by calculating bone age. This procedure is painless, but my daughter has had enough. She wails, squirming away from the cold examination bench, her happy mood finally shattered.
A few weeks later, we learn that the results are all normal. We start to relax just a little bit about food and nutrition, realizing that our daughter will grow and gain weight as she needs to, whether we choreograph every meal or not. We remember that nourishing her development means more than simply filling her belly, and that small size does not equate failure, nor does it affect her potential to live a meaningful life.
The type of growth that doctors measure is the kind that’s easy to see and track in a logical fashion. It makes sense, and it can be helpful. But it’s not the only information that matters.
Lately, I’ve been thinking that if I had my own chart, I’d plot an entirely different set of milestones, markers that have nothing to do with my daughter’s physical growth. Like the first time she was able to swim underwater to her dad, or the first time she read through an entire book on her own. Or her dance recital last year, when we dropped her off at the theater entrance and she skipped away to play with her friends, carefree and completely oblivious to her parents. Just like any other five-year-old. These are milestones worth celebrating, reminders that growth cannot be measured only by pounds or inches.
I think of all of these experiences like points holding my daughter in space on her own curve. Her path may not be linear. It won’t be the same as everyone else’s. She’ll probably always be small for her age. But I know that she is growing – exactly as she was meant to – each and every day.

Can Social Media Improve Vaccination Rates?

A recent study suggests that some forms of social media can effectively educate parents about vaccination, and maybe even influence their decision-making.

We tend to think of social media as an echo chamber in which our own ideas are amplified but never challenged. Any parent who has shared an article about vaccination is likely familiar with this concept: commenters dig ever deeper into their previously held positions, and everyone leaves both hostile and more resolute.
A recent study published in Pediatrics suggests that some forms of social media can effectively educate parents about vaccination, and maybe even influence their decision-making.

The study

The study, conducted between 2013 and 2016, enrolled over 1,000 pregnant women within the Kaiser Permanente Colorado Health Plan. The women were randomized to three different groups. The first received routine pre- and postnatal care. The second received the same care, but also access to a vaccine information website generated by the researchers. The third received the same care and website, but also social media access to vaccination experts. The researchers wanted to know if, by 200 days post-birth, vaccination rates would be any different for the three groups.
The website offered information about vaccine history, safety, and efficacy, as well as vaccination laws. For those enrolled in the third group, the website also granted access to a set of interactive features, including a discussion forum, chat room, and “Ask a Question” portal.
The researchers used recommended immunization schedules to determine whether or not the parents enrolled in the study vaccinated their children according to that schedule. They then used that information to compare the number of “undervaccinated days” between the infants from all three groups. Infants whose mothers were in the social media group had fewer undervaccinated days than those whose mothers were in the usual care group. In other words, mothers in the social media group were more likely to vaccinate on schedule than mothers who did not have this intervention.
Before we begin championing the power of social media to alter hearts and minds, it is important to note which social media components of the vaccine website parents used. The researchers intended “to foster interaction between parents” through chat rooms and discussion forums, but most of the participants did not interact with each other: “Parents who engaged in the social media applications were primarily interested in asking our experts questions to address their specific vaccine concerns.” The researchers concluded that parents contemplating their children’s care want a digital space to ask questions of experts.
The study had a few limitations. First, the sample size made it impossible to determine whether there was any difference in vaccination rates between the parents with only the website and parents with the website and social media components. The researchers also note that their website, which was developed specifically for the study and was not available to the public, may have looked “outdated” by the end of the study. The social media components may have been less effective because users were more likely to turn to other sources more easily accessed through their favored platforms.
The researchers also noted how expensive the website was to maintain: most individual pediatricians and group practices cannot afford round-the-clock live support. But those kinds of resources are already available … if parents know where to look.

Helpful resources, a parent-focused site maintained by the American Academy of Pediatrics, offers a robust library of articles about immunizations, including a feature that lets parents examine vaccine evidence for themselves and a FAQ about vaccine ingredients.
The AAP works to reach parents through a variety of platforms. Healthychildren’s Facebook and Twitter pages offer daily updates on children’s health issues. Healthychildren’s Pinterest boards offer helpful tips separated by age group. The AAP also sponsors the Minute for Kids podcast, which offers quick segments on timely health topics.
The Centers for Disease Control and Prevention offers many resources for parents, including a 60-page book covering all the details a parent might need to know about vaccination, as well as a slimmed-down infant FAQ. The CDC also maintains Facebook, Twitter, and Instagram pages with updates on health topics from around the world.
In addition to these national organizations, local hospitals likely have social media accounts, which parents can often message directly with questions.

An Overprotective Parent Asks, "When Do You Know It's Time to Step in?"

Yep, I am one of those: I am an overprotective parent.

He’s almost there!
He’s got it!
Nope, I was wrong.
At what point did I need to step in?
It was a perfect summer day and my five-year-old son was riding his bike in our backyard. I couldn’t have made it easier for him to practice. I rearranged various pieces of patio furniture to ensure that he had enough room to get around the in-ground pool. I was more than prepared to jump in if I had to.
Honestly, I was more afraid of him falling and scraping a knee. Or breaking a leg. Or bashing his head open. Those types of injuries are very serious, you know. I had considered all the scenarios.
But most importantly, I needed to focus on the challenge my son was facing: He was a little low on strength and needed a push to get moving again. Should I give him that push? My heart said yes, while my head said no.
Yep, I am one of those: I am an overprotective parent.
It’s in my blood. My father still brags to this day about how he managed to get through my first holiday without anyone dropping me on the head. I was a mere three months old and very delicate. Family and friends joked that my parents had the best baby-proofed apartment around. They always said it was the equivalent of living in a fully padded room.
Still, other circumstances have added to my neurosis. My firstborn son died at only nine days old due to a congenital heart defect, leaving my husband and I devastated. When my daughter was born 13 months later, I was terrified. I made a promise to never let anything happen to her.
I will freely admit that I did not let her fall enough. She, too, was born with hypotonia (low muscle tone), so I felt the overwhelming urge to protect her at all costs. With every step she took, I winced.
These days, I have a good laugh about my over-the-top paranoia. Still, other days, I fall right back into the pattern, which brings me back to my son and his bike….
In the end, I didn’t move. I let him figure it out on his own. As I am learning, there is a very fine line between being overprotective and letting them run without bounds. How do we manage to balance the two?
Mothers have that instinct of knowing when something is not right. But we have a tendency to overreact when our child gets hurt. Such is my dilemma. I don’t leave much distance between my kids and me. My hovering is almost instinctual. I am learning to take a step back. Literally.
While I know it won’t go away overnight, I am learning to give them space. I have discovered that I can be present in their lives without directly being on top of them. Of course, it’s easier said than done. I have been practicing in the playground, and along the way, I’ve noticed some things.
Watching my confidence boosts their own. I see the little things. They are more likely to take risks and try new things. They are less timid. It is a pleasure to watch.
They will question things. They will fall. But in the end, it is up to them to figure out the solutions. Sometimes, they need to learn themselves that which gives them happiness.
I don’t see myself changing completely. I am still the same overprotective mom, albeit a tad less smothering. I will always keep that watchful eye, even when they grow into adults. For now, I am going to enjoy the innocent bike riding stage as much as I can, because pretty soon, the wheels will get bigger.
And they will start to wander farther.
Through it all, I want them to know that I will still be there to pick them up when needed.
I wouldn’t have it any other way.

The Rainbow on Our Gratitude Tree

Last November, my little family began what I had hoped would be a new family tradition: a gratitude tree.

This is a submission in our monthly contest. November’s theme is Gratitude. Enter your own here!
Last November, my little family – my husband, my then-four-year-old son, and myself – began what I had hoped would be a new family tradition: a gratitude tree.
It sounds cheesy, right? I found it on Pinterest, of course, and after perusing dozens of templates, I selected both a tree silhouette and a leaf template for us to use. I used a fair amount of our precious color ink to print them both out, then painstakingly cut out each individual leaf. The actual tradition itself, if indeed it is destined to be one, took all of 10 minutes. We took turns saying something we were grateful for, wrote a word on a leaf, and then glued the leaf onto the tree.
After Thanksgiving, I carefully stashed that tree in our autumn decoration box, nestled between a handprint Turkey and a string of paper leaves, and much of our gratitude was quickly forgotten by all in the joy of setting up our holiday tree and preparing for the season of gift giving. But this year, as I pulled out our few Thanksgiving decorations to hang on our walls, I took a few moments to read over all the things we were grateful for last year.
One leaf stood out to me: Coconut Baby. Because you see, last year, I was holding my breath. We all were.
At Thanksgiving last year, I was pregnant. My third pregnancy since my son was born, although it was the only one that had lasted beyond the first trimester. I was not quite four months pregnant, just over the hump into my second trimester. We had tentatively told our parents and siblings. We had recently moved across the country, courtesy of the US Navy, and I had settled into care with a perinatologist near our new home to monitor what I already knew would be a high risk pregnancy.
So far, this pregnancy was proceeding normally. I’d already had an ultrasound, which showed a strong heartbeat and normal growth. All bloodwork was normal. I was feeling good overall, although, as anyone who has ever suffered a loss in the past could tell you, the fear that something could suddenly go awry was never far from my mind. I felt for movement constantly; I checked the toilet every time I used it for blood; I religiously avoided caffeine, strenuous exercise, and anything else I thought might somehow provoke my body into another miscarriage.
And despite the overwhelming odds, to paraphrase a line from one of my favorite songs, tomorrow came. Days passed, weeks, months. My pregnancy continued to progress, although it also got riskier, compounding the inherent internal stress that comes with carrying any baby especially a rainbow baby.
I’m Rh sensitized, you see – I have Rh negative blood, my husband has Rh positive, and at some point in my past, enough blood from one of our babies got into my own bloodstream to provoke an immune response. (And to those wondering, yes, I had the shot after my older son was born.) Consequently, my new baby was at constant risk; once my body realized Coconut Baby was there, my immune system would start creating antibodies against the baby’s blood. If too many of those antibodies destroyed too much of my baby’s blood cells, Coconut Baby could become anemic, and fetal anemia is potentially deadly.
Fortunately, in our age of modern medical science, we can both monitor my condition – via bloodwork and ultrasounds – and treat baby should complications arise – via intrauterine blood transfusions. Yes, we have the capability to give blood transfusions to babies while they’re still in the womb. Coconut Baby received three of them over the course of my third trimester.
It was a high risk pregnancy culminating in a fairly breezy birth, which was followed by a stay in the NICU. Baby came slightly premature, but thankfully was not anemic. However, the biggest consequence of my antibodies still present in baby’s own bloodstream was an excess of bilirubin – jaundice. After 11 days in the hospital – 11 days in which I pumped every three hours around the clock to bring in my milk, and in which I visited the NICU every single day while still trying to be a present and connected mother to my older son – plus a few additional weeks of extra monitoring, our baby boy was declared to be in the clear.
At Thanksgiving this year, Coconut Baby will be about seven months old. He’s chunky and snuggly, curious and clever, and absolutely normal in every way. For more than four years, I wasn’t sure I’d ever manage to give birth again, but thankfully, the universe has proven those fears unfounded. And I can guarantee you that our gratitude tree will once again have a leaf with this sweet baby’s name on it.