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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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What did you discuss?

Mamava Pod Post-it Notes – LaGuardia Airport

Thankyou!

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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