Quote of the Day

"You're braver than you believe, stronger than you seem and smarter than you think." - A. A. Milne

More on Shaken Baby Syndrome

There seems to be a lot of relevant news today - as I scanned the news one last time before going to bed tonight, this caught my eye, which is relevant to my post earlier today about postpartum depression and shaken baby syndrome. This article takes it wider, stressing that many parents are under extreme stress with the economy just as county and state funding has been decreased to programs who aim to help prevent such abuse. The children pay the price.

Shaken baby injuries rose in recession: Grim child abuse spiked; a third of kids older than 1

Seattle Children's was one of the medical centers citing a rise in numbers of babies and children (some up to age 6) presenting with shaken baby syndrome, or abusive head trauma.

The number of babies and young children suffering abusive head trauma climbed by 55 percent in the months after the recession began in December 2007, according to a review of 511 cases at four children’s hospitals across the U.S.

The spike came during a period of rising unemployment, falling home prices and cuts to state and county budgets, including those that fund safety net programs to prevent child abuse.

Crying it out harms babies' brains

Here's a link on crying it out, and why leaving your baby to cry isn't a great idea:


BBC News: Crying-it-out 'harms baby brains'

I really hesitated to post this because honestly, parents can be blamed for a lot. There are times when it feels the entire weight of the world rests on our shoulders... oh and speaking of rest, we aren't getting any. There's certainly the temptation to let a baby cry it out a little if that means that we'll get some sleep - and our baby will get some sleep! I had triplets, and believe me, I couldn't physically answer each baby's cry immediately - there were two others to attend to. So news like this can honestly wear me down and make me think no matter what I did, it wasn't going to be good enough.

But the reason I'm posting this isn't just about that sleep technique of crying it out. I do believe that babies cry for a reason and that babies become emotionally and physically healthy when we respond to them in a timely way and with loving, nurturing care. And when we leave our babies to cry - not once or twice, but regularly, and hard, and for long periods of time, it isn't good for the baby.

It says in the article:

Recent scientific tests show high levels of the stress hormone cortisol develop in babies when no one answers their cries... Dr Leach suggested unattended extreme crying bouts of 30 minutes or more could be damaging to babies... Dr Leach told the BBC News website: "We are talking about the release of stress chemicals. The best known of them is cortisol, which is produced under extreme stress."

"One is not talking about a wakeful baby lying there gurgling, one is talking about a baby that is crying hard and nobody is responding. When that happens, and particularly if it happens over a long period, the brain chemical system releases cortisol and that is very bad for brain development. Some neuroscientists describe it as toxic."

I am interested in this news because again there is scientific evidence that we must nurture our babies and respond to them. If a parent regularly chooses not to respond to a baby's cries, a baby's brain chemistry changes from the neglect and there are well-documented, lifelong effects.

Why would parents not respond to their baby? Some parents don't know it's important, some are emotionally unable to respond because of depression or other factors, some are too self-absorbed to attend to someone else's needs, some are purposefully abusive/neglectful and some are unable due to factors such as alcohol or drug abuse. One can see how such patterns can repeat through generations, however - with each generation leaving the next with additional challenges caused by early neglect and abuse.

In closing on this last day of April, I'd like to share this article with you: Blue Ribbon Campaign Means April is Child Abuse Awareness Month. We've seen this information before, but it's a really good write-up of the issues, and again says home visiting programs (such as Open Arms) work at reducing childhood abuse and neglect.

Postpartum Depression and Shaken Baby Syndrome

Thanks to Sarah Pulliam, LICSW, MPH, social worker at Seattle Children's Hospital and Open Arms Board Treasurer, for sending much of the information that appears in this blog post.

In this post, I'm again talking about postpartum depression. There has been increasing discussion about postpartum depression in the news, and I'm glad that this is coming up more to help build awareness.

As a mother who had undiagnosed (or perhaps unaddressed is a better term) postpartum depression during much of the first year of my own children's lives, I can say from personal experience that it is something that has a big impact on mothers' lives and abilities to care for their children. We as women often rationalize why we feel the way we do and don't address it, especially since it's something that we see reflecting on our abilities to parent. Women might think, "I'm not blissfully happy like a mom should be - in fact, I'm a wreck - but I can't let anyone see I don't have it all together so I'll hide it." Even partners, friends, family members and physicians can think, of course you're irritable, you're postpartum and don't have enough sleep - that's normal. But postpartum depression should not be dismissed - if "baby blues" last more than two or three weeks, there could be a problem. No one should feel the need to suffer in silence because postpartum depression is treatable.

I'm glad to see this issue coming to the forefront more, so physicians can address it and can help women and their families receive help in whatever form is needed.

Heidi Koss-Nobel, Executive Director of Postpartum Support International of Washington, was just interviewed on King 5's Learning for Life program on the topic of Postpartum Mood Disorders. She stressed that postpartum depression affects one out of eight women after pregnancy and is the most common complication of childbirth. In this video, she discusses ways to distinguish postpartum depression from baby blues and regular sleep deprivation during postpartum and how to get help.



Heidi Koss-Nobel also talked about the factors that increase the likelihood of postpartum depression: women with lots of stressors in their life, women with a history of infertility, teen moms, women with a history of depression or family history of depression, military families, low income women, even those who moved recently.

Related to this topic, Sarah also went to a presentation recently on Child Abuse prevention by Dr. Jenny Radesky at Seattle Children's Hospital. Dr. Redesky said that paternal postpartum depression is now becoming more accepted as a real problem as well. She said that environmental stressors such as poverty and unstable living conditions contribute to higher rates of postpartum depression in both parents, not just mothers.

We certainly can see why this can be a problem within a family, but the reason why this is so important is that the consequences of having parents with untreated postpartum depression are so high. There are real lasting effects. As Heidi Koss-Nobel says in the video, postpartum depression can eventually lead to long-term health problems for both parents & baby. As a result of depression, parents can interact less with the baby, be less responsive to their babies, and babies can later develop their own depression and anxiety as well. On the extreme side, postpartum depression can lead to more serious problems of neglect, abuse, psychosis or suicidal thoughts or actions on the part of the parent. These kind of grave consequences cannot be ignored.

A review of the literature suggests that a baby is more likely to be physically abused (also known as Shaken Baby Syndrome, or Abusive Head Trauma or AHT in the medical literature) by parents who are depressed in the postpartum, usually 2-3 months after birth. One of the main reasons is that these parents are having difficulty attaching to the baby in the first place. They may have trouble reading infant cues or responding to them appropriately. They may be sleeping and eating irregularly, and feeling ineffective and overwhelmed, and ambivalent about parenthood. This cumulative stress understandably tends to lower the threshold of self-control. But another important reason is that babies of depressed mothers are at higher risk for abuse is that the babies are often more irritable and resist soothing (stemming from attachment difficulty or even possibly inadequate care).

Taken together, it is not surprising that depression is a strong risk factor for trauma in infants — and the outcomes are grave. About 30% of babies who suffer abusive head trauma will die. The remaining infants who survive often have life-long disability and health care problems. The cost of one intensive care stay is on average $80,000. That is not including all of the chronic care a child may need the rest of their life, a cost borne by society. The real tragedy? These outcomes are entirely preventable.

A link to local support groups and other resources for parents is the Shaken Baby Coalition.

I'm pleased to say that Open Arms is now including postpartum screening as part of our program with all our clients. We believe that postpartum depression can occur for any woman regardless of her education, socioeconomic status, or any other measure. We strongly believe that all parents and their babies deserve to be as healthy as possible, and this means mental health as well.

No woman is immune to postpartum depression. I'm delighted that this issue is receiving the widespread attention it deserves.

For more information, visit the Postpartum Support International of Washington website.

Newsletter archive

Update: Our newsletter archive is now up and running!

It's not beautiful - see my previous post about being a bit busy right now. All right, let's be honest, at the moment the archive page is downright ugly. But ugly or not, it is functional and you can see the past two newsletters for Open Arms, including the one that we published today.

I'll put a link to this on our website in the next few days as well.

Managing resources

It's been a while since I've posted - life gets complicated and busy, and so I prune my to-do list down to the bare essentials so I can get it all done. It's a theme that runs through life - so many things to get done but we have limited resources.

The Open Arms Board had a board retreat yesterday - we had another great meeting. Have I mentioned how much I love being with these people? One of our many areas of discussion was being fiscally conservative while being open to opportunity.

Open Arms has always been a fiscally conservative agency. We don't go off and do things without having a deep understanding of how we'll pay for what we do, not only immediately but also into the future. Like many of us in our personal lives - we may have a lot of wants, but that doesn't mean the world is our oyster. Sure - we cover our essentials as a matter of daily business - no crisis. But sometimes we see something that really catches our eye and we think ..... oooooooh, THAT would be nice! ... and then reality hits and we add it to our wish list for more research and consideration.

We at Open Arms have a long wish list. There is so much need out there, and we could do so much more to help women and their babies in our region. But we are thoughtful about how we grow and what new programs we take on. As an organization, we've met most of our goals from our strategic plan five years ago (and changed direction where it was appropriate as well) and our strategy has worked well for us. Now we're back planning for our future for the next few years. It's an exciting time and quite frankly, I think we're an extraordinary organization with great staff doing great work. It's easy to want to reach far in our goals. But we are sticking with what works: careful growth, thoughtful and intentional decision-making, and fiscally responsible management of programs and agency. I think it's a great balance of high goals and caution, and with this process, we're excited to think about where the agency can be in five years.

Oh - and we had our newsletter come out today. We're working on a website where we can archive these and when it's up and running, I'll post a link to our past newsletters. Do you want to be on our mailing list? Send us your email address and we'll add you (don't worry, you can remove yourself at any time)! info@openarmsps.org