 The late afternoon intense fatigue setting in, I walk in, smile and greet my four month old patient and her family.
Doctor Hoffman: “Helloo!!! How are you? What’s the update?” Judith the Parent (thought but not said): “keep smiling, don’t let on that you are as tired as she is….” Patient’s Mom (PM) “ We are great! Baby X is doing so well, she’s rolling, jabbering up a storm.. She’s putting her hands in her mouth.. But you know- the four month sleep regression has definitely kicked in… I need HELP with sleep Dr. Hoffman.” J.T.P.: “am I familiar with the four month sleep regression? Hell yeah… how about the four year sleep regression… or the fact that i haven’t slept since my child was born…” Dr. Hoffman: “ Oh yeah, that can be so hard. Tell me more about bedtime routine, schedule and what exactly is going on with naps and night time sleep…” Patient’s Dad (PD): Well we read “Happy Baby Healthy Sleep Habits” and “12 Weeks to 12 Hours” and are so confused. We are trying to extend the times between feedings but Baby X is just miserable. We rock her to sleep at 6:30 every night but she wakes up without fail at 8:30 to eat. She cries, then we fight, then my wife cries, then I cry and we end up going in and giving her a bottle so we can get some sleep. J.T.P.: “At least i’m not the only one crying on the regular due to my child’s sleep… but still my kid is five and yours is four months… is there something wrong with me? Is my child a sociopath?” Dr. Hoffman: Ok let’s start with talking about a routine around bedtime and self soothing… I am sharing this not to give you too much of a window into my own sleep struggles with my child but rather to stress the fact that even those of us giving the advice have difficult times with sleep. It is on the top of everyone’s list when they come in the office and one of the more interesting parts of my job… But, unfortunately, there isn’t a “one size fits all” solution to sleep struggles with children. A few things that generally are true ( but still there are exceptions..)
All of this being said… I’m really looking forward to getting to bed early tonight!
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 Many women in my clinical practice suffer from postpartum anxiety or depression. These symptoms can present up to a year after you have your baby. Women (and/or sometimes their partners) may worry excessively, suffer from insomnia, experience low appetite, experience physical symptoms or panic attacks, have persistently low mood, feel overwhelmed, cry frequently, feel irritable or apathetic, experience mood swings along with a range of other symptoms When your default is compromised because of your emotional state, it can be particularly hard to trust yourself . At times it can feel difficult to access good, reliable information from a dependable resource. If you google “when to sleep train” you might find 20 articles saying different things about when, if and how. How do you know who to trust in the midst of information overload. The rates of postpartum and pregnancy-related mood disorders are higher than many people realize. -Roughly 80% of new mothers’ experience “normal” baby blues in the first few weeks after a baby arrives. -1 in 7 experiences serious levels of anxiety or depression during pregnancy or postpartum in the first 3 months following the birth of a child. If you follow these women for a year postpartum the rate increases to 1 in 5! -1 to 2 out of 1000 women suffer from postpartum psychosis -1 in 10 fathers experience postpartum depression (above three statistics are cited from: Wisner KL et al JAMA Psychiatry, 2013; Paulson et al, JAMA, 2010) Suicide is one of the three leading cause of maternal death around the world. Bleeding and hypertension were number 1 and 2. The peak risk for suicide in this study was 7 to 9 months postpartum. Dell & O’Brien, 2003 Who is at risk for postpartum mental health mood disorder?
Why talk about these statistics?
Med-Psych’s Parent Consultation approach is to both address the concern you have for your child from a medical perspective as well as help you identify whether there are parenting/psychological issues at play that impact your current struggle Whether a parent is experiencing a postpartum mental health disorder or simply something that is coming up for him/her surrounding a particular parenting struggle, we appreciate how important it is to help our clients understand their own reaction to the issue so that it can be most effectively addressed.  Working as a pediatrician in Manhattan, many of the families I work with choose to breastfeed. We’ve all heard the facts; breastfed infants are healthier, they have fewer ear infections, fewer stomach viruses, their intestines work better and they might be thinner and smarter when they grow up. The research does, indeed, show that in the short term there are many benefits to breastfeeding. What the research does not communicate, however, is how difficult this can be for the woman w,ho has these breasts attached to her body
The majority of women I work with who want to breastfeed are able to breastfeed. Often with the first child it takes a couple of weeks to get it down, but after a fortnight of sore nipples and a few visits with the Lactation Consultant it all usually works out. There are a few babies who have a tough time latching, and never really get the hang of it… and some of those women will end up pumping and giving bottles. If it’s working for you, that’s great. It can be convenient, it’s free and when it works, it can be enjoyable, easy and as stated before quite good for your infant. But, I am trying to get through to those women who after a few weeks of giving it their all the baby still isn’t on the breast, he/she is not growing, and you are in tears. Last week I had two women in my office who I had been working with for a few months, each, separately, had “breakthroughs.” Meaning, they finally realized that they had been prioritizing the act of breastfeeding their infant over their own well being and sanity, their baby’s health and their families’ ability to function. Breastfeeding usually works.. but sometimes it doesn’t. And when it doesn’t that does not mean you are a bad mother, robbing your infant of ever being healthy, thin or smart. Formula may not be ideal, but they spend a lot of time and money trying to make it as close to human milk as possible. And in this day and age there are even human milk banks if you can’t stomach the idea of formula. Women, having a baby is hard. If you didn’t know that before you had one you know that now. Be kind to yourself. Be kind to your friends when they are unable to breastfeed. And also be kind to your infant, who needs a somewhat rested mother over one who is beating herself up constantly and in tears over trying to breastfeed.  Most of you love food and eating, and hopefully you can pass this onto your little one. Many parents find starting solids overwhelming or stressful at first, we are hoping this information helps to make this process fun. A few key points:
4-6 months: Tastes of fruits and vegetables, let baby have as much as he/ she wants, offer food 1-2 times per day. It is not necessary to start solids before 6 months but if your baby is showing that they want it, feel free to give! 6-9 months: Fruits, vegetables, meats, bread, pasta, dairy, eggs, fish, cereals… Everything and anything other than honey. With eggs, start with the yolk and if they tolerate it you can offer the whole thing. Start slow, introducing one new thing at a time. As your child tolerates it, offer chunkier and chunkier things. Around 8-9 months some finger foods 9-12 months: Start to transition away from purees onto more finger foods and table foods. By 12 months most of his/ her nutrition should come from food rather than milk. Thanks for visiting. Ariella and I are new to the blogging world. We want this blog to be useful to you. We are hoping to include educational content, as well as thoughts/ideas about parenting, psychology, the practice of pediatrics. Please feel free to comment, give feedback and suggestions about what you want to learn more about.
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