Opinion: Why Gut A Program That Truly Helps New Mothers?



By Claudia M. Gold, M.D.
Guest Contributor

As any parent knows, caring for an infant is a 24/7 job. Contrary to the idealized “myth of motherhood” — which usually involves a quick, seamless return to pre-pregnancy weight, emotions and all-around functionality — there is no “schedule” to be had. Life has officially turned upside down.

All kinds of research suggest that new moms need help.

But in our culture today, where extended family may be far away, where spouses often return to full-time work almost immediately after the birth, mothers may be very much alone in the task of caring for a new baby. Mother-baby groups have a critical role to play in filling that void.

I have seen these groups in action working as a consultant to the William James College Freedman Center. When mothers feel supported and listened to, extraordinary thing happen: they share experiences not only about the lack of sleep and ability to take a shower, but also fears, anxieties, self-doubt, sadness and even depression. By the end of these groups, many mothers developed powerful, sustaining bonds with each other and interact with their babies with new confidence and joy.

A particularly innovative Massachusetts-based program for mothers is now at risk.

Massachusetts Child Psychiatry Access Project for Moms is a collaboration between the Massachusetts Psychiatry Access Project and MotherWoman, an organization that offers a network of groups as well as training for group leaders and seeks to make these groups available to mothers all across the state.

The program has its roots in a special legislative committee chaired by Representative Ellen Story. While at first the focus of the commission was to implement statewide screening for postpartum depression, it quickly became clear that such a step was meaningless without first having resources in place to help mothers identified by the screening.

That is where MCPAP for Moms comes in to play. In collaboration with William James INTERFACE referral service, when a mother is struggling, she can find support that is available close to home and right away. When a new mother feels alone, scared and overwhelmed, a three-month- or even a three-week-wait is unacceptable. She needs help today.

MCPAP for Moms offers a unique constellation of services: it offers toolkits and training for primary care clinicians — obstetricians, pediatricians and family practitioners, many of whom now do not know where to turn when they see a mom struggling with postpartum depression and/or anxiety. Second, it helps mothers connect with help — individual clinicians experienced in treating perinatal emotional complications as well as groups — right away. And last, MotherWoman has a growing network of support groups and trainings for group leaders so that the service can extend throughout the state. So, it’s a whole safety net that involves many things.

“I was so overwhelmed and stressed as a new mom that I didn’t know what to do and felt like a failure. Without MCPAP for Moms I don’t know where I would be today,” said one postpartum mom, Amanda Martin. “I am so grateful for them helping me get the help I needed to feel better for me and for my family.” Continue reading

Can Mindfulness Help My Raging Anxiety When My Kid Gets Sick?

I was a cool hand, before I became a mother. Now, I’m a hopeless phobic. Whenever a child of mine gets sick, even with just a routine flu or stomach virus, every cough makes my heart race. I have to force myself to breathe slowly and deeply while I wait for the number to flash on the thermometer.

And I know I’m far from alone in this. One otherwise sane mother I know still sleeps on the floor by her teenaged son’s bed when he gets the flu, to be sure he’s breathing. A college professor i know says three different pediatricians have prescribed a stiff drink — for her — whenever her child gets sick.

“Can you help people like me?” I abjectly ask Prof. Sue Orsillo in the latest episode of The Checkup, our WBUR/Slate podcast.

(Mary MacTavish/Compfight)

(Mary MacTavish/Compfight)

“Absolutely,” replies Dr. Orsillo, a professor of psychology at Suffolk University and co-author with Lizabeth Roemer of “The Mindful Way Through Anxiety.”

And she does. She offers a framework to help me think and feel better about my own thoughts and feelings. You can listen to her from minute 17:00 on in the podcast above. Below, see an edited transcript and three additional key points.

How can you help?

SO: We all experience fear and anxiety. It’s very natural. If your child were out in the street and you saw a car veering around the corner, that fear would tell you that there’s a threat present, and it would get you ready to take action. So you have these clear emotions. Why people struggle with emotions is when those clear emotions become muddy.

What’s the difference between a clear emotion and a muddy emotion?

Muddy emotions are ones that aren’t giving us particularly useful information. They also tend to be pretty intense and distressing. There are lots of ways that clear emotions can become muddy, like if we’re feeling overtired or we judge ourselves for having certain feelings. But the one that comes up a lot when we are worrying has to do with this unique human ability we have to think about something that happened before to us or imagine something that could happen, like a terrible disease or something awful happening to our child. Your emotion is saying there’s a threat, but it’s a threat you’re imagining and there’s not a clear action.

So it’s like an emotion with nowhere to go.

Exactly. And we keep worrying, going through our mind to try to figure out where to go. And there really is nowhere to go.

Your book is about mindfulness. So first, what is mindfulness?

Most people define mindfulness as paying attention to the present moment with curiosity and compassion, just allowing the moment to be as it is.

So it’s being here and now, not getting lost in your thoughts and imaginings.

Or noticing when you’re doing that and bringing your attention back to the here and now. Even when the present moment is not a perfect, beautiful moment, if it’s a moment of pain — letting go of that struggle against what is happening right now. Just letting go of that can be calming.

How do we use mindfulness to cope with muddy emotions?

Normally, when we’re in that cycle of a muddy emotion, we’re not thinking about, ‘Oh, here’s a thought,’ or ‘There’s a feeling.’ We’re right there in it, we’re being pushed around by it, we’re defined by it in some ways. With mindfulness, we can sort of take a step back and notice, this is a thought, this is a feeling, and ask ourselves, ‘Is this a clear emotion? Is there an action to take?’ Or  are these painful thoughts and feelings that are coming up just a natural part of being human? Am I trying to control the uncontrollable, and if so can I gently acknowledge that and bring my attention back to the present moment and the things I can do, and the things that matter to me?

So let’s say that my child has a 103-degree fever. Continue reading

Bomber Trial: How Do You Talk To Children About The Death Penalty?

In this courtroom sketch, Assistant U.S. Attorney Aloke Chakravarty points to defendant Dzhokhar Tsarnaev. Tsarnaev was found guilty and now faces the death penalty. (Jane Flavell Collins/AP)

In this courtroom sketch, Assistant U.S. Attorney Aloke Chakravarty points to defendant Dzhokhar Tsarnaev. Tsarnaev was found guilty and now faces the death penalty. (Jane Flavell Collins/AP)

Killing is the ultimate bad, right? That’s what we teach our children. So how do we talk to them about the very real possibility, splattered across our screens and newspapers, that we may put a young man to death for his crimes?

“I think he should die,” said my 9-year-old child when I raised the question leading the news this week: whether Boston Marathon bomber Dzhokhar Tsarnaev should be sentenced to death or life in prison. “If he killed [four] people and injured hundreds and ran from it he should have a very serious consequence.”

“Life in prison is worse,” said my older daughter.

The conversation then turned to what kinds of people commit crimes and why, and by the end, my young daughter was not so sure about the death penalty. Needless to say, it’s complicated.

Earlier this month, Tsarnaev, 21, was convicted on all 30 counts against him and was found responsible for the deaths of three spectators at the 2013 marathon as well as the fatal shooting of an MIT police officer.

Today, defense lawyers are making the case for life in prison for Tsarnaev, rather than the death penalty. The public, is seems, is also leaning in that direction: A recent WBUR poll found that only 31 percent of Boston area residents say they support the death penalty for Tsarnaev.

So how do we talk to our kids about all of this?

Shamaila Khan, Ph.D., is director of behavioral health at the Massachusetts Resiliency Center, a program of Boston Medical Center, and has been attending the Tsarnaev trial regularly, providing support for survivors at the courthouse. She was a responder on the day of the marathon in 2013 working with families and individuals brought to BMC. She has also worked closely with families affected by the bombing and its aftermath, including people in Watertown who were impacted by the hunt for the Tsarnaev brothers days after the bombings.

I spoke with Khan about how to help parents talk about these tough issues — life and death, justice and punishment and revenge — with children. Here, edited, is some of our conversation:

RZ: So, as a parent, how do you begin to talk to children about these complex issues?

SK: This is a very controversial topic. It’s hard enough for adults to talk about it, let alone children. Children respond differently based on their developmental level — depending on what age they are and where they are developmentally. But there are three basic things to consider: listening, protecting and connecting.

RZ: OK, can you give some more detail please?

So, first, listen. Ask the children if they’ve heard about this, and what they know. With social media, there’s so much information available and often children know more than parents think. If they have heard about this, listen to what they have to say. Often, our tendency as adults is to start explaining — first let the children tell you what they know. Once you know that, you can figure out how to answer their questions, and find out what they are curious about. If they are expressing opinions at one end of the spectrum [like my daughter], offer them another point of view, maybe something like, ‘Who knows why this person did this?’ and give them more information. Help them to think about it in a more complex way, highlighting the variation on the spectrum. But remember, sometimes not telling the whole truth is important.

Like if a child, say up to 12 years old, asks how exactly does the death penalty get carried out, you might want to explain it in a way that demonstrated how it’s done with the individual experiencing the least amount of pain. You can be kind of vague and abstract. I’ve given examples of a pet that needs to be put to sleep: It happens in a way that doesn’t hurt them. So, a little abstract and not giving all the graphic detail unless asked. You can explain the death penalty by saying, for example, there’s a process in place, and different ways that it can be done. They try to figure out the least painful method, maybe medication or an injection. They used to do worse things but they don’t do that any more. Just keep it simple and abstract.

So you also said “protecting” is important. How does that work in this context?

Children, no matter what you’re talking about, they think about their own self and safety: Where is this person? Can this person get out of prison and hurt me? Is he in the same town where we live? Is he chained up? What kind of person does this and can there be anyone else around to do this to me? So the child’s own sense of safety is triggered. As parents you want to make sure the kids are feeling protected and safe. So just reassuring them is important.

And “connection” — where does that come in?

Connection is about making sure their support system is in place. You make it clear that you are there as a parent or parents, and other people are around, teachers, family members and others. You make sure there are other people and systems in place and say, ‘If you ever want to talk, there are people around to talk to.’ Often children stay curious, and if talking is not what they want, offer them activities that give them other ways to address their feelings: write a letter — What would you say to this person? — write in a journal, create a drawing… Continue reading


Study: A Simple, Cheap Way To Help Low-Income Kids With ADHD

Boston Medical Center (Wikimedia Commons)

Boston Medical Center (Wikimedia Commons)

Say you’re a pediatrician whose 8-year-old patient is showing symptoms of Attention Deficit Hyperactivity Disorder. That’s not unusual, up to 12 percent of American kids are diagnosed with it.

But you know that in general, ADHD treatment tends not to work as well in poor kids, like your patient, as it does in their better-off peers. And you also happen to know that the symptoms began two months after the patient’s father was incarcerated. It might be ADHD, or it might just be horrible stress. What do you do?

This is the kind of challenge that routinely faces pediatricians at Boston Medical Center, where most of their patients comes from the inner city, says Dr. Michael Silverstein, chief of the hospital’s division of General Academic Pediatrics.

In a study of 156 young patients just out in the journal Pediatrics, Silverstein and colleagues report some success with an experimental intervention they designed to address such challenging cases.

They found that with a relatively modest investment — about a week of training for a care manager that the patients’ families interact with anyway — they could “move the needle” on ADHD symptoms and social skills, he says.

I asked him to elaborate. First, the background:

General pediatricians tend to be fully equipped to treat straightforward cases of ADHD, Dr. Silverstein says, but for tougher cases like the one described above, and many among BMC’s population of vulnerable kids, they need specialists to address the more vexing issues. One proven model of providing that expertise is called “collaborative care.”

Providing care for low-income kids through mechanisms that address the health of both generations, parents and children.

The pediatrician is “driving the boat,” he says, but the specialists “essentially provide what we call ‘decision support.’ They say, ‘For someone like who you’re describing to me, I would try something like this.’ They give the rules of the road to the primary care doc, but the primary care doc drives.

And because it’s so hard to get busy people into the same room at the same time, the communication between the primary care doctor and the specialist is mediated through a ‘care manager’ intermediary.” (Ideally, a child psychiatrist would be right down the hallway, but that’s “pie in the sky” for under-resourced hospitals like the BMC, he notes.)

Research has shown that collaborative care works well, “but at BMC and places like it, this way of delivering care is probably necessary but not sufficient.” The reason? “A lot of kids with symptoms of ADHD don’t get better even when treated optimally. Why is that? You give them access to proper medication, the diagnosis is made properly, yet they don’t get better. And we homed in on three reasons that kids with ADHD symptoms may not get better that really were relevant to our population:

• The first is that we know that parents of children with ADHD have a disproportionate burden of mental illness themselves. You could imagine a child’s improvement trajectory might not be as good if his mother is depressed.

• Also, in general we see a guardedness about going to the doctor for behavioral problems — that’s not in everyone’s cultural frame of reference. So the idea of medication for inattention might not be where everyone is at. These are potentially stigmatizing conditions, so lots of times people recommend a course of action — medication or something else — but the families aren’t quite there.

• And the third reason is that we know that for certain children with ADHD, behavioral therapies work really well in addition to medication, but our families tend not to have access to those.

So we developed an intervention that was hung on the structure of collaborative care, where the care managers who serve as intermediaries between specialists and generalists are trained to address those three things. Continue reading

Sip Of Latte With Binky? Study Finds Coffee Drinking ‘Not Uncommon’ Among Boston Toddlers

When Boston researchers asked mothers what types of fluids they were feeding their babies, they expected typical answers: breast milk, formula, water, juice.

But what they heard was surprising: a number of moms were giving their 1- and 2-year-olds coffee to drink. Not much, but still.

According to a new study on the links between early feeding and childhood obesity, researchers report approximately 15 percent of 2-year-olds were receiving up to 4 ounces of coffee every day (though the average was just over an ounce). Among the 1-year-olds in the Boston-based study, the rate of coffee consumption was 2.5 percent of children.

“We didn’t ask if it was decaf,” says the study’s principal investigator, Anne Merewood, PhD, MPH, director of the Breastfeeding Center at Boston Medical Center and associate professor of pediatrics at Boston University School of Medicine. The majority of the coffee-drinking children had Hispanic mothers who were born outside the U.S., the researchers wrote; and female infants and toddlers were more likely than males to drink coffee.

Merewood said while she was surprised by the findings, the practice does make cultural sense. “I’m English and I’ve been drinking tea since I was a very small child,” she said. “It’s a cultural thing, they just feed the baby what everyone else is eating.”

The researchers did not ask whether the children’s minimal coffee consumption impacted behavior, or whether the kids got hyper with the additional caffeine. Still, Merewood said: “It’s probably not a great idea to give caffeine to young children. We we need to investigate more.”

(Soul 2 Amor/Flickr)

(Soul 2 Amor/Flickr)

The study of 314 pairs of mothers and babies specifically looked at breast feeding and other eating habits of children at age 1 and 2 years. The findings, published in the Journal of Human Lactation, which is edited by Merewood, cites some earlier research on the downside of coffee drinking by young children:

Although coffee consumption in the first years of life has not been well documented, several risks of coffee and caffeine consumption in older children and adolescents have been identified. Research suggests an association between coffee consumption and higher rates of type 1 diabetes in children. Caffeine use among children and adolescents has been associated with depression, sleep difficulties, substance use, and concerning physiological, behavioral, and psychological effects…

It is unknown if these same risks apply to very young children and coffee. One study that did explore the risks of coffee consumption among toddlers found that 2-year-olds who consume coffee or tea between meals or at bedtime had “triple the odds of severe kindergarten obesity.”

The researchers also point out that: “In a recent statement, the US Food and Drug Administration expressed an intent to establish an acceptable limit for caffeine use by children, recognizing that the AAP discourages this practice.”
Continue reading

Beyond Carb-Cutting: Resolutions After A Trauma — Sleep, Play, Love



By Rachel Zimmerman

A friend, trying to cheer me up over the holidays, suggested I find comfort in this fact: “The worst year of your life is coming to an end.”

In 2014 I became a widow, and my two young children lost their father. Needless to say our perspective and priorities have shifted radically.

Last year at this time, my New Year’s resolutions revolved around carbs, and eating fewer of them. This year, carbs are the least of my worries. My resolutions for 2015 are all about trying to let go of any notion of perfection and seek what my mother calls “crumbs of pleasure” — connection, peace and actual joy on the heels of a life-altering tragedy that could easily have pushed me into bed (with lots of comforting carbs) for a long time.

As a mom I know with stage 4 cancer put it, when your world is shaken to its core, your goals shift from things you want to “do” —  spend more time exercising, learn Italian, make your own clothes — to ways you want to “be,” knowing that your life can shift in an instant.

So, with that in mind, here are my five, research-backed, heal-the-trauma resolutions for 2015:

A Restful Sleep

Yes, at the top of my list of lofty life goals is a very pedestrian one: sleep. Lack of sleep can devastate a person’s mental health and without consistent rest, the line between emotional stability and craziness can be slim. (See postpartum depression, for one example.) In my family at least, to ward off depression and anxiety, we need good sleep and lots of it; more Arianna Huffington and less Bill Clinton.

Play, Sing, Dance

The beautiful thing about children is that despite tragedy and loss, they remain kids; they are compelled to play, climb, run and be active. Resilience, as the literature says. In their grief, they can still cartwheel on the beach, play tag or touch football in the park. Shortly after my husband died, I tried very hard to play the games my kids liked, which often felt like that scene in the “Sound of Music” where the baroness pretends to enjoy a game of catch with the children. Soon I learned to broaden my definition of play — really anything, physical, or not — that serves no other purpose other than to elicit pure joy. Continue reading

Parents Who Spank, Swat, Switch: ‘On Point’ Takes On Corporal Punishment

Minnesota Vikings running back Adrian Peterson watches from the sidelines against the Oakland Raiders during the second half of a preseason game at TCF Bank Stadium in Minneapolis, on Aug. 8=. (Ann Heisenfelt/AP)

Minnesota Vikings running back Adrian Peterson watches from the sidelines during the second half of a preseason game against the Oakland Raiders in Minneapolis, on Aug. 8. (Ann Heisenfelt/AP)

Don’t miss this particularly point-filled On Point hour: “Kids, Discipline And The Adrian Peterson Debate.”

From the write-up:

Who ever imagined the National Football League would become the nation’s court of public opinion on how to live the domestic life. But here it is. First this season, Ray Rice and the terrible punch. Now, the Minnesota Vikings’ Adrian Peterson and the disciplining of children. Texas authorities have indicted Peterson for going too far with a switch, a branch, leaving welts and broken skin. Peterson says he disciplined his child the way he was disciplined, but he’s learned a lot and is re-evaluating his ways. Much of the country still spanks, swats, switches. Is it right? This hour, On Point: Corporal punishment, good parenting, and our kids.

When Teens Talk Of Suicide: What You Need To Know

By Gene Beresin, MD and Steve Schlozman, MD
Guest Contributors

Here’s the kind of call we get all too frequently:

“Doctor, my son said he just doesn’t care about living anymore. He’s been really upset for a while, and when his girlfriend broke things off, he just shut down.”

Needless to say, situations like this are terribly frightening for parents. Kids break up with girlfriends and boyfriends all the time; how, parents wonder, could it be so bad that life might not be worth living? How could anything be so awful?

For clinicians like us who work with kids, these moments are at once common and anxiety-provoking. We know that teenagers suffer all sorts of challenges as they navigate the murky waters of growing up. We also know that rarely do these kids take their own lives. Nevertheless, some of them do, and parents and providers alike must share the burden of the inexact science of determining where the greatest risks lie.

Suicide has been in the news lately with a flurry of new research and reports and, of course, the high profile death earlier this summer of Robin Williams.

But suicidal behavior among teenagers and kids in their early 20s is different and unique.

So let’s look at a couple of fictional — yet highly representative — scenarios.


Charlie, a 16-year-old high school junior was not acting like himself. In fact, those were his parents’ very words. Previously a great student and popular kid, Charlie gradually started behaving like a different person. He became more irritable, more isolated and seemed to stop caring about or even completing his homework. Then one morning, just before before school, he told his mother that he wished he were dead.

Myths: Common But Distorted 

There are countless other examples. Sometimes kids say something. Sometimes they post a frightening array of hopeless lyrics on Facebook. And most of the time — and this is important — kids don’t do anything to hurt themselves. Morbid lyrics and even suicidal sentiments are surprisingly common in adolescence. Still, this does not mean for a second that we take these warning signs lightly. In fact, there is a common myth that asking about suicide perpetuates suicide. There is not a shred of evidence in support of this concern, and in the studies that have been done, the opposite appears to be true. Kids are glad to be asked.

We have to ask. It’s really that simple. But, we ask with some very basic facts in mind. Suicidal thinking, and even serious contemplation of suicide, is, as we mentioned, very common among high school students. In the Center for Disease Control Youth Risk Behavior Surveillance Survey distributed every two years to about 14,000 high school kids in grades 9-12, students are queried about a range of high-risk behaviors, including suicide.

The Underlying Mood Disorder

In 2013, 17% of teens reported seriously considering suicide, and 8% made actual attempts. Each year in the United States, about 15 in 100,000 kids will die by suicide, making suicide the third leading cause of death in this age group. Additionally, we have no idea how many deaths by accidents (the leading cause of death) were, in fact, the product of latent or active suicide.

The greatest risk factors for a teenager to die by suicide include the presence of some mood disorder (most commonly depression), coupled with the use of drugs, or other substances, and previous attempts.

Although research suggests that girls attempt suicide more often, boys more often die from suicide. Add these risk factors together, and it turns out that Caucasian boys are at highest risk.

Some of this is also driven by a still immature brain. Impulsive behavior is notoriously common in teens, and in many cases, it looks as if the act of suicide was the result of a rash and sudden decision. Continue reading

Study: Bullying By Siblings May Double Risk Of Depression, Self-Harm

(Wikimedia Commons)

(Wikimedia Commons)

By Nicole Tay
CommonHealth intern

When I was growing up, I used to complain about the loneliness of being an only child. “I want an older brother like Mandy!” I would plead to my parents. I just wanted an older, cooler playmate; I never considered the potential downside.

Now, at 22, I’ve heard my share of horror stories; the sibling bullies who called my friends “butt face” or “stupid” or “brat;” the burnt Barbie dolls; the bag of caterpillars dumped on my poor friend’s head.

Is sibling bullying just a harmless rite of passage — or can it actually entail developmental repercussions?

A new study published today by the American Academy of Pediatrics targets that very question. After surveying more than 6,900 young people in the UK, researchers found that victims of frequent sibling bullying were twice as predisposed to depression, anxiety, and self-harm in young adulthood as non-bullied controls. This British-based study comes on the heels of similar findings in an American study last year. From the paper:

Of the 786 children who reported that they had been bullied by a sibling several times a week (55.3% female), depression was reported by 12.3% at age 18 years, self-harm occurred in 14.1%, and anxiety was reported by 16.0%.

And from the abstract: Continue reading

When One Twin Baby Lives But The Other Dies

(stitches1975 via compfight)

(stitches1975 via compfight)

By Dr. Karen O’Brien
Guest contributor

Never before in my obstetric practice have I taken care of so many twin pregnancies. What I witness in my own office is part of a nationwide trend: Over the last two decades, the twin birth rate in the United States rose 76 percent, from 19 to 33 per 1,000 births.

And never before have I taken care of so many twin pregnancies with complications.

The specific complication that has given me pause in the last year or two is the loss of one twin, either during or after pregnancy.

This doesn’t happen often, but I have taken care of a number of patients recently who have lost a twin during or shortly after pregnancy. And I’ve learned that though outsiders might see a glass half full, this experience is uniquely devastating, both emotionally and medically.

We must all understand that the life of one twin does not eradicate grief for the sibling who died.

The hope and anticipation of bringing home two healthy babies comes grinding to a halt. The joy of delivery is clouded by sibling loss.

As early as 18 weeks, Melissa’s identical twins showed signs of a complication called twin-to-twin transfusion syndrome, which occurs when one of the twins essentially donates blood to the other.

At 19 weeks, Melissa underwent surgery to try to correct the problem. Unfortunately, two days after the surgery, one of the twins passed away. Melissa remained pregnant for 13 more weeks and ultimately underwent cesarean section at 32 weeks.

She and her husband were able to hold the deceased twin for several hours after delivery. Her live twin did well; she spent a few weeks in the neonatal intensive care unit (NICU) and is now home and thriving.

Samantha’s twins were not identical, and were conceived through in vitro fertilization. At 14 weeks, we found that one of the twins, a boy, had several serious abnormalities. Even at that early gestational age, we knew that he would not live for long after birth, and might pass away during the pregnancy. The other twin, a girl, appeared normal throughout the pregnancy. Continue reading