Feature

Adopting a Child – The First Month

When adopting a child, keep in mind the importance of consistency. Insist on a good nap. Try to eat all your home meals together. Just be together.

Unless you have parented before, the physical care of any child can seem a bit overwhelming. You might experience amazement at all those diapers and an unending appetite. But somehow we all make it to sundown. And somehow even difficult nights come to a dawn. So take a deep breath and look at how lovely your new child looks asleep. Be grateful, and be joyful.

Falling in Love
If you are adopting a newborn, falling in love is the first priority. Career and housework can go to the back burner as you concentrate on nurturing. Create a special place for rocking, feeding, and sleeping. This will add solid grounding to your adopted infant’s world.

Share your child with those who love him. You might take lots of photos. Skype relatives. Make short visits out to greet close friends or neighbors. Or show him off at your place of worship. You want your baby to know that you are the center of his universe. However, you do not have to create a cocoon that excludes loved family and friends to create wonderful bonding.

Getting to Know You
For an adopted toddler or older child, sameness and routine will help to settle her within new family borders. Do encourage some favorite cuddly toy or blanket. However, try not to get your child too attached to things that provide artificial entertainment, such as electronic toys and television.

Be aware of a child’s tendency to try to get mom and dad to jump up every time their little darling whimpers. This becomes a game called yo-yo parenting.

Replace these attentions with your own rituals. My husband used to play his recorder while the rest of us danced around the laundry basket before bed. Don’t forget the classic bedtime rituals such as cuddles and saying goodnight to the moon.

To make our toddlers feel a part of our extended family, we bought each one a silver baby spoon and a baby cup. They are proud of the monograms that say, “I belong, I’m somebody.” We drew attention to ways they resemble their namesake grandparents.

Build a Vision for Your Child
Even in the first month, there is no harm in teaching your child what you want from him: calmness, good sleeping habits, and kindness. (No, you can’t pull Fluffy’s tail!)

An adopted older child will be uncertain about his schedule, so build it for him before he creates a pattern of frequent night awakenings.

We teach patience and endurance when we teach our children to wait “just a bit.” Lay the foundation for good sleeping habits by putting your child down to sleep the same time every night. When they are tired, children may fuss awhile. Let them do that rather than intervene at the start of the night.

If you ask a lot of your child, you will get a lot. Therefore, do not hesitate to be a demanding parent. Build their backbone and independence from the start. Help your child to see you as caring, thoughtful, and gentle so that they have a model to follow.

In the end, consistency during your adopted child’s first month in your home is most important. Insist on a good nap. Try to eat all your home meals together. Just be together.

By Dr. Anne Walker – Dr. Walker, who has three international adoptees of her own, is a part of a growing practice of pediatricians focusing on international adoption.

You may also be interested in: Growing a Family Through Adoption

Perinatal Depression: A Big Deal

Perinatal depression is the new label for ‘Post-Partum’ Depression; i.e.: Depression occurring during and after pregnancy. It occurs in 5 to 25 percent of pregnant women and leads to problems for the mother, the infant and the family, because depression leads to emotional distress and difficulty in carrying out daily activities. Let alone care taking responsibilities.

What is Perinatal depression? It is a collection of symptoms including sadness, eating and sleeping problems, crying spells, lack of enjoyment in previously pleasurable activities, feelings of inadequacy, and contemplation of suicide.

How to identify it? Medical Professionals are familiar with the disorder and many are equipped to treat it. It generally involves symptoms that have persisted for at least 2 weeks.  Screening scales, like the Edinburgh Post-Natal Depression Scale [ it is also reliable in pregnancy] are used because they have severity ratings and can track progress with treatment.

What is it confused with? It can be confused with depression due to Bipolar Disorder [ Manic-Depressive disorder] which has the same symptoms, the Baby Blues which occurs and lasts a few days shortly after delivery, and post-partum Psychosis which occurs in about 1 in 500 live births, happens within 1-2 weeks of birth, usually begins as critical voices telling the mother to harm herself and the infant, and is therefore a psychiatric emergency that usually leads to immediate psychiatric hospitalization to prevent suicide and infanticide.

How do I treat Perinatal Depression?

Probably the preferred treatment is psychological, with Cognitive Behavioral Therapy [CBT] having the most evidence of benefit. It is usually delivered in person in 10-12 weeks with a face to face contact between the patient and therapist. There have also been on-line CBT formats, which have been shown to be effective as well. Other depression therapies, like Interpersonal Therapy and Commitment Therapy have also been beneficial.

Medications: The most common anti-depressants are the SSRI serotonin reuptake inhibitors. There is concern about fetal risk with them, but data except for Paroxetine, which has been associated with fetal cardiac issues, has shown that the risk of fetal effect of these drugs is much lower than the risks of untreated depression, which can endanger the life of the infant and the mother and other children in the family. In fact, studies of maternal depression show it to be a risk factor for conduct problems in boy, and substance use in girls. The risk of autism from SSRI’s leading to autism has been a subject of ongoing debate, but the consensus appears to be that the risk is low and maybe complicated by  parental genetics  and environmental factors, but not vaccines.

Some studies have looked at complementary medications to treat Perinatal Depression, and have focused on L-Methyl folate [ Deplin] and S-Adenosyl Methionine, both of which can be precursors to antidepressant amino acid synthesis in the brain and body. We need more data to assess efficacy.

Perinatal depression screening should also include fathers, because there is evidence that they too can develop depressive symptoms and withdraw from their roles of parental support.

Warnings for Perinatal Depression

Warning 1:

Suicide is the most dangerous effect of depression and self-injury a close second. Being aware of these risks is important so that patients can tell their loved ones and their doctors, because it can be stopped and treated. Screening scales like the Columbia Suicide Severity Scale is adapted for use by healthcare professionals and lay individuals. Training on it use is freely available on the internet.

Warning 2:

Pregnancy also increases the risk for life threatening events for a mother and infant. This situation, although rare, occurs mostly in situations of domestic violence, spousal abuse, human trafficking, especially where substances like alcohol are abused. The assaults often occur when the mother is trying to leave the abusive situation. About one third of abusers who contemplate violent actions towards their spouses and children, also contemplate killing themselves. This is in marked contrast to only 1% of depressed persons who have thoughts of harming others. Signs include the wearing of sun glasses to hide bruises, and lack of freedom of the mothers to talk privately to friends or doctors, without the presence of the abuser.

Take Home Message

Peri-Partum depression is a disabling and potential fatal illness. However, we can prevent it, and we can treat it into remission and restore a person to health. We are, all of us, obliged to recognize it and help those with it to seek treatment.

News Alert

Flu Vaccine Update

The Center for Disease Control provides the following updates on the 2017 flu season:

  • As of early November 2017, only about 2 out of every 5 persons 6 months and older in the United States had received a flu vaccination.
  • People not yet vaccinated this season should get a flu vaccination as soon as possible.
  • The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used for the 2017–18 season.  Parents who previously got their child vaccinated with the nasal spray vaccine should get their child vaccinated with an injectable vaccine this season rather than having their child stay unprotected this flu season.

For a full report, see the CDC full report National Early-Season Flu Vaccination Coverage, United States, November 2017

Study Reports Hold Off Spanking

Health Day reports a new study that suggests you should refrain from spanking your misbehaving youngster.

Researchers analyzed data from more than 12,000 children in the United States and found that those who had been spanked by their parents at age 5 had more behavior problems at ages 6 and 8 than those who had never been spanked.

“Our findings suggest that spanking is not an effective technique and actually makes children’s behavior worse, not better,” said study author Elizabeth Gershoff, a psychological scientist at the University of Texas at Austin.

The increase in behavior problems among children who were spanked could not be explained by child or parent characteristics, or the home environment, according to the study published in the journal Psychological Science.

Dr. Olson Huff’s post on Good Parenting offers alternatives and good reasons to refrain from spanking.

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