Friday, May 23, 2014

Nursing my babies: Can it help prevent Postpartum Depression?

Written by Susan Bordon, LCSW

By all accounts, I should have had Postpartum Depression. All the risks were there.  Family History of depression? Check. Pain during pregnancy? Check. Traumatic pregnancy/birth? Check. Breastfeeding issues? Check. Baby who wouldn’t sleep? Check. If I had all of the risks associated with PPD, why was I able to escape the Fourth Trimester somewhat unscathed, while so many other moms suffer in silence from PPD/Anxiety? After hearing new research presented by Dr. Kathleen Kendall Tackett, Ph.D., IBCLC FAPA, my answer is: Breastfeeding. All this time I thought that I was breastfeeding my babies as a gift for their future wellness, a completely selfless act of love between me and my child and bonding us in a way that is unexplainable. All of that is still true, but who knew throughout my babies’ first year I was also shielding myself from developing Postpartum Depression/Anxiety?

Now, I must preface this by saying there is no judgment here if you are unable or make the choice not to breastfeed. I have complete trust that every mother they breastfeed, bottle feed or use some combination is making the best choice for themselves and their little one at that time. For me, if I am honest, with my first child, my choice to continue exclusively breastfeeding had more to do with fear of the wrath of my own Le Leche League Leader mother than nourishing my child.  Research in the field of Psychoneuroimmunology presented by Dr. Kendall Tackett at the recent Breastfeed LA conference suggests that breastfeeding is not only protective for baby, but can also be hugely protective against the development of PPD/Anxiety in the mother.   

PPD/Anxiety affects 1 in 8-10 women who give birth, making it the leading complication of childbirth, and still women often suffer in silence. While PPD/Anxiety can affect any mother, regardless of her history, there are risk factors, as I mentioned above.  A well-meaning psychiatrist recently told me “the first thing I do when a women is suffering from PPD is get her off breastfeeding. She needs sleep!” This old news pervasive way of thinking is completely out of sync with new data that states that when thinking about PPD, all roads lead back to inflammation. You know those risk factors I mentioned: pain, stress, history of familial mood disorders, sleep issues, trauma? They all cause an inflammatory response in your body. Women that experience PPD have a high inflammatory response. Guess what has anti-inflammatory effects? Breastfeeding!

Now from a practical standpoint, ok I get it, reduce maternal stress causing inflammation and decrease chances of PPD. Well, I don’t know about you, but predispositions aside, having a newborn is stressful. That is like telling me to get more sleep and I will feel better. Thanks. I know. I have always heard from my slightly smug well-rested formula feeding friends that formula fed babies sleep longer. According to a study by Doan et al. J. Perinat Neonat Nars 2007, exclusively breastfeeding mothers are getting 40 minutes more sleep than formula or mixed feeding mothers. Even though EBF babies were having more frequent awakenings, the EBF mother was able to fall back into deeper more quality sleep quicker than the formula or mixed feeding mother. Because these mothers were getting slightly better sleep, they also had decreased inflammation. So, while some might advocate giving up breastfeeding to protect sleep, that treatment may backfire, increasing inflammation and the chances of developing PPD.

From a treatment standpoint, the take away from this conference for me was that in order to treat the Depression, we must treat the inflammation first. Chronic pain can lead to depression. If the pain during breastfeeding is causing the inflammation, then let’s see if we can fix that with a lactation consultant and reduce the inflammation. Known treatments that reduce inflammation are exercise, anti-inflammatory nutritional supplements such as St. John’s Wort and EHA/DHA, and, you guessed it, breastfeeding. Breastfeeding diminishes stress and protects maternal mood. In fact, all treatments for depression are anti-inflammatory and almost all are compatible with breastfeeding.

So, thanks, mom, for instilling in me an often dysfunctional fear of parental disappointment, and encouraging me to nurse those kiddos. All in all, I am adding this to the list of reasons why I am pretty convinced that boobs are absolutely the brains behind this operation.

Your Pool, Your Rules

My thirteen year old son and his friend are hanging out today, working on a science fair project. It’s spring break, I’m taking my younger son to a museum and the park. I have no problem with the older two being home alone for a couple of hours. My son knows the rules, knows who to call and has proven over time that he can be trusted. HOWEVER, when he asked me if they can go swimming while I’m away, the answer is a flat out “NO.” “But WHY?” he protests, “you know we’re safe, you know we can both swim, you know we won’t do anything stupid....”

It’s true, what he says. I do know he’s safe and his friend as well, who I’ve known for ten years. I know they can both swim and in THEORY I know they won’t do anything stupid. But in spite of what he classifies as ‘stupid’ (i.e. taking power tools into the water, jumping from our second floor balcony into the deep end, trying to hold their breath until they pass out... ) doesn’t mean that stupid things don’t happen.

It doesn’t mean that an attempt at a cannonball can’t result in a head injury, it doesn’t mean that a surprise leg cramp can’t rattle even the most confident swimmer making it difficult for him to reach the side, it doesn’t mean that just because they are responsible teenagers with years of swimming experience that accidents can’t happen.

I am frequently asked by my clients for my opinion on what I call ‘The Whens’: When can my child swim without me in the pool, when can my children swim while I read a magazine or talk on the phone without having to worry, when can I be in the house with them in the pool and not have to watch every move? They are legitimate questions and they deserve legitimate answers. The reality is that there is no one right answer to any of these (I know you saw that coming... it’s such a parent thing to say). It’s your pool, it’s your rules.

I had a client for years who would comfortably let her four children swim (ages 5-13) without her being present, although she could hear them from the kitchen and den. I have others who feel that until the child is of a certain age there must be a parent in the pool with that child at all times, including the parent of a friend who was over for a swim date. I generally feel this way about pool situations; when it’s your children without friends over, you figure out what works best for you. I typically prefer that an adult actually be present around the pool area during the entire time, even if the children are older and competent swimmers and you can read a book (heaven!) the entire time, just the fact that an adult is there is all that’s required. If however, you add other people’s children into the mix, it’s my recommendation that you act as lifeguard because you just never know what unpredictable thing may occur when it’s not your children.

Believe it or not, the general recommendation for swimming (even adults) is that you never swim alone. While swimming is often considered the lowest risk sport in terms of injury, there are many unknown variables that can cause an accident faster than you can turn a page in your beach read. When you are hosting a swim playdate at your house, don’t feel you have to be the ‘nice guy.’ Lifeguards are not there to be your buddy, they are there to keep you safe.

Establish your rules before anyone gets in and don’t compromise. If the kids in the pool are not listening and respecting your rules, GET THEM OUT. Don’t give more than one warning or they will know you don’t really mean what you say. Above all else, if I had to pick my top rules in terms of safety it’s everyone keeps their hands to themselves and no running on the pool deck. Those two things can create a myriad of possible lifeguard interventions.

Thursday, May 22, 2014

Spring is Here, Summer’s Coming! Tips For a Smooth Transition Back Into the Pool

Original post on on March 28th, 2014

Everyone’s excited about swim season. It really is the best way for children to get several hours of exercise without even knowing it. To them, its all fun and games. Here are some tips for a smooth transition after the ‘cold’ winter LA months.

1) Do a test run with your pool heater and pump. Often after a winter of no use, pool heaters need to be serviced, pumps replaced, filters cleaned or fixed. Its always better to do it before you have a group of excited children ready to dive in, only to find that your pool is 74 degrees and the pump isn’t working.

2) Remember that initially it takes several days for a pool to heat up. Once your pool is at a temperature that you like, you can either maintain that temp or drop it back to a reasonable 80 or 82 so getting it back up to where you want it only takes a couple of hours.

3) Assume your swimmers have regressed. With the exception of children above age 6, most children forget a variety of their skills for the first couple of days. Younger ones (3-5) may even forget that they can swim! Don’t be alarmed, this is perfectly normal and with a few practice runs or some refresher lessons, they will be up to speed in no time.

4) Don’t forget your older kids too. Even though they are water safe, have been swimming for years, they will be going to camp (often sleepaway), end of school swim parties, beach activities, etc.. It’s a good idea to have them brush up on their skills as well and even make some refinements with technique (until age 11 or 12, technique should be the #1 focus for lessons).

5) Check your deck. Pool covers, gates, decks themselves... There may be wear and tear and often decks need some tiles or concrete areas replaced. Look for sharp, jutting edges in the tiles.

6) Resurfacing. For some pools, after a few years, the pool itself needs to be resurfaced. This is when the smooth bottom becomes rough and sandpapery, causing abrasions and general discomfort. You’ll know right away if you need it done. It takes a few weeks to complete the process; draining the pool, resurfacing, letting it dry, refilling, treating, heating.

7) Trim the trees. Believe it or not, this is a biggie. It is lovely to have lush foliage around the pool area, but often leaves, flowers, seeds will fall right into the pool, clogging the drains, causing the pump to back up which shuts it down and turns off the heat. You can solve this problem by having a retractable cover on the pool but in general, trimming back a bit before the season hits helps tremendously.

Hope this helps! Have a fantastic season and we’ll see you in the pool!

Wednesday, May 21, 2014

Half-naked in the middle of the day.

Nahal A. Papehn MS, CCC-SLP, COOS, BABBLE, & TALK founder

I hear a knock at the door and I start to rehearse what I am going to say when I open it. “His socks JUST disappeared. Shirt is all soiled. The pants have travelled to space,” I want to tell Granny as she greets me at the door with a look of worry and mere disappointment.  I have run out of excuses for why I like to have my son play half naked in the middle of the day. It’s not only because it is absolutely adorable, usually warm, and just easier sometimes, but there is more to it. I believe it’s important for him to find and feel his body in space, to feel and experience textures, temperatures, and learn what his body parts are all about. I want him to UNDERSTAND the world….to COMPREHEND what he needs to comprehend in order to communicate his most basic needs, thoughts, and ideas. And yes, this involves a lot of half naked play.

Important for development, communication, and cognitive growth is sensory play.  Areas of the brain that involve touch, smell, taste, sight, and sound are crucial to nurture during everyday activities. I often see children with major or minor sensory deficits such as gagging at the sight of a banana for it’s slimy texture, or refusing to touch a scaly crocodile toy. When I work with parents and children I always promote early exposure and desensitization of textures and consistencies. I also TALK about, DESCRIBE, and EXPLAIN what is happening, consciously using verbs, nouns, and adjectives, while the child is engaging in a sensory driven activity. The more you do this, the more they become AWARE. Awareness, another important cognitive skill, is the foundation for developing language comprehension skills. If your child can differentiate his knee from his ankle, when you ask him about the “boo-boo”, then he can tell you exactly where he might be hurting. He can tell you about his earache, or how he may be hungry….the list goes on. In order for your child to able to do this, there needs to be a level of comprehension in place. The more you talk about WHAT is happening, and WHEN it is happening, the stronger their comprehension skills become. 

Often times when I am coaching parents they ask me, “What do I talk about?” I tell them about the five senses. Whether your child is at the zoo or playing half naked in the kitchen, you can always talk about what they are seeing, hearing, touching, feeling, smelling, and tasting. This sums up their entire experience and provides them with the building blocks for language expression and comprehension skills.

Allow your child to touch what they are reaching for, looking at, or whatever mommy might be handling at the moment. Let them safely explore, for example, gentle and rough textures so they can problem solve (a cognitive skill) and decide whether or not something is preferable/safe/hot/cold, etc… Your child will go from being stationary and not touching much, to crawling, walking and touching almost everything in sight. This can be scary sometimes. However, find it in yourself to safely allow them to experiment with their sense of touch to stimulate their cognitive skills, and to soon be able to tell you WHAT they want to touch.

Talk to your child about smell. This is a sense we usually forget to talk about, we introduce sometime later, or one that the child just simply discovers on their own. Take control and have your little one smell unusual and more common items - good smells and bad ones.  I like to communicate about YUCKY vs. YUMMY smells, using nonverbal facial expressions and words to describe the smell--toddlers have FUN with this.

Tasting the sweet AND the bitter, among other flavors, helps your baby develop preferences and become aware of their taste buds. Not only is it great introducing foods and textures that you love, but also introduce ones that you don’t normally eat or don’t like. Your baby might love it! TALK about the specific taste your child is experiencing. For example: “SALTY cracker!”

What does your child see? What do they not see? TALK about both. If you’re playing indoors or outdoors, there is plenty to talk about. Point out what you see near or far and use your finger to POINT. Pointing is an important skill and is a form of communication; help your child point to what they see in the world, in books, up in the sky, or under the bed! Talk about things your see in the dark and things you see when the lights turn on!

Loud sounds. Soft sounds. A whispering sound. These are all fun to enact. Be goofy with your child and imitate the loud lion or the soft purr of the cat. Teach your child how to whisper in your ear. Being able to understand how to use an inside voice versus an outside voice is key for social language. How does your child use an excited voice? Do they understand a stern voice? Can they tolerate various noises? Expose your child to the loud coffee grinder and the roaring vaccum, and also the quiet humming of the fan or the constant ticking of the clock.

So….. my son plays without his shirt, socks, or pants….SO WHAT!? He’s essentially learning that his feet are TOUCHING the cold tile, he might be SMELLING his dirty diaper, TASTING the leftover puffs stuck to his big toe, SEEING his cute little belly button usually covered by his long shirt, and HEARING his stomach slide on the tile as he sways his body back and forth, back and forth, back and forth to the sound of the music in the background!

Let your baby play and explore freely. You’re doing them a favor. Without a shirt. Forget the socks. Leave the pants behind!

Nahal A. Papehn MS, CCC-SLP
COOS, BABBLE, & TALK founder