Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary developmental science can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Tuesday, December 28, 2010

A Baby's Intuition

2-month old Max sat comfortably on his mother's lap and intently studied his hand. "He discovered them a few weeks ago. He's working hard to get his thumb in his mouth," Ellen told me." Ah ooh," Max cooed to me when I smiled at him and commented on his new skill. "He's talking a lot too," Ellen said proudly. We wore huge grins of delight with Max's obvious talents.

Our visit three weeks earlier, in contrast, was painful and difficult. Max slept the whole time, but Ellen wept as she spoke of debilitating anxiety and periods of inexplicable sadness. "I sometimes feel so lost, she had said." We spoke about her strained relationship with her husband, John. She described an intrusive ever present mother-in-law who always managed to make her feel bad. Arguments between her and John were escalating. She felt increasingly that he didn't support her when she was overwhelmed. I was worried about the degree of her emotional distress, and asked if she wanted the name of a therapist to talk with about her sadness and anxiety. She said yes. I gave her some names, and also made a follow up visit to see her with the baby.

Ellen hadn't called the therapist, and explained that she was having longer periods where she felt better. Max was becoming such a delight that he was pulling her along. "I have three or four good days, but then the bad feelings return." I followed Ellen's lead, focusing on all the positive changes she had made. She was learning to take care of herself and was excitedly thinking about going back to work. As she described these good feelings, Max's little body was relaxed and content in her arms. After the trauma of the last visit, she seemed to delight in telling me the good parts. I wanted to give her the space, yet wondered to myself if the anxiety had indeed passed.

Then in the middle of telling me about the holiday it happened. She started calmly enough to describe a visit to her in-laws. But quickly her distress escalated. Her voice became tense, her face contorted with anger. I tried to follow the details of the story, but noticed that Max had begun to squirm on Ellen's lap. He pushed his head back and his legs extended. She distractedly held him up against her shoulder, increasingly agitated by her rage at her husband's behavior. But Max would not be calmed, and soon his fussing escalated to an all out cry. I sensed that Ellen was asking me to validate her position in the argument with her husband. But this was not my role, and I took a different approach.

"This anger you experience seems to be making you feel bad." She paused. "Yes-I'm really a nice person and I don't like to feel so mean." "I bet if I took your blood pressure right now it would be sky high." She readily agreed. As she shifted her focus from her rage, Max's fussing decreased. Ever mindful of not wanting to make her feel blamed, I commented on how Max was reacting to her mood. Fortunately she did not respond defensively, but rather observed, "He's very intuitive. He can tell exactly what I'm feeling."

Extensive literature, much of which I have discussed on this blog, describes the negative effects of a mother's depression and anxiety on a baby's development. My visits with Max an Ellen offer a close up snapshot of what this can look like and what might be done to help.

Elizabeth Meins, PhD and colleagues have shown in their research that a mother's capacity to think about her baby's mind is a associated with secure attachment. Secure attachment, in turn, is linked to many positive outcomes including emotional regulation, cognitive resourcefulness and social adaptation. Ellen's noting of her son's intuitiveness represents a perfect example of thinking about her baby's mind. She showed a non-defensive willingness to reflect on his experience. She could think about what might be going on in is 2-month-old mind when her anxiety took over.

Ed Tronick,PhD and colleagues have shown that if parents and infants are attuned 30% of the time, but disruptions occur in up to 70% of interactions, as long as most of these disruptions are recognized and repaired, development proceeds in a healthy direction. Ellen was able to repair the disruption caused by her momentary agitation, and to help Max to calm down.

Ellen, Max and I will meet again in a few weeks. Perhaps Ellen will need more intensive treatment for depression and anxiety. She still has the number of the therapist. Perhaps she and John will need support for their marriage. But I feel hopeful about Max and Ellen. She has seen how Max thrives when she is feeling good. This knowledge I believe, will motivate her to take care of herself so that she can continue to be emotionally available for Max in the way he needs and loves.

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