I feel like I should be on a first-name basis with my kids’ pediatrician. It feels disrespectful to call her by her first name, but with three kids, there are quite a few visits — annual checkups, sick visits, my daughter’s repeated ear infections and my baby’s acid reflux. I see the pediatrician a lot, far more frequently than I see any of my own doctors.
Recently, prior to my daughter’s 3-year-old checkup, her pediatrician had forwarded an extensive developmental and behavioral assessment form for me to fill out. Following a string of questions about my child, such as “does your child run around in settings when he should sit still?” and “does your child have a hard time staying asleep and falling asleep?” came a series of questions directed to me.
Asked to rate on a scale of “rarely/not true,” “sometimes/sort of true,” and “”almost always/very true,” the questionnaire listed four categories:
- I feel too stressed to enjoy my child.
- I get more frustrated than I want to with my child’s behavior.
- I feel down, depressed or hopeless.
- I feel little interest or pleasure in doing things.
As a psychotherapist who works frequently with patients experiencing a range of perinatal mental health issues, I was glad to see such questions designed to determine whether a parent may be struggling with anxiety or depression.
A few short weeks later I was at my younger daughter’s 4-month-old checkup. At this appointment, however, there was no paperwork to fill out in advance, presumably since there are so many more appointments during the infancy stage. Given my recent postpartum status, I expected to be asked in person some similar questions about my own mental health.
Although we discussed my daughter’s development, her terrible sleep patterns, and her drool-induced neck rash, there were no such questions about my postpartum mental health. I wondered afterward whether I would have felt comfortable broaching the topic of mental health if I felt I needed help. (Probably not.) Putting the responsibility on the mom probably would diminish the likelihood that mental health concerns would be addressed — even more so if mom wasn’t sure that her experience of anxiety or a depressed mood was atypical and worth mentioning.
An estimated 80 percent of new mothers experience the “baby blues,” characterized by transient, milder anxiety and depressive symptoms, while 10 to 15 percent of new mothers struggle with significant postpartum depression. Given these numbers, this seemed to be a clear missed opportunity on the pediatrician’s part.
I would argue that every pediatrician should screen postpartum moms for postpartum depression, anxiety or other mood disorders, whether that mom is a first-time parent or a veteran. Although “mom” is not the patient and not under the purview of the pediatrician per se, mom’s mental health has an obvious impact on the child’s well-being. Research shows that infants of depressed mothers may have cognitive delays, poor sleep and feeding habits, and lower levels of exploration and interaction with their environment. Long-term maternal depression is correlated with irritability, sadness, low self-esteem and cognitive and social deficits in the child.
During the first year of a child’s life, I estimate that there are six or seven appointments with the pediatrician, just for regular well-visit checkups. Likely, many moms also bring in their children for additional sick visits that first year — especially overly anxious first-time parents.
Although the DSM-V qualifies that a specifier of “peripartum onset” for a major depressive episode can only be applied if onset is during pregnancy or within the first four weeks after delivery, many experts agree that the onset of postpartum depression can occur well beyond that. Anecdotally, many of my patients report experiencing symptoms of postpartum depression within the first several weeks following delivery, but initially attribute the symptoms to sleep deprivation or a typical adjustment period.
Women may not realize for several months that what they are experiencing is actually a postpartum mood disorder that may require professional intervention. Others have reported the onset to be many months post-delivery. The pediatrician is uniquely positioned to see the parent and child interact on a regular basis and make an initial assessment about mom’s mental health. Given that there is so much to cram in during these visits, a basic self-report questionnaire, such as the Edinburgh Postnatal Depression Scale, could be an invaluable tool for alerting the pediatrician to a potential mental health concern. (I use the word “mom,” because mothers experience post-partum depression more frequently than fathers, but fathers can experience postpartum depression as well.)
My kids’ pediatrician may only know me as generic “mom,” one of many she sees throughout her busy day. We may never be on a first-name basis, but that shouldn’t preclude her from inquiring about postpartum depression. After all, it is unquestionable that a mentally healthy mom is advantageous for the child, and that is ultimately the pediatrician’s top responsibility.
Postpartum depression photo available from Shutterstock