Big adjustments- Little people

One major adjustments for many infants is learning to share their parent with another baby.  For many, this is an exciting time but for others it brings to the fore the ongoing issues that the child has around its own sense of security.  What is common for all older children is the mixed emotions that a new member of the family will bring.

cropped
Much of research on the impact of a new sibling into family life has focused on when one of the children has a disability or chronic illness. Siblings Australia are very active in supporting research and collating this type of research.   See http://siblingsaustralia.org.au/research-journals.php

In the community though there are many parents and infants who struggle with this transition moment.  The reasons for this are many and may be present beyond the issue of the new sibling.  Older children are often at a time in their lives where they are experiencing intense emotions, like love and hate, and will need support from parents if they are to learn “ I’m Ok and you’re OK” as they meet the new baby.
loved this horse growing up
For families, their own experience of their sibling relationship appears to be highly significant.  Parents will say “ I want them to be close and love each other” or “ There are going to be no favorites in this household!” or other statements that derive from their own lived experiences and can lead to emotional loading that does not support the transition.
me and my big sister
Often too parents have tried to make the older child feel that they are the “ big” child now and this may add to the loss and confusion the child may experience.  Children will often regress at stress points, just when parents are hoping they will be making the “step up” to make room for the new baby!  Toilet training, sleep routines and other developmental milestones frequently lose gains made and this can add to parent’s frustrations and again leave an older child in a difficult space.  Often encouraging parents to treat the older child as if they are still “ little” and in need of lots of assistance will break the battle ground that can become set up.  In addition helping parents tolerate and empathise with their child’s emotional response to the new baby, will often be the biggest challenge.  This involves allowing them to express anger and frustration without shame, all the while setting limits to ensure everyone is safe.  Ensuring that each child’s needs are not ‘dropped” from the mind of the caregiver, will demand much from often sleep deprived parents but will help smooth the way in a hugely emotionally demanding time for the older child.  Then the much wanted hope that they will support each other through thick and thin may be realised!
the most gorgeous young people!

Mandy Seyfang

 

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Goodies and Baddies… dangerous interpersonal thinking

Splitting involves a failure to bring together both positive and negative qualities of the self and others into a cohesive, realistic whole. Many works of fiction are based on splitting, for example, Disney tales that pit “good over evil” – the “fairy god mother” verses the “wicked step mother”.
Evil-Queen
Ronald Fairbairn,  a Scottish psychiatrist, psychoanalyst and a central figure in the development of objects relations theory, thought that in splitting, the good and the bad parts of a person are kept apart, leading to no possibility to feel ambivalence, only idealisation or denigration. It is in infancy that there is a  struggle to integrate the two primary drives, love and hate, into constructive social interaction and ultimately capacity to de-polarize these two drives.

When this doesn’t occur then there can be many manifestations in representations of self and the other- the “good baby” verses the “ bad baby” or the “ perfect parent”  or “therapist” verses the other extreme.  Splitting often leads to instability in relationships as people of course are neither all good or all bad. When the person who is seen as all good disappoints (which of course is inevitable when expectations are unrealistic) they quickly become “all bad”  leading to chaos and damage in relationships.

In practice, splitting occurs not just in the individuals and families seen by workers but is often experienced in the therapist and in the team without careful reflection to prevent it from taking hold. Individuals will often work unconsciously to split supports- one seen as “ Good” and the other “Bad” and as workers we need to be careful not to blindly accept this version particularly if we are in the favoured position! Ensuring there is clarity in and between teams, capacity for empathy and the willingness to keep working through the struggle of moving beyond fantasy to reality relationships becomes key in the therapeutic work.

Mandy Seyfang

 

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What’s served up with the food?

In infancy there are many developmental tasks to conquer with the support of caregivers..

  • Developing trust and building healthy relationship with the parent
  • Learning arousal and emotional regulation
  • Sleep
  • Feeding
  • Building language and communication
  • Learning to play and explore and take risks

Often in clincial practice, sleeping and feeding difficulties are where the first struggles occur that lead the parent to present the infant to health services for assistance.  What is an important focus in assisting with these difficulties is to look to the emotional backdrop in which the infant is placed for trying to learn these new skills and how the first two tasks on the list are foundational for the development of the others.

In the area of feeding, there has been heated debate over the issue that breast milk is best for baby’s development and even formula companies agree and have this labelled on their products.  What is often of MORE significance than the nutrients in the milk, is the experience the baby has in being fed. Feeding, especially for a young baby, is more than just intake of nutrition- it is one of baby’s first experiences of care. How a baby is held, looked at, spoken to in the midst of feeding will contribute to the quality of the feed but also in the attachment relationship which is the most significant predictor of lifelong wellbeing.  This is why therapeutically there is a stronger emphasis on the relational aspects of the feeding experience than on “ Breast is Best”. Identifying what emotions are  “ served up” with the food and the meaning of the food and feeding becomes the focus if we are to assist parents and infants with this developmental task.

faces

To feed well, an infant (like an adult) needs to be feeling relaxed which means he will need to use the face of the caregiver as a key reference point for managing his arousal in feeding.  Allan Shore has written in detail of intricacies of how the infant and caregiver engage in these arousal-regulating transactions (http://www.trauma-pages.com/a/schore-2001a.php) and quotes Idman, Greenbaum, and Yirmiya ( 1999,p 223)

Face-to-face interactions, emerging at approximately 2 months of age, are highly arousing, affect-laden, short interpersonal events that expose infants to high levels of cognitive and social information. To regulate the high positive arousal, mothers and infants…synchronize the intensity of their affective behavior within lags of split seconds

What is required then of the parent is presence and focus on the infant during the task of feeding and a transmission of calmness.  Likewise, for older children the atmosphere around the task of feeding is ALL important.  The following parent guidelines can be very helpful when working with parents and toddlers around fussy feeding issues:

  • Meal times need to be relaxed
  • Do not make eating something TENSE or have fights over food
  • Have meals at regular times and in same place as much as possible- maximise predictability
  • Offer small healthy portions of food
  • Try to make all meals self-feeding- allows child to feel more in control over feeding
  • No forcing a child to eat
  • Offer food and then after around 20 minutes take food away till next meal time
  • Try to keep emotion out of your response to how much is eaten
  • No sneaking or tricking to get child to eat!
  • No used car sales pitch, coaxing or begging to eat
  • Limit distractions while eating (for both parent and child!)

KEY: think about what is served up with the food- work to keep your emotions under your control and the environment calm and soothing

In feeding, parents provide structure, support and opportunities. Children choose how much and whether to eat from what the parents provide. The parent is responsible for what and the child is responsible for how much (http://www.ellynsatterinstitute.org/)

For many parents there will need to be additional support around these guidelines, as enacting them may bring up distress or anxiety, particularly if there has been previous grief, loss or trauma.  Food and feeding has many meanings for individuals and ensuring we understand what they are when there are struggles becomes an important part of the work as well.  For example, parents may question“will my baby be healthy, can I keep him alive, will my body feed him adequately, can I know this infant, relate and nurture, can I meet this infant without losing myself”…

Like all tasks of infancy, the key to healthy development is the relationship with the parent. Their need goes beyond the milk, puree or solids. A friend sent me this quote that highlights relationship as a nurturing goodness in and of itself.

Robert Bly ,author and poet, says that when a man spends time talking and listening to his son, “something like food passes between them.”

Helping parents maximise their relational focus when supporting their infant to feed will help the infant to develop more than healthy eating patterns that will sustain them throughout life.
food glorious food

Thanks to Lynly Mader for her expertise and inspiration in this area of practice!
Mandy Seyfang

 

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Contagious calm

For a long time we have known that when an individual is in stress overload they most likely will respond with fight or flight, submission or freeze response.  For children, we have further understood that if the stress is continued  and there is a prolonged alarm reaction then there will be altered neural systems in the brain (  see http://www.mentalhealthconnection.org/pdfs/perry-handout-effects-of-trauma.pdf for a detailed description of the effects of trauma on children).   When there is an inability to use flight or fight, then other maladaptive strategies are used to manage the overwhelming feelings, for example dissociation- where the individual withdraws attention from the outside world and focuses on the inner world.  Bruce Perry, a leader in this field,
Bruce Perry

describes the Hyperarousal and Dissociation continuums and the linked internal state that can shift from calm through to fear and then terror in response to stress.  In the terror state there is little thinking possible and this is extremely unhealthy if there is no calming either by the person or offered by another.

As a therapist working with parents and infants, a key role is to track the hyperarousal and dissociation continuums in adults and children and ensure that our responses do not inflame the other by either being too directive, too distracted, or too rescuing. Providing an empathetic response that matches the others feelings, validating the feelings of the parent or infant, whilst remaining calm is key to positive influencing the hyperarousal and dissociation continuum and preventing further trauma.  Bickerton and Garretty ( 2013 Project Air, A Personality Disorders Strategy) in their work with families describe this as “contagious calm” that helps the person to move down the arousal continuum from terror to calm so that the thinking mind can again be used.  Their work is focused on supporting families to gain these skills for managing the emotional crisis that are common when there is a family member with a diagnosis of Borderline personality disorder.  The principles though are helpful in any relationship where you are assisting the other with managing BIG dysregulated feelings. They have 4 relationship principles

  1. Care for self to care for others
  2. Contagious with calm
  3. Draw a line in the sand- have clear boundaries
  4. Listen without fixing

Working out ways to have a soothing environment that you work and live in becomes even more important if we are to be able to achieve this for the most traumatised and distressed families.

Mandy Seyfang

 

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Not angry just concentrating!

Social referencing is a term used to describe how babies and young children look to their caregivers reactions to make sense of a moment.  The parent becomes the reference point as to how the infant makes decisions about how to react to novel situations.  The caregivers face is of particular importance and there has been repeated studies that show younger infants look at the caregivers face most often when their caregiver expresses positive affect, while older infants look most often when their caregiver displays fearful reactions ( Walden and Ogan 1998, Child Development, Oct;59(5):1230-40).

Carver and Vaccaro ( 2007), detail that the skill of social referencing involves at least 3 abilities- looking at an adult in an unfamiliar situation, associating that adult’s emotion with the novel situation, and regulating their own emotions in response to the adult’s emotional display.  Haviland and Lelwica (Developmental Psychology 1987) found that as young as 10-week-old infants’ responded to caregivers joy, anger and sadness and there was often matching in the baby’s emotional state, showing how powerful the impact can be on babies emotional wellbeing.

The importance of tracking one’s own facial expression when with young children is important considering their reliance on it for social referencing. Often though it is difficult to change our facial reactions in the moment they are triggered.   What can be helpful is processing past painful experiences so the associated feelings don’t ambush and derail our composure with our children when they need to experience our confidence.  The adult face may also be misread.  As a child myself I can remember at times becoming distressed when looking at my father’s face across from me at the dinner table.  He was not angry, in fact, he is and was a most gentle man, but he had a look of anger creating unnecessary distress for me.
dad looking sad... hates to see port play so badly!
Like my father, as I age I wonder if likewise my growing frown lines are amplified when I am concentrating and how that might frighten an infant.  A colleague related a story to me after I shared with her my own concern.  Her young daughter put it into words for us both “Mum, why are you doing that face?” and I said “do you mean this thing with my eyebrows” (frown) Sometimes I do that when I’m concentrating really hard” Her child replied “ohhhh! I was confused. I thought you were doing it because you were feeling cross. It looks like the same”.

Creating playful moments is a potential antidote when concentration gets confused with anger and remembering how much infants rely on reading your face to make sense of their world.

Mandy Seyfang

 

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Don’t forget anxiety!

There has been ongoing concern that a focus on depression after the birth of a baby may make invisible other disorders that occur around this time.  Matthey, Barnett, Howie and Kavanagh ( 2003) highlight that panic disorder and acute adjustment disorder with anxiety occur at high rates in pregnancy and in the post natal period and question, as stated in their article’s title.. Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety?Recent findings as described by Ross and McLean in their systematic review (J Clin Psychiatry 2006) indicate that symptoms of anxiety are common during pregnancy and the postpartum period. What is also now well substantiated is that symptoms of anxiety during pregnancy are associated with adverse fetal and developmental consequences (Van den Bergha, Mulderb, Mennesa, Gloverd, 2005) and that maternal anxiety impacts the mother–infant interaction in the postnatal year and children’s development in the longer term.

Working with parents with anxiety and helping them to stay in the “here and now moment” ( rather than rushing into predicting the future) and managing the uncomfortable feelings that anxiety brings but that can be lessened is important work alongside of building a support network.  But just as important is to think more broadly about the wider community messages that surround parents.  Despite awareness of the negative impact of anxiety on parents and unborn babies and children, there has been few health promotion campaigns that drive home the message that mothers in pregnancy and early parenthood need to be supported to feel as relaxed and calm as possible. If anything we surround expectant mothers with fear campaigns.

anxiety 

This only continues once babies are born and then become children.  Lenore Kenazy has written at lengths about how we have grown fear in our communties around children and raises questions that at a time when anxiety has got its grips on most parents we should be asking.  Her book Free Range Kids: How to raise safe, self-reliant children without going nuts with worry ( 2009) is well worth delving into as we begin to question our culture of anxiety.

free range kids

In all of this though we don’t want to add yet another burden to parents.  As Oates ( 2002) writes, “The modern Western pregnant woman must not drink more than four cups of coffee a day, drink alcohol, smoke cigarettes, change cat litter trays, eat soft cheese, uncooked eggs or packaged salads or go into the lambing sheds. They should not work too hard or too long, nor at night or be ambivalent about their pregnancies. Now it seems they must not become anxious either.” 

This Post natal depression awareness week, lets remember also “anxiety” but with a focus on ways we can support parents and children to feel safe and secure personally and within our communities of care.

Mandy Seyfang

 

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Post natal depression- a whole of family condition

Next week is Post Natal Depression awareness week.
PND awareness week

Each week in Australia more than 1000 new parents are diagnosed with postnatal depression and there is growing recognition that this disorder does not just effect the mother but the whole family unit and the new baby is particularly susceptible to its effects.  Murray and Cooper in 1997 ( Archives of Diseases of Childhood) in their review of research concluded that studies “attest to a significantly raised level of emotional disturbance in late infancy in the children of mothers who have had a postnatal depression“, particularly when the depression was severe and enduring though also could be in other circumstances- indicating other factors are involved.  Parental responsiveness to the infant appears to be key in whether the occurrence of maternal depression impacts significantly on the infant.  Often mothers with depression withdraw or become more irritable with their infants leading to patterns of interaction that don’t support the infants development in the first months of life. Alongside of this depression may alter the mother’s representation of the infant in her mind, perhaps seeing the infant as ” demanding” or “unlovable” leading to interactions that also may negatively impact on the infant in the longer term.

mother baby
Interesting, we know the presence of irritable behaviour in the infant contributes to the persistence of depression in mothers- highlighting the vicious cycles of interaction that are common between mothers struggling with depression and their infants.

How is dad going
Postnatal depression is also a father’s illness and more likely when there has been a history of depression or when there is the presence of depression in their wives or partners during pregnancy and soon after delivery.  Despite the longitudinal study of Growing up in Australia that showed distress amongst fathers was 1.5 times higher than men in the general population, and comparable to rates of postnatal depression in mothers, services frequently still focus on maternal care.  There is also strong evidence that the marital relationship after the birth of the first baby has a 30% more chance of breakdown than at other times in the couples life ( Family Figures: Family Dynamics and Family Types in Ireland, 1986-2006′), highlighting the need to work with the couple relationship not just with fathers or mothers alone.  Older children can also be impacted by post natal depression, frequently believing they are to blame for the illness in their caregivers.  A recognition that the extended family is also likely to be effected by post natal depression has yet to receive much attention in research, apart from to identify that family of origin issues are highly significant and play an important role in disturbed parent-child relationships.

The importance of working with the whole family unit when there is post natal depression can not be highlighted enough and often means family sessions rather than or at least in addition to individual sessions. We need to ensure parents, children and infants are particularly supported through this time and the sensitive attunement that infants need is being met, if not by the parents then with another adult who can temporarily take on this crucial role.

 

Go to Panda site for more info on this weeks awareness activities

http://www.panda.org.au/panda-events/postnatal-depression-week

Mandy Seyfang

 

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