Losses from Divorce

If you are divorcing it is very important to sit down with your children, preferably both of you together, and later separately, and tell them these things repeatedly:

1. You are loved by both of us even though we will be apart. We each love you and will take care of you. You will be safe, loved and cared for in your life. It can be hard for you to get used to our living apart, but you will get used to it.
2. It is not your fault. Many times children feel it is their fault because they see parents angry and fighting and then start believing they caused it.
3. It is real. You have to accept that we are divorcing. You may not like it, but it is happening.
4. You must realize that though you will be taken care of and have time to be with each of us you cannot get us back together. Repeat this and that it is not their fault because children carry the fantasies it is their own fault and that their parents will get back together again.
5. Try and keep them from hearing each other complain about the divorced partner. It’s important not to go to your children with those conflicts. They will feel burdened and pressured by it. It can affect their relationships later.
6. When either of you is dating or planning on remarrying it is important to tell your children that these are your choices and that they cannot pick your mate for you. They will develop a relationship on their own with the new person.

Tell your children you will always be there with them to help them with their feelings, and to comfort them. Show them you mean what you say by your actions during the typically tumultuous time surrounding your divorce.

In my psychiatric practice I have seen over and over again how children blame themselves for their parents divorce. It really affects them. It is not their fault and this needs to be repeated to them, again and again.

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).

Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.

To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.

How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.

The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.

But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.

Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.

Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.

It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.  Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.

Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of overtreatment.

But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.

Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.

This piece was originally published in Zocalo Public Square, an online magazine of ideas. 

Dr. Greene`s Answer:

It can be rough on everyone in the family when Grandpa dies. Questions, uncertainties, fears, and sorrow are all common and past hurts and fears often reverberate once again. Kids of all ages are likely to have many questions, even long after their loved one’s death. Each question does deserve an honest and simple answer from you. Being open teaches them that it is acceptable to talk about it, and it sounds like your answers and reassurances are right on target.

It’s important to take a child’s age into account when you choose words and explanations related to death. Try to explain things in terms that she can relate to…that she can understand. Once you have explained something, be sure that your child understood what you said. They may ask the same question time and time again, so be prepared to repeat yourself.

We also need to remember that, as adults, we very well may not have all the answers to their questions, particularly when it comes to death. It is OK to tell your child that you just don’t know.

Sometimes art, in its various forms, can be a good way for kids to work through some of these things. For instance, you could do little dramas where a child isn’t feeling well and a toy ambulance comes and helps the child. Use dramas, stories, or pictures to make the solution as tangible as possible.

For more great advice on this topic, I recommend visiting Hospicenet.org and reading their article entitled “Talking to Children about Death.”

Dr. Greene’s Answer:

Zoloft (Sertraline HCl) is a powerful medicine that has been used to treat depression, panic disorder, obsessive-compulsive disorder, and post-traumatic stress syndrome–all situations that by themselves can have worse side effects than Zoloft.

But, Zoloft can cause irritability and confusion in some, especially if combined with alcohol. Worsening depression and suicidality have been reported in some patients. About one in 20 people on Zoloft feel unpleasant mood changes, especially agitation or emotional instability.

Zoloft can be the best choice for some kids and for some nursing moms. It has brought about many excellent results in treating some serious medical conditions. But it shouldn’t be taken lightly–it is quite a powerful medicine.

Related concepts:

Stranger anxiety, object permanence

Introduction to separation anxiety:

Your baby has been able to tell the difference between you and strangers from the earliest days of life. Young babies prefer their mothers and fathers (and others who are frequently involved), but will usually respond happily to others as well.
Until…
They begin to get upset when others come too close – even regular babysitters, grandparents (who may feel heartbroken), or one of the parents (who may feel very unsettled by this).
At about the same time, most babies begin to fuss and cry whenever you leave their sight, sometimes even to step into the next room!

What is separation anxiety?

Separation anxiety and stranger anxiety both coincide with a new intellectual skill called object permanence. They now remember objects and specific people that are not present. They will search for toys that have dropped out of sight. They are able to call up a mental image of what (or who) they are missing. They don’t want the stranger, because the stranger is not you.
They understand that people leave before they learn that people return. They can tell from your actions that you are about to leave. Anxiety begins to build even before you leave.
They can’t tell from your actions that you are about to return. They have no idea when – or even if – you will come back. And they miss you intensely. For them, each separation seems endless.
Dropping a screaming child at day care tugs at parents’ hearts. Much nighttime screaming is an expression of separation anxiety. Sleep is a scary separation.
Peek-a-boo and bye-bye are fun ways for us to interact with babies, and great ways to teach them about object permanence. For babies at this age, these are issues of great concern.

Who gets separation anxiety?

Most healthy babies and toddlers exhibit at least one phase of stranger/separation anxiety as part of normal development.
A small number of school-aged children and adolescents will develop separation anxiety disorder (SAD), an intense fear of harm to parents and a refusal to tolerate separation, even for school or sleep.

What are the symptoms of separation anxiety?

Object permanence is usually first noted when a baby searches for a toy that has fallen out of sight.
The symptoms of normal developmental separation anxiety include increasing anxiety at signs that demonstrate that you are about to leave. Upset and crying occur at the time of separation, and often at the approach of others. Sleep difficulties are common.

Is separation anxiety contagious?

Anxiety can be contagious. The more anxious you are about leave-taking or about others caring for your baby, the more anxious your baby will be.

How long does separation anxiety last?

The first peak of separation anxiety usually takes place in the second half of the first year, and lasts for about 2 to 4 months, though there is great variability in this.
There is often a second peak in the second half of the next year. At this time, toddlers have emerging language skills and a strong desire to communicate. They have developed a rich, multimedia array of ways to communicate with you that strangers just don’t understand. The second peak of separation anxiety usually fades as language skills improve.
In some children, the two peaks run together, resulting in separation anxiety for up to 8 months or so at a stretch.
Separation is usually a dominant issue from about 6 months until language is understood by strangers.

How is separation anxiety diagnosed?

Normal separation anxiety is not a diagnosis.
The uncommon separation anxiety disorder (SAD) is diagnosed by mental health professionals based in the history and interview.

How is separation anxiety treated?

Once children have learned about leaving, you want them to learn about returning. Separation/return games, and short practice separations are quite helpful.
The classic separation/return games are peek-a-boo and “where’s the baby?”
I like playing peek-a-boo with the feet. With the baby lying on his back, lift the legs “up, up, up” to hide your face, and then “Peek-a-boo!” as you open the legs wide. Often babies love to open their legs themselves to find you.
In “Where’s the Baby?”, drop a lightweight cloth over your baby’s head, ask, “Where’s the baby?” and pull the cloth again grinning and saying, “There you are!” Soon your baby will delight at pulling the cloth off and laughing. The cloth can also be placed over your own head, or you can partially hide behind a chair or around a corner where you will be easily discovered.
Hiding and finding objects is another fun form of separation/return play; under clothes or buckets, anywhere the baby can delight in finding you.
With practice separations, tell your baby that you will be going to another room and that you’ll be back soon (even though the baby will not understand the words yet). If there’s crying, repeat the reassurance that you’ll be back soon. Then pop back in smiling and say, “Hello”. “Bye-bye” is one of the first words most babies learn. You want to teach them to understand hello as soon as you can. Gradually make these practice separations longer and longer. The baby will learn that you’ll come and that it’s okay when you are gone for a bit.
When you really leave, good-byes should be brief, affectionate, and with a clear statement that you will be back. If the caregiver can engage your child with a toy or mirror, it can make your leaving easier. If you are leaving your child at a day care or someplace other than home, the separation will be easier if you spend a few minutes there with your child (and also with the new caregiver).
Transitional objects, such as blankets or stuffed animals, are healthy ways to minimize separation anxiety.
Regular routines make the “returning” lesson easier to learn.

How can separation anxiety be prevented?

Helping your child select a transitional object can help reduce separation anxiety.
During the ages when separation is a big issue, you want to avoid prolonged absences and avoid having your child cared for by someone who will not look at her and smile.
When you must leave, do not make a big fuss over leaving and do not sneak out. Children need a simple, direct, “Bye-bye, I’ll be back.” Be sure to tell them when you’ll be back.
Separation anxiety is more pronounced when children are tired, hungry, or sick. Try to time separations when they are happy and satisfied.

Related A-to-Z Information:

Nightmares, Tantrums

Related concepts:

Major Depression, Mood Disorders, Dysthymic Disorder, Childhood Depression, Infant Depression.

Introduction to depression:

United States Surgeon General David Satcher released a report in January 2001 describing a mental health crisis in children. Mental illness severe enough to hinder kids from learning or developing appropriately is quite common — but fewer than one in five affected children get the help they need. Mental disorders are a major untreated problem in children. Recognizing and treating conditions such as depression can be a powerful contribution to children’s lives. Some children’s depression is missed because they appear to have ADHD.

What is depression?

Major depression is a mood disorder that affects sleep, eating, growth, mood, and interest level. Dysthymic disorder is a milder (but often longer lasting) variant, where the child has a depressed mood for at least a year.
Not long ago, people used to think that young children did not suffer from depression. Now we know that depression in children is both real and common – although the symptoms are often different from those seen in adults.
Depression of Infancy and Early Childhood is defined as a pattern of depressed or irritable mood with diminished interest or pleasure in developmentally appropriate activities, diminished capacity to protest, excessive whining, and diminished social interactions and initiative. This is accompanied by disturbances in sleep or eating and lasts for at least 2 weeks.

Who gets depression?

Depression affects up to one in 40 children. It involves the interplay of a genetic predisposition to depression, an imbalance of brain chemicals, and events in the child’s life.
There is a strong link between mental disorders in parents and their children. When parents have major depression, their children are at increased risk for emotional and behavioral problems of their own. Depression in parents is associated with depression, social phobia, disruptive behavior disorder, separation anxiety disorder, multiple anxiety disorder, and/or poorer social functioning in children.
Yet when parents are diagnosed, the children are often not even considered. I hope that this will prompt caregivers to notice whether the children are in any distress and to provide support for them, even at a very young age. And of course, I hope that parents will get the treatment and support that they themselves deserve, both for their own sake and for their children.

What are the symptoms of depression?

Children may have many of the same symptoms as adults. In general, though, children may be less likely to report sadness or depressed mood, and more likely to develop phobias, anxieties, physical complaints, behavior problems and hallucinations. In addition, the pattern of symptoms in children can vary by age.

• Infants and toddlers – developmental regression, increased crying, increased clinginess, increased anxiety, irritability, head banging, increased sleep issues, increased feeding problems, falling off growth curves, developmental delay, limited speech, limited social interaction
• Preschoolers – uncontrollable behavior, hyperactivity, tantrums, breath-holding, biting, kicking, scratching, nightmares, toileting problems (refusal, withholding, smearing, bedwetting, increased “accidents”)
• School-age children – worsening school performance, worsening homework performance, increasing school and homework resistance, headaches, tummy aches, fatigue, lack of motivation, anxiety, increased lying, stealing, masturbation
• Teens – school failure, promiscuity, delinquent behavior, increased aches and pains, suicidal thoughts or attempts, may look more like adult depression

Sometimes ADHD and depression are confused with each other. Many children have both.

Is it contagious?

Depression in parents and caregivers can worsen depression in children, and vice versa.

How long does depression last?

The symptoms of depression usually develop over several days or weeks. Without treatment, the depression usually lasts between six months and a year. About 90% of cases will resolve – some without treatment. However, about 40 to 80% of these children will often become depressed more than once.

How is depression diagnosed?

Whenever there is concern that a child might be depressed, an evaluation is important. This might include rating scales or structured interviews. Sometimes blood tests or EEGs are used to support the diagnosis.

How is depression treated?

Depression in children may be treated with antidepressant medication and/or therapy, such as cognitive behavioral therapy. The response to treatment in children can be quite good.

How can depression be prevented?

Parents taking care of their own needs can help prevent depression in their children. In addition, nurturing attention, exploration and activity, good sleep, and good nutrition can be helpful. Some kids will become depressed, though, even in an ideal situation.

Related A-to-Z Information:

Attention Deficit Hyperactivity Disorder (ADHD), Breath Holding, Head Banging, Headache, Lead Poisoning, Nightmares, Sexual Curiosity in Young Children, Sleep Apnea, Stuttering, Thumb-sucking, Tourette’s Syndrome

Introduction to colic:

It usually strikes toward the end of a long day, when your baby is just about at the age when your sleep deprivation has really begun to set in. Your baby stops being the quiet, peaceful, miracle baby and begins screaming every evening. It is no wonder that parents become frustrated, discouraged, and depressed.

What is colic?

Almost all babies go through a fussy period. When crying lasts for longer than three hours a day, and is not caused by a medical problem (such as a hernia or an infection), it is called colic. This phenomenon is present in almost all babies, the only thing that differs is the degree.
The child with colic tends to be unusually sensitive to stimulation. Some babies experience greater discomfort from intestinal gas (and they tend to swallow even more air when they cry!). Some cry from hunger, others from overfeeding. Some breastfed babies are intolerant of foods in their mother’s diets. A few bottle-fed babies are intolerant of the proteins in formula. Fear, frustration, or even excitement can lead to abdominal discomfort and colic.
Whatever the mechanism, I believe that the fussy period exists in order to change deeply ingrained relationship habits. Even after the miracle of a new birth, many parents and families would revert to their previous schedules and activities within a few weeks – if the new baby would only remain quiet and peaceful. It would be easy to continue reading what you want to read, going where you like to go, doing what you like to do as before, if only the baby would happily comply. Instead, the baby’s exasperating fussy period forces families to leave their previous ruts and develop new dynamics that include this new individual. Colic demands attention. As parents grope for solutions to their child’s crying, they notice a new individual with new needs. They instinctively pay more attention, talk more to the child, and hold the child more – all because of the colic. Colic is a powerful rite of passage, a postnatal labor pain where new patterns of family life are born.

Who gets colic?

Almost all babies will develop a fussy period. About 20 percent of babies will cry enough to meet the definition of colic. The timing varies, but colic usually affects babies beginning at about three weeks of age and peaking somewhere between four and six weeks of age.

What are the symptoms of colic?

For most infants the most intense fussiness is in the evening. The attack often begins suddenly. The legs may be drawn up and the belly distended. The hands may be clenched. The attack often winds down when the baby is exhausted, or when gas or stool is passed.

Is colic contagious?

Colic is not contagious, but babies do respond to the emotions of those around them. When others are worried, anxious, or depressed, babies may cry more, which can make those around them more worried, anxious, or depressed.

How long does colic last?

Colic will not last forever! After about six weeks of age, it begins improving, slowly but surely, and is generally gone by twelve weeks of age. When colic is still going strong at 12 weeks, it’s important to consider another diagnosis (such as reflux).

How is colic diagnosed?

Colic is usually diagnosed by the history. A careful physical exam is wise to be sure the baby does not have a hernia, intussusception, a hair tourniquet, a hair in the eye, or another medical problem that needs attention.

How is colic treated?

Helping a child with colic is primarily a matter of experimentation and observation. Different children are comforted by different measures. Some prefer to be swaddled in a warm blanket; others prefer to be free. The process of treating colic involves trying many different things, and paying attention to what seems to help, even just a little bit.
Holding your child is one of the most effective measures. The more hours they are held, even early in the day when they are not fussy, the less time they will be fussy in the evening. This will not spoil your child. Body carriers can be a great way to do this.
Some babies are only happy when they are sucking on something. A pacifier can be like a miracle for some.
Singing lullabies to your baby can be powerfully soothing. It is no accident that lullabies have developed in almost every culture. The noise of a vacuum or of a clothes dryer is also soothing to many babies.
As babies cry, they swallow more air, creating more gas and more abdominal pain, which causes more crying. This vicious cycle can be difficult to break. Gentle rocking can be very calming (this is directly comforting and seems to help them pass gas). When you get tired, an infant swing is a good alternative for babies at least 3 weeks old with good head control.
Holding your child in an upright position may help (this aids the movement of gas and decreases heartburn). A warm towel or a hot water bottle on the abdomen can help. Some babies prefer to lie on their tummies, while someone gives them a backrub. The gentle pressure on the abdomen may help.
Some children seem to do best when they are going for a ride in the car. If your child is one of these, you might try a device developed by a pediatrician to imitate car motion and sound.
Some parents report an improvement by giving simethicone drops, a defoaming agent which reduces intestinal gas. It is not absorbed into the body and is therefore quite safe. Sometimes doctors will prescribe stronger medicines for severe colic (but this should only be done after a physical exam). If nothing else seems to work, you might try pretending your baby is sick, and taking a rectal temperature (do not use a mercury thermometer). This will often cause babies to pass gas and obtain relief.
There are many stories about foods that breastfeeding moms should avoid. Most often, I hear about abstaining from broccoli, cabbage, beans, and other gas-producing foods. The scientific evidence is strongest for avoiding stimulants such as caffeine and caffeine-related compounds (those found in chocolate). The other foods in mom’s diet that are most likely to cause a problem are dairy products and nuts. I would try eliminating these for a few weeks. Other foods may also irritate the baby. Experimentation and observation will guide you.
Switching formulas is not helpful for most babies, but is very important for some.
Taking a break is a good idea. Each of you can take charge and spell the other. Time for oneself is an important part of the new family dynamic. You will be able to pay more loving attention to your baby when you’ve had a chance to get refreshed.

How can colic be prevented?

A fussy period is likely no matter what prevention techniques are undertaken. Good feeding techniques (as advised by a lactation consultant, if appropriate), good burping, and early identification of possible allergies in the baby’s or mother’s diet may help prevent colic. Experimenting with the comfort techniques outlined above before colic develops can help you identify your baby’s needs and desires, and can help stop the fussy period from becoming so intense.

Related A-to-Z Information:

Diaper Rash, Food Allergies, Gastroesophageal Reflux, Hernia (Inguinal hernia), Intussusception, Nightmares

Related concepts:
Head injury

Introduction to concussion:

Children’s energetic exploration of life often results in head “bonks.” Fortunately, most of them are not serious. Nevertheless, when we hear the awful thud of a child’s head, our breath catches for a moment…

What is concussion?

A brief, temporary loss of consciousness following a blow to the head is called a concussion. It is possible to have a mild concussion without losing consciousness completely. Any brief alteration in consciousness, vision, and balance following a head injury could be a mild concussion.

Who gets concussion?

Is toddlerhood a contact sport?
Almost every child experiences minor head injuries. They occur throughout childhood and adolescence. They are most common in infants and toddlers and then later when children engage in contact sports.

What are the symptoms of concussion?

The classic symptom of a concussion is a brief loss of consciousness. A mild concussion might only cause brief confusion or momentary amnesia. It can be normal to have a headache, feel sleepy, or vomit once or twice afterwards.
In a baby or toddler, a prompt cry after a head injury is reassuring. The following is a list of signals that tell you that you need to talk with your pediatrician, either initially, or again if they develop after the first conversation:
If your child is (or has):

• Under 6 months of age
• Unconscious, even briefly
• Crying for longer than 10 minutes
• Vomiting repeatedly
• Bleeding or clear liquid from the ears or nose
• Rapid swelling just above the ear
• Unable to walk or talk normally
• Unequal pupil size
• Severe, worsening headache (or irritability before a child can talk)
• Neck pain
• Seizures
• Skull indentation or large bump
• Great force of injury (car accident, long fall, baseball bat, etc.)
• Changes in behaviour, such as being sleepy and difficult to arouse>

If any of these symptoms or situations is present, call your physician right away. Your child may be fine but you should be in touch with an expert. If your child is unable to get up by himself immediately after the head injury, there may also be a neck injury. It might be best not to move him. Call 911 and wait for emergency help to arrive.

Is concussion contagious?

Concussions and head injuries are not contagious, although the risk-taking behavior that leads to them can be.

How long does concussion last?

The loss of consciousness from a concussion may last only a few seconds, but it can last considerably longer. If it lasts a few minutes or longer, the child will likely need to be hospitalized for observation or treatment.
New symptoms can develop after a head injury during the next 24 to 48 hours, especially if there is some internal bleeding.

How is concussion diagnosed?

The nature and extent of a head injury is first assessed based on the story and on the physical exam. If there is any concern that a serious injury may be present, additional studies, such as a head CT, may be needed.

How is concussion treated?

For most concussions, observation and rest is all the treatment that is needed. During the first night afterward, you’ll want to try to awaken your child once or twice to be sure that he awakens normally.
Some children need definitive treatment at a hospital or even in a pediatric ICU for severe head injuries.
With any concussion, the risk is much higher from a second concussion soon after the first one (called the second impact syndrome) because the healing brain is not able to regulate blood flow as well.
The Colorado Medical Society has developed guidelines for return to contact sports (or practice) following a concussion. In these guidelines, a Grade III concussion involves a complete loss of consciousness, a Grade II concussion involves only confusion and brief amnesia surrounding the injury, and Grade I involves a player who is only confused after a head blow.
A player with a Grade I concussion, and no symptoms when examined, may return to play after 20 minutes. A player with a Grade II concussion may return to play after there has been one week with no symptoms. A player with a Grade III concussion should not return for a full month (including no symptoms in the last week before returning).
Repeated concussions increase the risks of acute or ongoing problems. After a second Grade I concussion, the player should avoid contact sports for at least two weeks; after the second Grade II, for one month; and after the second Grade III, the season is over.

How can concussion be prevented?

Helmets for using a bicycle, scooter, or roller-blades, and helmets for contact sports can help prevent many serious head injuries. Make sure your child is properly equipped for his activities.
Stair gates for infants and toddlers and car seats or seat belts for everyone in the car are also important safety equipment.
“Rock-a-Bye Baby,” the lullaby about a baby toppling from a poorly placed cradle, warns parents of a real danger. Falls from open windows, rooftops, balconies, play structures, and other heights injure more children than any other cause.
Summertime is the greatest danger period, with more open windows and more outdoor play. Children love to climb, so furniture is best kept back from windowsills and balcony railings. Window guards and window stops can let fresh air in but keep a child from falling out. Don’t rely on ordinary window screens to keep your children safe. In addition, placing shrubbery or something soft under danger areas can lesson the injury if a child does fall.

Related A-to-Z Information:

Head Banging, Headache, Hemophilia, Vomiting

Dr. Greene’s Answer:

MsHopeful, I sense your beautiful mother’s heart in what you write. I can see how it must feel for your daughter when her baby cries and she cannot soothe her. I also see how it must feel for you when your daughter cries and you cannot soothe her.

The tears and sadness are not a sign of inadequate mothering by either of you. As magical as the journey of parenthood is, it often begins with a period of feeling blue. A woman’s body is the scene of a powerful changing tide of hormones in the days and weeks after a baby is born. The rising hormone levels that gradually effected the incredible changes in your daughter’s body during the time she was carrying your granddaughter have now precipitously dropped.

Most new mothers, MsHopeful, (perhaps as many as 90%) will have periods of weepiness, mood swings, anxiety, unhappiness, and regret. Usually this lasts for a few days or less and is quickly forgotten (it may have happened to you, even though you don’t remember!). Sometimes the blue period comes and goes for six weeks. For some moms, the blues don’t begin until the baby stops nursing (another time of major hormonal shifts). Hormones, however, are not the entire story…

Every new beginning is also an ending of what was before. Every ending is a beginning. Whenever a baby is born, the world will never be the same. This is wonderful. It’s also okay to grieve for the loss of the way life was before.

Now add to all this — SLEEP DEPRIVATION! Your daughter may be more exhausted than she has ever been. Whenever people are sleep deprived, they are more subject to swings of emotion and to feelings of inadequacy. This, by itself, is enough to cause a blue period.

And the baby’s crying: Research has shown that women with the postpartum blues tend to have babies who cry significantly more than those of their counterparts. It hasn’t been proven whether the fussy, crying babies make moms sadder, or whether the sad moms make the babies less happy — but it seems to me that both are true, and that the crying is a vicious cycle.

A grief reaction, at a time of great stress (and insistent noise), in a person who is chronically sleep deprived, all built on a shifting foundation of tremendous hormonal surges — it’s a wonder that postpartum blues aren’t more of a problem. Most of the time, though, the powerful positive feelings that also accompany this time of new beginnings soon displace the sadness.

There are several things you can do to help:

• Help your daughter get as much sleep as possible. If she is breast-feeding, she will probably feel sleepy just after nursing. Encourage her to take a nap. “Sleep when the baby sleeps.”
• Get your daughter out of the house. Even brief breaks can be very restoring, especially if you get outside.
• Release your daughter from as many of her usual roles and responsibilities as possible. At the same time, help your daughter to realize that she is not marginal to the household. She is an incredibly important person!
• Shower your daughter with praise and encouragement. Point out to her the things that she is doing well, the ways that she is becoming more adept at baby care, the magnificence of what her body has done in creating a new life. Let her know that you believe in her capacity to be a wonderful mother. Gently remind her that it’s normal and fine for motherhood to be an unfolding process. She doesn’t have to have all the answers. Over time she will be amazed at how skilled she will become in understanding and nurturing her child.

If your daughter can’t sleep (because she can’t, not because the baby won’t), if she doesn’t want to eat, if she loses interest in life or feels hopeless, if she is having disturbing or suicidal thoughts, or if the blues are lasting more than a week or two, this might be more than postpartum blues — she might have true postpartum depression. 30-75% of new mothers experience postpartum blues and 10-15% experience postpartum depression (Int Rev Psychiatry. 2003 Aug;15(3):231-42). Even though true depression is much less common than the blues, it’s important to seek professional advice right away away if you suspect there may be a component of true depression. Her obstetrician or family doctor is a good place to start. Don’t let anyone brush this off. True depression is much less common than the blues. Professional treatment is important, and is usually quick and effective.

Whether your daughter’s situation is the blues or full-blown depression, don’t minimize it. The weeks following a child’s birth are different from any other time in life. They are rich, complex, and often out of control. So take a deep breath. Relax. Pamper yourselves. Enjoy the little things. When life seems particularly hard, take comfort in knowing that this time will soon be over. Though life will never be the way it was before, soon things will settle down. In the meantime, remind yourself and your daughter that this is a once in a lifetime experience that you don’t want to miss.

Dr. Greene’s Answer:

Masonwalls, my heart weeps for you. Such sadness in your time of joy, such joy in your sadness. And fear surrounding it all. No wonder you can’t stop crying.

Sometimes life feels so unfair.

People often think of pregnancy as a special time when women feel biologically complete and insulated from the sadness in the surrounding world. And it is special…

The truth is, though, that the rates of depression in pregnant and non-pregnant women are very similar. From this you know that you are not alone, and that many women have gone through difficult times while pregnant, shed many tears, and had healthy, wonderful babies at the end.

Still, ongoing full-blown depression can sometimes affect a developing baby, both directly and through inadequate nutrition. The risks are small, but real. Thankfully, there are safe treatments for pregnant women. Whether you need treatment or not, the outlook for your baby is good.

When there are major emotional storms during pregnancy, it is wise to stay in close touch with both an obstetrician and a psychiatrist. You deserve their support and their help in navigating this journey.

Today is a beautiful spring day where I am. As I feel the warmth of the sun, I am hoping that you find moments of sunshine and wildflowers to warm your heart.

You and your little baby are so closely linked. You do shield your baby from most of what happens outside. You surround your baby with love and with the perfect hug. And your baby hugs you, inside, where you need it the most.

Life is bittersweet. But you face it together.

Please stay in touch…