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Evolution, Parenting, Pediatrics, Research, Women's Health

Just when did it begin to “take a village to raise a child”?

9640826608_e65589c650_zImagine a prehistoric human mother raising her baby outside of any community or family structure, with no help from others. It sure doesn’t fit with my idea of the “village” that raises a child, a phrase I often associate with romantic notions of pre-modern lifestyles. But according to a study done by University of Utah anthropologist Karen Kramer, PhD, if you go far back enough in human evolution, mothers raised their young alone and didn’t feed or care for them past weaning (which happened around 5 or 6 years of age!).

The study, published in the Journal of Human Evolution and interestingly titled “When mothers need others: The impact of hominin life history evolution on cooperative breeding,” examines how humans transitioned into family and community patterns of child rearing. It suggests that the earliest cooperative groups were formed by a mother and many of her children, with older ones helping rear younger siblings; after this was established, other adults were incorporated, probably when bands of mothers with their offspring teamed up. As women became better at reproducing, they needed the extra help.

As noted in a University of Utah press release, this is different from the predominating theories among anthropologists, which point to cooperation among adults. Kramer also comments:

Human mothers are interesting. They’re unlike mothers of many other species because they feed their children after weaning and others help them raise their children. As an anthropologist, I live and work in traditional societies where, like other researchers, I have observed many times that it takes a village to raise a child. Not only do mothers work hard to care for their young, but so do her older children, grandmothers, fathers and other relatives. But this wasn’t always the case.

The consequences for health likely factored into the “economic decision making” that Kramer modeled in her study – children reared cooperatively were more likely to survive, and I imagine mothers garnered more than a few benefits from extra pairs of eyes, ears, hands, and feet, as well.

And another thing this study shows us: Some of the same decisions that parents weigh today – how many children to have, which kind of help to recruit in raising them, and what kind of balance between kids and other pursuits will optimize health – are really not so novel.

Previously: Computing our evolution and Revealed: Epic evolutionary struggle between reproduction and immunity to infectious disease
Photo by Jaroslav A. Polak

Parenting, Pediatrics

Overwhelmed as a mom of multiples

Overwhelmed as a mom of multiples

twin babies

My babies were three days old when my husband offered to get take-out from one of our favorite restaurants. I said, “Yes,” as I might have said it before the girls were born. But as soon as he left I realized this was my first time alone with my twins. In the small, silent room, I whispered to them, “Okay girls. It’s just you and me. Be good for mommy.”

Everything was quiet for a while, until one started crying. I picked her up and rocked slowly side to side. Just when she calmed, the other started crying. That got the first one crying again, this time louder and more distressed. I had one baby crying in my arms and the other crying in a bassinet and I didn’t know what to do.

The day-to-day challenge of multiples is simply this: There may be multiple of them, but there’s often only one of you

Was it five minutes? Ten? It seemed like eternity. I tried putting them on the bed next to each other, and leaning over to hug them both at once. They hated it. Unable to choose one over the other, I found myself choosing neither. I felt absolutely overwhelmed.

Finally, an early Beatles song came to mind, and I sang it softly to them. “Tell me why-y-y-y you cry…” When I saw how my singing quieted them, suddenly the tears started pouring out of my eyes, but I didn’t dare stop singing: “Is there anything that I can do? ‘Cause I really can’t stand it, I’m so in love with you.”

“Hello!” My husband returned with the take-out. My face was red hot, my eyes half blind from crying, my nose uselessly stuffed, my throat caught. I was a mess. And I was singing – badly. But my babies weren’t crying anymore.

That’s when I knew – I mean really felt – that I was their mom. I could hardly believe there was a moment even a minute long when I felt so alone and helpless. Their dad took one baby, I took the other; we fed them, we changed them, we tucked them back to sleep. And after it all, the food was still warm.

The day-to-day challenge of multiples is simply this: There may be multiple of them, but there’s often only one of you. Sometimes your babies need more of you than you have to give. You love them equally and you don’t like having to choose one to take care of first while another waits and cries for you. You will envy the single moms of single babies who complain that they must hold their baby all the time. You wish you could hold your babies all the time – the best you can do for them is one at a time.

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Events, Parenting, Pediatrics, Stanford News, Videos

Pediatric health expert Alan Guttmacher outlines key issues facing children’s health today

Pediatric health expert Alan Guttmacher outlines key issues facing children's health today

The inaugural Childx conference was held here last month, and video interviews featuring keynote speakers, panelists and moderators are now on the Stanford YouTube channel. To continue the discussion of driving innovation in maternal and child health, we’ll be featuring a selection of the videos this month on Scope.

During his keynote speech at Stanford’s recent Childx conference, Alan Guttmacher, MD, director of the Eunice Kennedy Shriver National Institute of Child Health and Development, told attendees, “We need to be a society that values children.”

In the above video, Guttmacher emphasizes this point as he outlines key issues facing children’s health today. He explains that it’s the dawn of a new era in medical research with the potential to improve the lives of children throughout their life span. To make a lasting difference in children’s lives, he says, research needs to go beyond the medical approach and integrate social and environmental factors. He highlights the example of preterm birth, saying that while we’ve made strides in reducing the infant mortality rate of babies born too early, more needs to be done to understand the causes of preterm birth and prevent it.

Watch the full interview to learn more about why investing in pediatrics research can help the generations of tomorrow build a healthier future.

Previously: “It’s not just science fiction anymore”: Childx speakers talk stem cell and gene therapy, Global health and precision medicine: Highlights from day two of Stanford’s Childx conference, Innovating for kids’ health: More from first day of Stanford’s Childx, “What we’re really talking about is changing the arc of children’s lives:” Stanford’s Childx kicks off and Countdown to Childx: Q&A with pediatric health expert Alan Guttmacher

In the News, NIH, Parenting, Pediatrics, Pregnancy, Research

Maternal interaction helps pre-term infants grow, study shows

Maternal interaction helps pre-term infants grow, study shows

new mom with baby

It’s not surprising that interaction with their mothers is helpful to babies who are born prematurely – but new research spotlights some of the specific benefits. Featured in an NIH press release today, a study of a method called H-HOPE (Hospital to Home: Optimizing the Premature Infant’s Environment) found that it correlated with a marked improvement in infant weight gain, length growth, and muscular ability to feed from a bottle.

The H-HOPE program has two parts: First, it teaches mothers to use a multi-sensory intervention that features auditory, tactile, visual, and vestibular stimulation (an “ATVV intervention”), and then it trains mothers to recognize their infants’ subtle communication cues, which are much more discreet than those of term infants. Instead of crying and putting their hand in their mouth to indicate hunger, for example, pre-term babies may weakly lift their hand towards their mouth. The fifteen-minute ATVV intervention, which was administered twice daily before feedings, started with a soft female voice, followed by a gentle massage, eye-to-eye contact, and then rocking-in-arms.

The initial study, published in the Journal of Perinatology, was headed by Rosemary C. White-Traut, PhD, RN, professor emeritus in the department of Women, Children and Family Health Science at the University of Illinois at Chicago College of Nursing. The 183 babies in the study were born between 29 and 34 weeks gestation, and their mothers were involved in the H-HOPE program from the time the baby reached 31 weeks until one month after the approximate date the baby would have been born had the pregnancy reached term. The mothers each received visits from a nurse-community health advocate to make sure the procedures were going smoothly, twice in the hospital and twice after discharge.

Each of the participants had at least two social-environmental risk factors, and half of them were Hispanic, a group with a high rate of prematurity. As White-Traut commented in the release, “When we planned our research, we thought that preterm infants from impoverished backgrounds likely would benefit the most from this intervention. Poverty is linked to poorer long-term health and infant development. And as with other negative health influences, preterm infants usually are affected more strongly than term infants.”

White-Traut’s study showed improved weight gain and growth in the babies; a follow up study (to be published in Advances in Neonatal Care) showed that infants also had better muscular ability to suck from a bottle just after receiving the ATVV intervention, via a sensor placed on the bottle’s nipple while they ate.

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In the News, Men's Health, Mental Health, Parenting, Pregnancy, Research

Examining how fathers’ postpartum depression affects toddlers

Examining how fathers' postpartum depression affects toddlers

Zoe walking with GilPostpartum depression doesn’t only affect moms, and new research shows that fathers who suffer from it have just as great an effect on their kids as depressed mothers do. As described in a press release from Northwestern University late last week, toddlers who have a depressed parent of either sex can experience emotional turmoil that manifests both internally and externally, through behaviors such as hitting, sadness, anxiety, lying, and jitteriness.

Most previous studies on the consequences of postpartum depression have focused only on women; this study (subscription required), published in Couple and Family Psychology: Research and Practice, is one of the first to examine how toddlers are affected by depression in either parent. It was led by Sheehan Fisher, PhD, professor of psychiatry at Northwestern University’s Feinberg School of Medicine.

As quoted in the release, Fisher states:

Father’s emotions affect their children. New fathers should be screened and treated for postpartum depression, just as we do for mothers… Early intervention is the key. If we can catch parents with depression earlier and treat them, then there won’t be a continuation of symptoms, and, maybe even as importantly, their child won’t be affected by a parent with depression.

Data for the study was collected from nearly 200 couples; questionnaires were administered both in the first few months after their child’s birth, and when their child was three years old. The forms were completed by each partner independently. Parents who reported signs of postpartum depression soon after the birth of their child also showed these signs three years later – the symptoms didn’t self-resolve. The questionnaire also asked about fighting between parents, which, interestingly, did not contribute to children’s emotionally troubled behaviors as much as having a depressed mother or father did.

Fisher stated in the release that depressed parents may smile and make eye contact less than parents who are not depressed, and that such emotional disengagement may make it hard for the child to form close attachments and healthy emotions.

Previous studies have shown that fathers are at a greater risk of depression after the birth of a child than at any other time in a typical male’s life.

Previously: A telephone lifeline for moms with postpartum depression, 2020 Mom Project promotes awareness of perinatal mood disorders, In study, health professionals helped prevent postpartum depressionDads get postpartum depression too and A call for depression screening for pregnant women, moms
Photo by Michelle Brandt

Mental Health, Parenting, Pregnancy, Women's Health

A telephone lifeline for moms with postpartum depression

A telephone lifeline for moms with postpartum depression

Van_Gogh_-_Madame_Augustine_Roulin_mit_BabyI’m currently pregnant and due in less than two weeks. It’s my second child, so I’m not as worried about caring for a newborn as I was the first time around. But one nagging worry I have is the risk of postpartum depression, sometimes called postnatal depression. I have a family history of depression and that puts me at higher risk. Luckily, it wasn’t a problem with my firstborn, but it can crop up in later pregnancies – and scientists don’t entirely understand the reasons for it.

Postpartum depression usually hits four to six weeks after delivery—though it can show up months later. It’s characterized by feeling overwhelmed, trapped, guilty or inadequate, along with crying, irritability, problems concentrating, loss of appetite or libido, or sleep problems. An estimated 9 to 16 percent of new mothers are affected by postpartum depression. Even men are known to suffer from it sometimes. PPD affects not just the mother (or father), but can have lasting effects on the child as well, so helping these parents through a difficult and isolating time is critical

Now, a study published in Journal of Advanced Nursing shows that providing a social network for new moms, via phone calls from other mothers who had recovered from PPD, could alleviate symptoms for moms in the study for up to two years after delivery. A news release summarized the findings:

For the present quasi-experimental study, researchers recruited 64 mothers with depression up to two years after delivery who were living in New Brunswick. Peer volunteers who recovered from postnatal depression were trained as peer support and provided an average of nine support calls. The average age of mothers was 26 years, with 77% reporting depressive symptoms prior to pregnancy and 57% having pregnancy complications. There were 16 women (35%) who were taking medication for depression since the birth.

I find the idea that this insidious problem could be tackled with a phone version of the ubiquitous and valuable moms’ groups an uplifting one. Compared to drug treatments, regular phone calls from a peer who’s gone through something similar is a relatively cheap treatment. Further studies are needed, but I’ll be watching to see whether this approach takes hold as a standard intervention for PPD.

Previously: “2020 Mom Project” promotes awareness of perinatal mood disorders,  Is postpartum depression more of an urban problem?, Helping moms emerge from the darkness of postpartum depression, Breastfeeding difficulties may lead to depression in new moms, and Dads get postpartum depression, too
Image by Van Gogh

Mental Health, Parenting, Pediatrics, Pregnancy, Women's Health

“2020 Mom Project” promotes awareness of perinatal mood disorders

"2020 Mom Project" promotes awareness of perinatal mood disorders

3505373098_0c1961a29a_zHaving a baby is a huge life alteration – who wouldn’t be at least a bit anxious? The vast majority of women experience mood shifts surrounding pregnancy: Around 80 percent experience “baby blues,” and in up to 20 percent this develops into something more serious. But most of these women go untreated, and many undiagnosed.

The California Maternal Mental Health Collaborative (which is changing its name to “The 2020 Mom Project” as they expand outside California) is spearheading efforts to get the word out about perinatal mood disorders. Last Friday, they hosted a seminar on emerging considerations in maternal mental health. As a birth doula, I was particularly happy to listen in. The keynote speakers approached the issue from a pointedly broad perspective, considering the social, economic, and cultural factors that influence health problems and care provision. The take-home message was that to address perinatal mood disorders, we need to address the context in which they happen, including protecting tomorrow’s moms while they are children today.

Vincent Felitti, MD, professor of medicine at UC San Diego and founder of the California Institutes of Preventive Medicine, has done extensive research on how “adverse childhood experiences” affect health by correlating an “ACE score” of self-reported negative experiences such as abuse, neglect, or household dysfunction with incidence of disease. The top-10 causes of death in the U.S. are strongly correlated with high ACE scores. Moreover, so are their risk factors! Much abuse of alcohol, drugs, and food is a coping mechanism for prior traumas. “What we see as the problem turns out to be somebody’s solution to problems we know nothing about,” Feletti said. “Depression is considered a disease, but what if it was a normal response to adverse life experiences? ACE score statistics support this.”

In a similar vein, Calvin Hobel, MD, an obstetrician-gynecologist at Cedars Sinai Medical Center in Los Angeles, spoke about how maternal stress surrounding pregnancy causes complications and adverse child outcomes, including premature birth. Stress causes uterine irritability, which causes cervical changes that favor pre-term delivery. It signals to the placenta that things aren’t going well, and the baby better get out early. Just as soldiers with stressful backgrounds are more at risk for PTSD, moms who’ve had a rough life are more stress-reactive and less prepared to cope with the demands of motherhood.

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Bioengineering, Ethics, Fertility, Genetics, In the News, Parenting, Pregnancy

And baby makes four? KQED Forum guests discuss approval of three-parent IVF in UK

And baby makes four? KQED Forum guests discuss approval of three-parent IVF in UK

newborn feet Scope BlogLast week, the U.K. House of Commons voted to legalize a controversial in vitro fertilization technique called mitochondrial donation, popularly known as the “three-parent baby” technique. The technique is intended for mothers who have an inherited genetic defect in their mitochondria – the fuel compartments that power our cells – and can help them from passing on the incurable disease that often entails years of suffering and ends in premature death.

Doctors replace the DNA from a donor egg with the mother’s DNA, use sperm from the father to fertilize it, then implant it into the mother’s uterus via IVF technology. The donor egg’s cytoplasm contains defect-free mitochondria and DNA from both parents. Proponents say the technique gives parents with mitochondrial disease the chance to have disease-free children, but critics say it brings us one step closer to the reality of genetically modified “designer babies.”

On Friday, Stanford law professor and biotechnology ethicist Hank Greely, JD, was among the guests on KQED’s Forum broadcast to discuss the issue. He’s in favor of the procedure, noting that when looking at genetic modifications, “the purpose, the nature, [and] the safety” should be considered. “There are some things that I think shouldn’t be done,” he said, adding that “things like this, which gives women who have defective mitochondrial DNA their only chance to have genetic children of their own… if the safety proves up… seems to be a good use.”

Previously:  Daddy, mommy and ? Stanford legal expert weighs in about “three parent” embryos and Extraordinary Measures: a film about metabolic disease
Photo by Sean Drelinger

Neuroscience, Parenting, Research, Stanford News

Math and the brain: Memorization is overrated, says education expert

Math and the brain: Memorization is overrated, says education expert

4008476814_a7d70651f7_zRemember being drilled multiplication tables? Or taking a timed math exam? These have been common activities in school, but Stanford experts say they’re not really helpful to kids learning math facts. In fact, they deter students who might otherwise be excellent mathematicians.

Jo Boaler, PhD, is a professor of mathematics education and lead author on a new working paper, “Fluency without Fear.” As part of the research, educators looked at MRI scans of students who are better and worse at math memorization. The only difference in the brain shows up in the hippocampus, the working memory center, leading researchers to believe that there are no differences in math ability, analytical thought, or IQ between the groups. Moreover, the working memory shuts down when under stress. This makes it harder to recall facts when under time pressure, and seems to particularly affect high-achieving and female students.

Boaler’s research shows that students are better at math when they’ve developed “number sense,” or the ability to use numbers flexibly and understand their logic, which comes from relaxed, enjoyable, and exploratory work. Investigators found that high-achievers actually use number sense, and not rote memorization; likewise, it’s not that low-achieving students know less, but that they don’t use numbers flexibly.

Boaler told Stanford News, “They have been set on the wrong path, often from an early age, of trying to memorize methods instead of interacting with numbers flexibly… Number sense is the foundation for all higher-level mathematics.”

So, good math students are not necessarily fast math students, which is a common misconception. In fact, many mathematicians are slow with numbers, because they think carefully about them. The danger is that kids who aren’t fast with math sometimes become convinced they’re not good at it, and they turn away.

Compare times-tables drilling with how English is commonly taught. Students learn words by using them in many different settings: reading novels or poetry, writing thoughtful pieces, speaking about their thoughts or observations. “No English student would say or think that learning about English is about the fast memorization and fast recall of words,” says Boaler.

Boaler teaches a class for educators, “How to learn math,” in which she encourages a variety of math activities, including those that focus on the visual representation of number facts. Visual and symbolic number associations use different pathways in the brain, and connecting them deepens learning, as shown by recent brain research.

Photo by Jimmie

Addiction, Health Policy, Parenting, Pediatrics, Podcasts, Public Health

Discussing the American Academy of Pediatrics’ call to put the brakes on marijuana legalization

Discussing the American Academy of Pediatrics' call to put the brakes on marijuana legalization

A wave of changes in state laws on the use of marijuana for medicinal and recreational purposes has stirred the American Academy of Pediatrics. It’s taken 10 years for the AAP to update its policy on the legalization of marijuana, and they released its new one on Monday.

74381759_e5a563cf3d_zThe organization still opposes legalization but it has opened the door to reform in several ways. First, recognizing that minority kids bear the brunt of criminal penalties for pot use, they call for decriminalization. Second, they call for the U.S. Drug Enforcement Agency to reclassify marijuana from a Schedule 1 listing for controlled substances to a Schedule 2. This action would effectively allow more research to be conducted and in turn scientifically determine where marijuana is most effective as a treatment. A review by the federal government is currently underway.

I asked Stanford pediatrician Seth Ammerman, MD, the lead author of the statement, what the AAP was trying to achieve with its policy redo and why such a restrictive stance on legalization since the train for legalization – recreational and medicinal –  seems to have already left the “coffee house.”

In this 1:2:1 podcast, Ammerman cites major two concerns. First, if legalized and commercialized, marijuana will become a big business, and the same marketing efforts by tobacco companies that encouraged teens to take up cigarettes will lasso them to pot smoking. “Well, aren’t kids smoking pot already?” I asked. Ammerman fully realizes that any teen who wants pot can readily buy it – legalization, to the AAP, is an imprimatur. Secondly, Ammerman cited, as does the new policy statement, the compelling and growing scientific evidence that the brain in formation continues to gel through the teen years and into the 20s. Marijuana, just like alcohol and any other drug, is likely to play a lot of bad tricks as the prefrontal cortex solidifies.

As described in the policy paper:

New research has also demonstrated that the adolescent brain, particularly the prefrontal cortex areas controlling judgment and decision-making, is not fully developed until the mid-20s, raising questions about how any substance use may affect the developing brain. Research has shown that the younger an adolescent begins using drugs, including marijuana, the more likely it is that drug dependence or addiction will develop in adulthood.

Ammerman says that the AAP will follow closely what happens in states where marijuana has been legalized both for health and recreation, and it will look carefully at what future evidence suggests. Clearly, there’s still a lot of smoke around this issue.

Previously: To protect teens’ health, marijuana should not be legalized, says American Academy of Pediatrics
Photo by Paul-Henri S

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