Maternal Mental Health, First 1000 days, Childhood Flashcards
When can maternal mental health issues arise?
Antenatal - during pregnancy
Postpartum - after birth up until one year
What are the presentations of Maternal mental health disorders?
Continuation of existing mental disorder
Relapse in pre-existing condition
New onset mental disorder
Baby blues
Why are doctors particularly concerned about mental health during pregnancy?
- Women may cease medications = relapse
- Stressful time - physical complications, anxiety, social difficulties (family violence more prevalent)
- Effects of substance abuse during pregnancy
When do the Baby Blues occur?
3rd to 5th day after giving birth
Only lasts few hours/days
Persisting beyond 2 weeks = PPD
How can the mother be feeling when having Baby Blues?
Overwhelmed, tearful, exhausted, irritable
Still good times
Not a disorder, transient
How can the Baby Blues be overcome?
Good support, rest and nutrition, the Baby Blues can be resolved naturally.
When does Post Partum Depression occur?
Occurs within 4 weeks of birth.
What percentage of women experience PPD?
10-16% of women
Why can PPD be missed?
Dismissed as hormonal imbalance or baby blues
What is the leading cause of maternal death in NZ and other Western countries?
Suicide
What are the risk factors for PPD?
- Previous history of Depression or PPD
- Discontinuation of medications by a woman with a history of depression
- Childhood abuse
- Negative attitude towards the pregnancy
- Lack of social support/social isolation/domestic violence
- Having twins/triplets
- Losing a baby (stillbirth, miscarriage)
- Pregnancy & birth complications - risk for PTSD
How do you detect PPD?
Screen all women who have had a baby. Be aware of risk factors.
Consultation with patient and/or family, significant other - ask depression screening questions, feelings towards baby, social situation & support.
Edinburgh Postnatal Depression Scale - used during pregnancy/postpartum. 10 item, self administered. Easy to score.
PHQ-9 (screening tool)
List the impacts of untreated PPD on mother’s interactions with infant.
Decrease in affectionate behaviour
Decreased responsiveness to infant cues
** Effects more likely if PPD is chronic/severe and untreated.
List the impacts of untreated PPD on childhood development.
Increased behaviour problems when young
Poorer educational outcomes
Diminished social competence
Increased rates of mental disorder & risky behaviour in childhood and adolescence.
What are the statistics of Postpartum Psychosis (PPP)?
1-2 episodes per 1000 births
When does PPP occur?
Clinically rapid onset, mostly in first 2 weeks postpartum.
What are the tragic outcomes associated with the severe disorder of PPP?
Suicide and infanticide
What causes PPP?
It can be a recurrence of pre-existing bipolar disorder or schizophrenia or may be new onset
Who has a higher risk for developing PPP?
Women who have a history of bipolar disorder or schizophrenia.
What is the treatment for PPP?
Inpatient stay and medication (antipsychotic and mood stabilizer)
What are the symptoms of PPP?
- Extreme agitation
- Paranoia, confusion, disorientation
- Inability to sleep/eat
- Losing touch with reality
- Delusions
- Hallucinations (tactile, auditory, visual)
- Disorganized behaviour
- Psychomotor agitation
What are delusions?
Fixed, false beliefs or thoughts that are unlikely to be true e.g. baby is possessed by the devil.
What is a warning sign for PPP?
Extreme sleep disruption
What do you need to consider regarding treatment of breastfeeding mothers?
Careful risk/benefit assessment. Must weigh risk of treatment against risk of untreated illness to mother and infant.
What are the concerns regarding Mood Stabilizers taken by breastfeeding mothers?
Used to treat bipolar disorders (e.g. Lithium) & antipsychotic medications have teratogenic effects (associated with birth defects)
What are the issues with Antidepressants on breastfeeding mothers?
SSRIs are safer, but some concerns and research ongoing. Antidepressants excreted into human breast milk - no clear harms, but ongoing research.
Maternal depression also has adverse effects on infants
What other factors need to be considered when dealing with treatment of breastfeeding mothers?
Severity of illness
Psychiatric history
History of response
Available safety data in lactation
What are the domains of development?
Physical, social, emotional, cognitive, language
List the characteristics of physical development of children.
Weight: doubles by age 4 months, triple by first birthday
Length (2.5cm per month in first year)
Direction of growth is cephalocaudal (head to feet) and Proximodistal (centre outwards)
Describe the sensory development of children.
Hearing, smell, taste and touch are well developed at birth.
Vision develops rapidly during first 4 months
Between 6-8 months visual acuity is just as an adults
What are the motor skills at birth?
Survival reflexes (sneezing, sucking) Legs make crawling movement (when lying on stomach)
What are the motor skills at 3 months?
Head control, lifting head up
Push up head and shoulders on tummy
Grasp rattle and reach with two hands
List the motor skills at 6 months.
Sit briefly unaided
Rolls from back to tummy
Transfer block between two hands
Describe the motor skills at 9 months
Standing up, walking holding furniture/fingers
Crawl
Pick up button with thumb and forefinger
What are the motor skills at 12 months?
Walk unaided
Make mark with crayon
Name the motor skills at 18 months.
Climb stairs
Throw ball into box
Build tower with three cubes
What are the motor skills at 24 months?
Run, walk backwards
Place square peg in square hole
Build tower of six blocks
Describe the motor skills at 36 months.
Dress self
Toilet training underway (day vs night)
Ride a balance bike
What is cognitive development?
The ability to think, reason & solve problems.
Cognitive development is gradual, orderly changes by which mental processes become more complicated.
Describe Jean Piaget’s Stages of Cognitive Development.
Sensorimotor Stage - birth to 2 yrs
Preoperational Stage - 2 yrs to 7 yrs
Concrete Operational Stage - 7 to 11 yrs
Formal Operational Stage - 12 and up
What is the importance of Jean Piaget’s Stages of Cognitive Development?
Helps understand how children develop thinking
Each developmental stage follows after the other and there is no going back
Three stages are universal
When does the Sensorimotor Stage occur?
Birth to nearly 2 years
What is the description of the Sensorimotor Stage?
Experiencing the world through senses and actions (looking, hearing, touching, mouthing and grasping)
What are the developmental phenomena of the sensorimotor stage?
Object permanence (out of sight, out of mind concept no longer exists) Stranger anxiety
What is object permanence?
Out of sight, out of mind concept no longer exists. Able to find objects after they have disappeared.
When does the Preoperational Stage occur?
2 to about 6/7 years
What is the description of the preoperational stage?
Representing things with words and images; using intuitive rather than logical reasoning. Thinking is rigid, limited to one situation. Can’t master conservation.
What are the developmental phenomena of the Preoperational Stage?
Pretend play, egocentrism, animism.
Imaginary companions
When does the Concrete Operational Stage occur?
About 7 to 11 years
What is the description of the Concrete Operational Stage
Thinking logically about concrete events, grasping concrete analogies and performing arithmetical operations.
What are the development phenomena of the Concrete Operational Stage?
Conservation, mathematical transformations
When does the Formal Operational Stage begin?
About 12 yrs through adulthood.
What is the description of the Formal Operational Stage?
Abstract reasoning
Describe the developmental phenomena of the Formal Operational Stage.
Abstract logic, potential for mature moral reasoning.
What is egocentrism?
Assume that other’s perceive, think and feel the same as they do.
What is Animism?
Treating inanimate objects as if they were living ones.
What is Conservation/conservation tasks?
Pouring equal volumes of liquid into two different containers. Child decides one is bigger than the other, despite having the same volume.
What language skills does a 1-6 month baby possess?
3 months –> cooing & gurgling
6 months –> babbling
What language skills does a 6-12 month baby possess?
Baby begins to babble. Babbling sounds like “dada or da do”
12 months –> first word
What language skills does a 12-18 month baby possess?
Baby’s first words appear. Likes to copy sounds and words.
18 months –> knows 5 to 40 words
What language skills does an 18-24 month baby possess?
Toddlers beginning to join two words together. Lots of new words being learnt.
2 years –> 150 to 300 words, 2-3 word sentences
What language skills does a 2-3 year old possess?
Child using little 3-5 word sentences.
3 years –> 900 to 1000 words, asks short questions
What are the language skills of a 5 year old?
Identifies letters, creates longer sentences
What skills does a 4 year old possess in terms of language?
2000 words, 5+ word sentences
In general, what are the first 50 words a baby learns?
Tend to be names of important people, greetings, food and other daily routines.
How do girls differ compared to boys with language skills?
Girls begin to acquire words earlier and have faster initial learning than boys.
What environmental factors aid in language development?
Interactions with adults (books, playtime), parental responsiveness, presence of siblings
What is over extension in language terms?
Specific category for everything similar (e.g. bird ca be any flying object)
What is under extension in language terms?
Reserve a specific category for one thing (e.g. ball is only the favourite red ball)
What are common causes of language delays?
Hearing impairment, intellectual disability (dyslexia), Autism, psychological issues (neglect)
What is social development?
A process of learning how to show self expression & interaction with others.
What influences social development?
The action of parents/caregivers and type of care received. Lack of love and attention may cause failure to grow and develop optimally.
How do infants play?
Infants do not have friends, parallel play is common.
When does gender identity emerge?
Around 2 years old
What are the social and emotional milestones at 2 months?
Begins to smile
Can briefly calm self
Directs gaze towards caregivers
What are the social and emotional milestones at 4 months?
Smiles spontaneously at people
What are the social and emotional milestones at 6 months?
Knows those who are familiar
Likes to interact in play with others
Looks at self in the mirror
What are the social and emotional milestones at 9 months?
May be afraid of strangers
Has favourite toys
What are the social and emotional milestones at 12 months?
Nervous with strangers Cries when caregiver leaves Cooperate with dressing Brings a book to be read Repeats sounds
What are the social and emotional milestones at 18 months?
Afraid of strangers
Affection for familiar people
Simple pretend play
What are the social and emotional milestones at 24 months?
Copies others especially those familiar
Excited with other children
Parallel play
Increasing independence
What is the parent/caregiver relationship attachment?
Bond between child and primary caregiver.
What does the parent/caregiver relationship allow the infant to do?
Seek proximity to the attachment figure
Provides soothing when distressed
Develop an internal working model of a secure base
Caregiver becomes safe haven from which child can explore the world.
What are the 4 different types of attachment styles between child and caregiver?
Secure attachment
Avoidant attachment
Disorganised attachment
Ambivalent attachment
Describe Secure Attachment
Mother is quick, sensitive, consistent
Child is secure, exploring & happy
Believes and trusts that his needs will be met
Describe Avoidant Attachment
Mother is distant, disengaged
Child is not very explorative, emotionally distant
Subconsciously believes that his needs won’t be properly met
Describe Disorganized Attachment
Mother is extreme, frightened, frightening, passive
Child is depressed, passive, angry, non-responsive
Severely confused with no strategy to have his needs met
Describe Ambivalent Attachment
Mother is inconsistent, sometimes sensitive, sometimes neglectful
Child is anxious, insecure, angry
Cannot rely on his needs to be met
When does physical development slow down in children?
Slows down during middle childhood, 6-11 years.
Discuss some qualities of physical development in children.
Girls have slightly more fat while boys have more muscle.
Growing pains as muscles adapt to enlarging skeleton.
Balanced diet is important or growth and development.
When are primary teeth lost?
Between 6-12 years
What are the gross motor skills of a child aged 6-7?
Hop, jump, climb, bike
What are the fine motor skills of a child aged 6-7?
Tie shoelaces, do buttons, zippers, brush teeth, wash themselves, use knife and fork (chopsticks), hold pencil like adults
What are the physical skills of a child aged 8-10?
Develop balance, coordination and strength which allows them to take part in team sports.
When does the concrete operational stage of development occur?
7-11 years
What skills are acquired in the concrete operational stage of development?
Logical thinking about concrete events. Child now needs concrete objects to process cognitions. CANNOT UNDERSTAND ABSTRACT FORM. Will struggle with verbal instructions.
What are the characteristics relating to concrete operational stage?
Seriation Classification Reversibility Conservation Decentering Identity Transitivity
What is seriation?
Sort objects according to size, shape and colour
What is classification?
Classify birds, fruits based on characteristics
What is reversibility?
Numbers and some objects can be changed but can return to former state e.g. ice to water and water to ice
What is conservation?
If nothing is added or subtracted, then the amount remains the same e.g. tall glass & small glass have same amount of liquid.
What is decenteration?
Able to consider multiple aspects e.g. tall glass is less wide, small glass is shorter in length, but greater in width.
What is identity?
Objects have qualities that do not change even if the object is altered in some way e.g. deflated balloon is still a balloon
What is transitivity?
Ability to logically combine relations to understand conditions e.g. if A=B and B=C then A=C
When does the formal operational stage occur?
Age 12+ approximately
What does the formal operational stage involve?
Abstract thinking
Logical thought and deductive reasoning & systematic planning
Can solve complex math/science problems in a planned, logical manner as opposed to trial and error when younger.
Can think of future (hypothetical, abstract)
What does language development during middle childhood incorporate?
Children are able to use long & complex sentences.
Understand other points of view & show they agree/disagree.
Keep a conversation going by giving reasons & explaining choices
Start conversations with adults/children they don’t know.
Understand & use passive sentences
Describe the clarity of speech in a 3 year old.
Speech unclear (75% understandable)
Describe the sentences of a 3 year old.
3-4 word sentences
Describe the answers and questions of a 3 year old.
Answers simple questions
Lack of understanding about some questions (what do chickens eat)
Doesn’t understand comparative words
Describe the clarity of speech in a 7 year old.
Clearer speech
Describe the sentences of a 7 year old.
Longer sentences
Describe the answers and questions of a 7 year old.
Able to understand & answer questions correctly
Still uses short answers
More aware of preferences and can reason why
Describe the clarity of speech of a 10 year old.
Speech quite easy to understand.
Describe the sentence structure of a 10 year old.
Complex sentences
Describe the answers and questions of a 10 year old.
More elaborate answers (more expressive)
More comfortable using language
More elaborate & confident reasoning
Understands preferences & can rank them in order
Can think/answer questions regarding hypothetical situations (superpowers)
Explain the physician’s role in understanding cognitive/language delays.
Encourage parents to share any concerns about child’s development or behaviour.
A prompt referral to pediatrician if development delay is present.
Early identification of developmental delays & timely early intervention can positively alter a child’s longterm trajectory.
What is middle childhood marked by?
Forming a coherent self-concept (more refined and realistic because of cognitive development, exposure to experiences and feedback)
Growing understanding of emotions
Major developments in peer relations
What is self concept?
Beliefs, attitudes that we have about ourselves in terms of skills and abilities.
Culture also has an influence.
Euro American children use personal references
Chinese children use social references
What is the early childhood (4-8 yrs) definition of “Who am I?”
Singular and concrete attributes and comparisons
“I am a boy/I have yellow hair”
What is the middle childhood (8-11 yrs) definition of ‘Who am I?”
Perceived personality characteristics & psychological qualities rather than physical appearance.
Self descriptions more abstract (smart, friendly)
More complex & differentiated (able to recognize strengths/weaknesses)
“I am funny/like to help people.”
Self concept vs self esteem?
Self concept is our self-description according to various categories, such as our external and internal qualities.
Self-esteem is an evaluative judgement about who we are.
What are characteristics of children with high self esteem?
Positive image of themselves Confident Easily make friends, not anxious with new people Solve problems on own/ask for help Proud of achievements Admit mistakes & learn from them Try new things, adapt to change
What are characteristics of children with low self esteem?
Negative image of themselves
Lack confidence
Hard to make & keep friendships, feel victimized
Lonely, isolated
Avoid new things/change
Can’t deal with failure
Not proud of what they achieve, think they could do better
Constantly comparing themselves in a negative way
What is emotional regulation?
The ability to monitor, evaluate and modify emotional reactions to accomplish goals.
Help children recognise their emotions
Validate the emotion
“Name it to tame it”
What happens regarding emotions in middle childhood?
Children are able to recognize emotions in themselves and others, control their own emotions & communicate about emotions. Most children have developed their capacity for regulating their own emotions.
What do children learn about emotions in middle and late childhood?
A single situation/event can lead to multiple mixed emotions.
Learn emotional display rules .
What does bullying behaviour involve?
An intentional act of aggression with the objective of causing physical, psychological or emotional distress to another
Disproportionate distribution of power, with the stronger individual/group abusing the weaker one
Behaviour pattern is repeated over time
Name physical health consequences of bullying?
Headaches, poor appetite, abdominal pain, sleeping problems, enuresis
What is enuresis?
Involuntary urination
What are the mental health implications of bullying?
Depression, self-harm, suicide, psychosis, anxiety, personality disorder
What are the societal problems caused by bullying?
School absenteesim, elective home education, poor employability, lowered income, drug use, offending behaviour
What are the four goals of a physician with regards to bullying?
1 - identify the problem
2 - counsel children, parents & school personnel on methods of intervention/prevention
3 - screen for, treat or refer to psychiatrists when symptoms for mental illnesses are present
4 - advocate for violence prevention in schools/communities
What are screening questions for bullying?
Why don’t you like school?
Do other children tease you at school?
At recess do you usually play by yourself?
How long have these things been going on?
Have you told the teacher?
