Vasha was ready for her child to be born. She had picked a
name – Terrance. It was a name she had always liked, and pre-natal ultrasounds
had revealed that her child was a boy. Vasha went into the hospital for a
relatively easy delivery.
It became apparent that Terrance was not like most babies.
In fact, what Terrance’s birth revealed was that she had been wrong about her
lack of alcohol consumption during the first weeks of pregnancy. First,
Terrance’s delivery was relatively easy because his birth weight was low.
Additionally, he presented with some facial abnormalities that were a clear
indication of FASD.
Vasha was at once overjoyed at the birth of her son and also
had a sense of incredible guilt with regard to Terrance’s challenges. Vasha
could feel herself spiraling downward into a depression as the reality of the
situation sunk in. She wasn’t sure she could do back to AA – it was too much a
reminder of her past and of her responsibility for having done this to her
child. She didn’t know what to do.
* What happens when a child is born with FASD? Is there
anything unique about the postpartum process given the observable disabilities
that were apparent with Terrance? Are further tests typically done to ensure
that there are no other issues with internal organs, etc.?
* Outline the typical developmental milestones for newborns
and infants in their first year. How are babies born with FASD likely to approach
those milestones?
* What are the recommended immunizations for newborns? What
immunizations are typically provided just after birth? Which ones in the first
year? How frequently should the newborn visit the pediatrician in terms of what
is recommended? What is the M-CHAT and when is it given to parents? Outline
Terrance’s first year in terms of doctor visits. Provide rough information as
to the fees associated with these visits. How does Terrance’s FASD affect these
visits and the associated costs?
* What is postpartum depression? What is the prevalence of
the disorder? How is it typically treated? What resources might be available to
Vasha in terms of self-care? What is the effect of postpartum depression on
parent-child attachment?
* With regard to FASD, what publically available services
are there to support a newborn with FASD?
DECISION POINTS :::
Does Vasha return to AA? How does Vasha decide to manage her
depression?
* What happens when a child is born with FASD? Is there anything unique about the postpartum process given the observable disabilities that were apparent with Terrance? Are further tests typically done to ensure that there are no other issues with internal organs, etc.?
ReplyDeleteThere are several medical problems that children are born with when they suffer from Fetal Alcohol Spectrum Disorders (FASD). According to the medical website, WebMD, children that are born with FASD are more likely to have “brain and spinal cord damage” (WebMD, 2012). Other characteristic features that FASD children are born with include facial abnormalities, low birth weight, birth defects, and learning and behavior problems (WebMD, 2012). Some examples of facial abnormalities that FASD children can have include: “low nasal bridge, droopy eyelids, wide set eyes, ear abnormalities, short up-turned noses, extra folds of skin close to nose, and cleft lip” (Kids to Adopt, 2012). Other health problems and birth defects that FASD children can have include: “kidney problems, joint problems, hearing impairments, genital deformities, visual impairments, and heart defects” (Kids to Adopt, 2012).
After the postpartum process there were some unique qualities that Terrance possessed that were indicative of FASD. Terrance’s low birth weight and distinct facial abnormalities were among some of these unique qualities. Due to the increased chance of kidney and heart problems in children with FASD, further medical evaluations and interventions may be enabled.
* Outline the typical developmental milestones for newborns and infants in their first year. How are babies born with FASD likely to approach those milestones?
ReplyDeleteWithin the first year of life, newborns and infants reach several developmental milestones. At the end of the first month, newborns can “lift their head momentarily, clench their hands, and follow moving objects with their eyes.” After a month newborns can also “see black and white patterns, cry to express displeasure, and recognize their parents.” (American Pregnancy Association, 2012)
At the end of the second month, newborns typically “lift their head while laying down, visually search for sounds, and vocalize to familiar voices.” After the second month, newborns also “make noises other than crying, cry more distinctively to indicate when wet or hungry, and demonstrate smiling in response to various stimuli.” (American Pregnancy Association, 2012)
By the end of the third month, infants can typically “bear partial weight on both legs when held in a standing position, hold their head upright, and bear weight on their forearms.” After the third month, infants can also typically “hold and clutch onto objects, follow objects 180 degrees, and locate the direction of sounds.” Another typical milestone for the third month is that infants tend to “coo and babble when spoken to.” (American Pregnancy Association, 2012)
By the end of the fourth month, infants typically “begin to drool, have good head control, sit with support, and roll from their back to side.” Within the fourth month, infants also “explore with their hands, reach and grasps for objects, and make consonant sounds.” The fourth month is also when an infant’s “eye-hand coordination and laughing begins.” (American Pregnancy Association, 2012)
At the end of the fifth month, infants “begin teething, holding their head up while sitting, rolling from their stomach to back, and voluntarily grasp objects.” Infants that are five months old are also known to “play with their toes, take objects directly to their mouth, determine family members from strangers, and discover the different parts of their body.” (American Pregnancy Association, 2012)
At the end of the sixth month, infants typically start to “chew and bite, bear the majority of their weight when being held in a standing position, and adjusts body to see objects.” Other developmental milestones of six month old infants are their ability to “say one syllable sounds, and recognize their parents.” (American Pregnancy Association, 2012)
* Outline the typical developmental milestones for newborns and infants in their first year. How are babies born with FASD likely to approach those milestones? (CONTINUED)
ReplyDeleteBy the end of seven months, infants are able to “sit without support, bear full weight on their feet, bear weight on one hand when lying on their stomach, and transfer objects from one hand to another.” Infants at this age are also able to “respond to their name, have depth and visual awareness, and attempt to communicate while others are talking.” (American Pregnancy Association, 2012)
At the end of eight months, infants typically begin to develop fine motor skills of “picking up and releasing small objects, and pulling on strings to obtain objects.” Other developmental milestones of eight month olds includes: “selectively listening to familiar words, combing syllables to form very small words, and understanding the word ‘no’.” (American Pregnancy Association, 2012)
By nine months of age, infants “begin to crawl, pull themselves up into standing positions, and respond to simple verbal commands.” Infants at this age also “may develop a preference for using one hand over the other, and have an increased interest to please their parents.” (American Pregnancy Association, 2012)
By ten months of age, infants have more control of their balance while standing or sitting. Infants at this age also begin to talk by saying small words like “mama, dada, hi, bye, no, and go.” During this month, “object permanence” also begins to develop. (American Pregnancy Association, 2012)
By the end of the eleventh month, infants are typically able to “walk while holding furniture or other stable objects, explore and manipulate objects more thoroughly, and follow small commands” (American Pregnancy Association, 2012).
By the end of twelve months, infants are typically able to “walk with one hand held, stand alone, sit down without assistance, and say three or more words.” Other developmental milestones of this month include: “comprehending the meaning of several words, repeating words or imitating sounds, recognizing objects by name, show affection, and show independence in familiar surroundings.” (American Pregnancy Association, 2012)
In contrast to the typical developmental milestone patterns of healthy babies, FASD babies approach these milestones very differently. According to an encyclopedia reference of fetal alcohol syndrome, newborns and infants with FASD have “delays in achieving developmental milestones such as rolling over, crawling, and walking and talking” (Seaver & Odle, 2006). Some other difficulties that may occur include “irregular sleep-wake cycles, decreased or increased muscle tone, and seizures or tremors” (Seaver & Odle, 2006).
* What are the recommended immunizations for newborns? What immunizations are typically provided just after birth? Which ones in the first year? How frequently should the newborn visit the pediatrician in terms of what is recommended? What is the M-CHAT and when is it given to parents? Outline Terrance’s first year in terms of doctor visits. Provide rough information as to the fees associated with these visits. How does Terrance’s FASD affect these visits and the associated costs?
ReplyDeleteThe recommended immunizations for newborns are the hepatitis B (HepB), rotavirus (RV), diphtheria (DTaP), haemophilus influenzae (Hib), pneumococcus (PCV), and polio (IPV). Hepatitis B is typically provided just after birth and then given in two other doses. In the first year the baby should be given in addition to HepB, RV, DTaP, Hib, PCV, IPV, Measles (MMR), Chickenpox (Varicella), and hepatitis A (HepA) ("2011 child &," 2011). Newborns are recommended to see their pediatrician within the first 24-48 hours of birth and then at 2 weeks old. Doctors then like to see infants at regular intervals to monitor their growth, development and health. Most infants are seen when they are 2, 4, 6, 9, 12, 15, 18 and 24 months old (Eden & Eden, 2012). The M-CHAT, The Modified Checklist for Autism in toddlers, is given to parents to assess risk for Autism Spectrum Disorders following an assessment with a doctor. It is a list of questions concerning the behaviors of your child indicating whether there are signs of ASD (Robins, 1999).
Terrance was born with Fetal Alcohol Syndrome, a condition that occurred due to his mother’s consumption of alcohol during her pregnancy. There is no cure for FAS but it has been shown that early intervention treatment services can improve a child’s development. During Terrance’s first year he will have the same baby care, vaccinations, good nutrition as a child without FASD. However, concerns specific to the disorder must be monitored and addressed by either the pediatrician or referral to a specialist. Depending on Terrance’s symptoms he might need to visit physical therapists, occupational therapists, plastic surgeons, speech-language pathologists, audiologists, dysmorphologists, otolaryngologists, and/or geneticists etc ("Fetal alcohol syndrome," 2011). Depending on whether or not Vasha is Terrence’s primary care giver or someone else, they will need to be extremely educated on the care and costs for Terrance’s needs. It is estimated that the cost of a child over a lifetime with fetal alcohol syndrome is $2 million dollars. Terrance’s FASD affects theses visits and the costs are dependent on the types of specialists he goes too, the time spent, the services provided and insurance (Vaux, 2010).
* What is postpartum depression? What is the prevalence of the disorder? How is it typically treated? What resources might be available to Vasha in terms of self-care? What is the effect of postpartum depression on parent-child attachment?
ReplyDeletePostpartum depression (PPD) is a moderate to severe depression that is triggered by childbirth. Postpartum depression can start any time after delivery but typically begins after 2 to 3 weeks and does not go away quickly (KidsHealth, 2010). The symptoms for PPD are indistinguishable with depression occurring at other times (National Center for Biotechnology Information [NCIB], n.d.). However, thoughts of hurting the baby, of hurting oneself, and not having any interest in the baby may also be included (Massachusetts General Hospital [MGH] Center for Women's Mental Health, 2008). Postpartum depression will not go away on its own and therefore will need to be treated by a doctor.
Although PPD is thought to be brought on by rapidly changing hormone levels after childbirth, there are several risk factors that my increase the likelihood of developing postpartum depression (NCIB, n.d.):
Are under age 20
Currently abuse alcohol, take illegal substances, or smoke
Did not plan the pregnancy, or had mixed feelings about the pregnancy
Had depression, bipolar disorder, or an anxiety disorder before your pregnancy, or with a previous pregnancy
Had a stressful event during the pregnancy or delivery, including personal illness, death or illness of a loved one, a difficult or emergency delivery, premature delivery, or illness or birth defect in the baby
Have a close family member who has had depression or anxiety
Have a poor relationship with your significant other or are single
Have financial problems (low income, inadequate housing)
Have little support from family, friends, or your significant other
The estimated prevalence rate of postpartum depression varies according to the source. It may be difficult to get an accurate number because Insel, (2010) documented that postpartum depression isgenerally under-recognized and under-treated. The estimates varied between 7 and 20 percent. More specifically several sources estimated the following prevalence rates:
7 to 13 percent (Insel, 2010)
10 to 15 percent (MGH Center for Women's Mental Health, 2008)
9 to 16 percent (American Psychological Association [APA], n.d.)
10 to 20 percent (Mental Health America [MHA], n.d.)
15 to 20 percent (Postpartum Support International [PSI] n.d.)
It is also documented (PSI, n.d.) that the percentages are even higher for women who are also dealing with poverty, and can be twice as high for teen parents.
Postpartum depression is typically treated with therapy/counseling, medication or a combination. The type of treatment and recovery time is based on the severity and type of symptoms present (MGH Center for Women's Mental Health, 2008 & Mayo Clinic, 2010) and should be adapted to the needs of the individual. Treatment must continue even after the depression subsides to avoid a relapse.
* What is postpartum depression? What is the prevalence of the disorder? How is it typically treated? What resources might be available to Vasha in terms of self-care? What is the effect of postpartum depression on parent-child attachment? (CONTINUED)
ReplyDeleteEven though postpartum depression should be treated by a professional, there are several resources which might be available to Vasha in terms of self-care. Eat a healthy diet, exercise, and avoid alcohol. Furthermore, the following suggestions have been found helpful (KidsHealth, 2010):
Take time for yourself. Schedule a babysitter for a regular time. This way you'll be sure to get time for yourself and know that it's coming.
Focus on little things to look forward to during the day. This might be a hot shower, relaxing bath, walk around the block, or visit with a friend.
Read something uplifting. Since depression may make it difficult to concentrate, choose something light and positive that can be read a bit at a time.
Indulge in other simple pleasures. Page through a magazine, listen to music you enjoy, sip a cup of tea.
Be with others. Create opportunities to spend time with other adults, like family and friends, who can provide some comfort and good company.
Ask for help. Don't shy away from asking for emotional support or help with caring for the baby or tackling household chores.
Accept help. Accepting help doesn't make you helpless — by reaching out you help yourself and your baby.
Rest. Give your child a quiet place to sleep, and try to rest when the baby does.
Get moving. A daily walk can help lift mood.
Be patient. Know that it may take time to feel better and take one day at a time.
Be optimistic. Try to think of small things you're grateful for.
Join a support group. Ask your doctor or women's center about resources in your community.
There are also a multitude of books, websites, and on-line resources that focus on postpartum support and education. However, if at any time Vasha has thoughts of harming herself or the baby, she should immediately give the baby to a trusted individual and call 911.
The effect of postpartum depression on parent-child attachment is that if left untreated, postpartum depression can lead to the decreased ability of the mother to correctly or consistently respond to the child’s needs and cause them to interact less with their child thereby developing an insecure attachment. When a child is insecurely attached, they are at risk for multiple developmental difficulties and delays. Several studies have shown that the more depressed a new mother is, the greater the delay in the infant’s development (MHA, n.d.). The following are examples of possible developmental issues that the child may encounter due to the mother’s postpartum depression (APA, n.d. & Mayo Clinic, 2010):
behavioral problems such as sleeping and eating difficulties, temper tantrums and hyperactivity;
problems in cognitive, social, and emotional development;
become withdrawn, irritable, or inconsolable;
have a higher risk of anxiety disorders and major depression in childhood and adolescence;
delays in language development
* With regard to FASD, what publically available services are there to support a newborn with FASD?
ReplyDeleteA newborn with FASD would be eligible for services under Part C (Early Intervention) of the Individuals with Disabilities Education Act (IDEA) since they have a high probability for having developmental delays. Even though there is no cure for FASD, research has proved that early intervention services would be a great benefit (Centers for Disease Control and Prevention [CDC], n.d.). According to the National Dissemination Center for Children with Disabilities (2011), these services would address the development of skills for typically developing children such as physical, cognitive, communication, social/emotional and self-help.
* Decision Points: Does Vasha return to AA? How does Vasha decide to manage her depression?
ReplyDeleteSoon after Vasha’s depression had sunk in and she was feeling the lowest of the lows, the first thought that came to her mind, was that she could really use a drink. This was the moment she had to make one of the most important decisions of her life: pick up the bottle, or pick up her car keys and head straight to AA. She knew going back to AA would be hard, having to sit through discussion after discussion about alcohol and its affects it can have on one’s personal life. But would any of the other members there really know what it was like to have to watch their own child be born with FASD knowing that it was solely their own fault that harmed their baby, potentially for the rest of their child’s life?
Vasha knew that it was the right thing to do, so she decided to pull herself up by her bootstraps and go to that week’s AA meeting. There she met with a fellow member, 24 year old Sarah, who also had given birth to a child with FASD, 3 years ago. Sarah’s story was strikingly similar to Vasha’s own. This was the factor that allowed Vasha to feel like this group of people at AA really did relate to her, and wanted to help her overcome this obstacle that had caused such a heartache to her and her newborn child. She decided to stick through it, attend the meetings every chance she got, not just for her, but for Terrance as well.
Now that Vasha had made the first steps to bettering herself, and made a new friend and confidant at AA; it was time to focus on the other elephant in the room, her postpartum depression. At first Vasha was in denial that this could really be as big of an issue as it was, but day after day, she realized that she wasn’t the person or mother, that she intended to be. That’s when she spoke to Sarah about her fears of possible harming Terrance, even more than she already has through her drinking. Sarah recommended that she should research postpartum depression.
Vasha did just that, and realized that it explained her symptoms to a T. The feelings of “anxiety, irritation, tearfulness, and restlessness, agitation, changes in appetite, feeling worthless, guilt [for causing this harm on her own child], loss of concentration, loss of energy, problems staying focused, negative feelings toward her baby, trouble sleeping, an inability to care for herself or her baby, being afraid to be alone with her baby, and worrying intensely about the baby (Merrill & Zieve, 2010)” were all consistently there. She presented all of the risk factors that were stated, “being under [or] 20 years old, currently abused alcohol, did not plan the pregnancy, has a poor relationship with the significant other or are single, and has financial problems (Merrill & Zieve, 2010).”
Vasha decided to go to her doctor, and he referred her to a mental health therapist. This is when she started to attend regular “Cognitive Behavioral Therapy and Interpersonal therapy, which are both types of talk therapy (Pearlstein, 2009).” Vasha’s doctor decided to avoid resorting to the medications that are available for postpartum depression which include “paroxetine, sertraline, and nortriptyline (ACOG Committee, 2008)”, due to her past history of drug abuse.
With both the AA meetings, her new friend Sarah to help talk her through some of the issues, and the talk therapy for overcoming her postpartum depression, Vasha finally feels like she is doing some good in her life. This good is not only for her, but for Terrance’s future as well, and will work as hard as she can every day to help him with his FASD.
References
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