EI Talk: A Blog for Early
Childhood Professionals


Caring for Mothers and Children: a Holistic Approach

Early Childhood Interventions May 08, 2015

Perinatal depression. Many people, when they hear the term, are confused about its meaning. “Does it have to do with the baby blues? Is it the same as postpartum? What does the prefix ‘peri-’ mean?” Both this apparent lack of pertinent knowledge and the enduring stigma against mental illness contribute to the barriers parents face when this debilitating depression seeps into the joy that would usually surround the birth of their child.

A diagnosis of perinatal depression indicates that a parent experiences a major or minor depressive episode, or the milder but longer-lasting dysthymia, during the months of pregnancy and/or within a year after birth (Field, 2011). Although there may not be widespread awareness about the issue, perinatal depression is not an uncommon condition, with both mothers and fathers experiencing symptoms. More prevalent than its male counterpart, maternal depression generally affects anywhere between 5 to 25 percent of pregnant and postpartum mothers, with rates steeply escalating to the range of 40 to 60 percent in populations of low-income and teenage mothers (Knitzer, 2008). While studies show that several other factors can also increase a mother’s risk for perinatal depression, a few commonalities emerge amidst the research, including a personal or family history of depression, stress from life events and circumstances, a lack of social networks and support, difficulties with or absence of a partner, and repercussions of an unplanned or unwanted pregnancy (Field, 2011). Also undoubtedly appearing more frequently within the Latina population, maternal depression nevertheless occurs across all races and classes, and thereby influences family life in a variety of households (Le, Perry, & Stuart, 2011). With these consequences of maternal depression reaching far into numerous homes, it is crucial that we research any impacts that negatively affect children and implement programs that simultaneously support mother and child.

Because mothers experiencing perinatal depression often suffer from further medical symptoms and/or other external hardships at the same time, deciphering the direct effects of maternal depression on early development can be a difficult task. Nevertheless, many researchers have rigorously demonstrated that maternal depression increases a child’s risk for numerous different negative outcomes, both very early and later on in life. Several studies have shown that maternal depression is correlated with higher incidences of preterm delivery and low birth weight, both of which themselves can cause multiple complications for new babies as they develop (Field, 2011). The most commonly reported concerns of mothers experiencing perinatal depression are their infant’s excessive crying and disorganized sleeping patterns. These sleep problems can continue into childhood, along with other delays in cognitive, social-emotional, and behavioral development (Field, 2011; Earls, 2010). By decreasing a mother’s capability for positive interaction, attentiveness, and empathy with her child, perinatal depression can result in a child’s insecure attachment to their mother, which in turn can lead to the child’s later behavior problems (Earls, 2010). Depending on the gender of the child and the timing of the depressive episode, different research has found that maternal depression is associated both with externalizing behavior problems, like noncompliance and aggression, and with internalizing behavior issues, like anxiety and withdrawal, in preschool-age children. Similar findings demonstrate that perinatal depression even predicts a higher chance of these children later developing conduct disorder and major depression themselves (Field, 2011).

With such strong associations between perinatal depression in mothers and adverse

consequences for their children, one might think that the identification and intervention services for these populations would be equally as robust. Unfortunately, with several barriers to accessible treatment, including stigma, financial strain, and transportation difficulty, a large proportion of mothers diagnosed with perinatal depression obtain no mental health treatment (Le et al., 2011). Furthermore, as both Alvarez, Meltzer-Brody, Mandel, and Beeber (2015) and England and Simms (2009) point out, these services rarely integrate both parental mental health and children’s early intervention into one programs. Because developmental delays and perinatal depression are typically noticed and assessed in uncoordinated agencies (if at all), this disconnection ignores the “complex interplay” between the two factors (Alvarez et al., 2015). However, crafting comprehensive and creative approaches to simultaneously address both early child development and maternal mental health might offer numerous benefits for families, as some emerging initiatives have testified.

These programs have adopted myriad strategies to incorporate the alleviation of maternal depressive symptoms, the promotion of child well-being, and the improvement of the mother-child relationship. In Pittsburgh, Pennsylvania, for example, The Helping Families Raise Healthy Children Initiative fostered increased communication and collaboration between separate service agencies by hosting cross-system trainings and networking meetings (Schultz, Reynolds, Sontag-Padilla, Lovejoy, Firth, & Pincus, 2013). The initiative’s findings suggest that, with well-defined protocol, “screening for parental depression can be integrated into routine care in the…early intervention system” of the Individual with Disabilities Education Act (Schultz et al., 2013). Having already then established relationships between these early intervention specialists, behavioral health practitioners, and maternal health organizations, the initiative increased the rate of appropriate referrals made, which in turn nearly doubled the rate at which mothers attained treatment or families engaged in relationship-based practices.

Providing another strong example, Early Head Start, a federal “comprehensive family support and child development program,” is a major frontrunner in addressing maternal depression and its potential outcomes on children (Knitzer et al., 2008). With a growing number of Early Head Start programs successfully screening for maternal depression, Early Head Start concentrates on improving the mother-child relationship and enhancing parenting practices in their program. Utilizing home-visiting services allows Early Head Start the important opportunity to prevent or detect perinatal depression in mothers having trouble leaving their house due to transportation, mobility, or mental health issues (National Center on Parent, Family, and Community Engagement, 2013). Studies have shown that depressed parents participating in Early Head Start are more likely to lessen their depressive symptoms and to improve their parenting practices through more positive interactions and less harsh discipline. Meanwhile, compared to peers not enrolled in Early Head Start, their children demonstrate gains in vocabulary and engagement, along with decreases in aggression and negativity (Knitzer et al., 2008).

With trial initiatives and nationwide programs alike showcasing the possibilities for comprehensive care, it is clear that both mothers and children benefit from integrated services addressing perinatal depression and its possible detrimental outcomes. With the collaboration of community organizations, the continuation of screening practices, and the provision of home visits, it is time to support both mothers and their children in the way best suited to their needs.

References

Alvarez, S. L., Meltzer-Brody, S., Mandel, M., & Beeber, L. (2015). Maternal depression and early intervention: A call for an integration of services. Infants and Young Children, 28 (1), 72-87. doi: 10.1097/IYC.0000000000000024

Earls, M. F. (2010). Clinical report: Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. American Academy of Pediatrics, 126, 1032-1039. doi: 10.1542/peds.2010-2348

England, M. J. & Simms, L. J. (2009). Depression in parents, parenting, and children: Opportunities to improve identification, treatment, and prevention.Washington, D.C., National Academic Press.

Field, T. (2011). Prenatal depression effects on early development: A review. Infant Behavior and Development, 34, 1-14. doi: 10.1016/j.infbeh.2010.09.008

Knitzer, J., Theberge, S., & Johnson, K. (2008). Reducing maternal depression and its impact on young children: Toward a responsive early childhood policy framework. National Center for Children in Poverty, 2.

Le, H., Perry, D. F., & Stuart, E. A. (2011). Randomized controlled trial of a preventative intervention for perinatal depression in high-risk Latinas. Journal of Consulting and Clinical Psychology, 79 (2), 135-141.

National Center on Parent, Family, and Community Engagement. (2013). Family well-being: A focus on parental depression. Understanding Family Engagement Outcomes: Research to Practice Series.

Schultz, D., Reynolds, K. A., Sontag-Padilla, L. M., Lovejoy, S. L., Firth, R., & Pincus, H. A. (2013). Transforming systems for parental depression and early childhood developmental delays: Findings and lessons learned from the Helping Families Raise Healthy Children initiative. Santa Monica, CA: RAND Corporation.

Amber Rybnick
Georgetown University,
College, Class of 2016

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Walkers, Jumpers, Exersaucers: The Good, The Bad, The Ugly

Early Childhood Interventions April 13, 2015

Infant devices such as walkers, jumpers, and exersaucers are a frequent topic of concern in early intervention. These devices are widely marketed as helping promote a baby’s development and parents often feel they have to have them in order to meet their child’s needs. Additionally, some babies really seem to enjoy the time they spend in their devices. Research on the safety of these devices as well as on their effects on development, however, has not been as positive.

Walkers were originally developed to provide a means of mobility for exploration before a child learns to walk. DiLillo, Damashek, and Peterson (2001) found that parents use walkers and exersaucers for entertainment, perceived developmental benefit, and easy availability.

Concerns have arisen regarding the safety of these devices. Injuries have been reported related to the device itself such as pinching fingers and toes in device hardware and injuries caused because the child is more mobile. Increased mobility in these devices has led to burns when a child can maneuver close to a hot stove, poisonings when a child can bring themselves closer to cabinet sinks and other storage areas, and falls down stairs when a child gets too close to the edge (AAP 2001). Mandatory standards that were implemented in 1971 addressed the incidence of pinch injuries and, as a result, those injuries have decreased. Voluntary standards to address tip overs and falls were implemented in 1996, thus these injuries have decreased also.

However, providers should be aware that many families purchase these expensive devices from second-hand stores or receive them handed down from family members or friends and therefore, a provider cannot assume that the walker a child is using meets safety standards. The American Academy of Pediatrics recommends against the use of walkers entirely due to questions around the safety of the devices. The AAP recommends that when families choose to use a device, they should select one that does not roll (an exersaucer), however, they caution that data on injuries with these devices are not yet available.

Safety concerns have also been observed with jumper devices that hang over doorways. Concerns related to falls are common. There have also been incidents in which children gained too much momentum and swung into door frames. Generally, devices that remain stationary are recommended over the jumpers over doorways.

The infamous Bumbo® seat has been recalled several times for safety modifications. Children have been able to tip out of the Bumbo® leading to injuries. The current recommendation is that the parent or caregiver supervise the child in the Bumbo® at all times. Also, children should only be placed in a Bumbo on the floor. They should never be placed in the Bumbo ®on top of a counter, couch, or other surface.

The impact of these devices on a baby’s development is also concerning. Siegel and Burton 1999 found that babies who spent time in walkers sat, crawled, and walked later than the control group that did not use the devices. In addition, the babies in the walker group scored lower on the Bayley Scales of Infant Development-Mental and Motor, indicating that the devices may not have the positive impact on cognitive development as once thought.  Another study (Kauffman & Ridenour, 1977) showed that children who spent time in walkers were more likely to use abnormal patterns of movement such as tiptoe walking when first learning to walk. However, there are other studies that indicate that the use of walkers provide a child a means of independent mobility that promotes cognitive development through independent environmental exploration (Kermoian &Campos).

The best place for a baby to learn to move their body is on the floor. There, the baby can learn to use his or her own muscles to initiate movement. Seats that help support a baby in these devices do not require the muscles to work as hard and often place the baby’s hips in a position of excessive external rotation and abduction. In addition, when babies spend less time on the floor, they lose opportunities to perform skills such as crawling that develop trunk and upper body strength.

When families ask if it is ok to use these devices, always make sure they are aware of the safety concerns around the particular device they are using. It is best for the baby to play on the floor, but if a family’s routines indicate a device is necessary, it should be used in moderation. Parents should also be cautioned about the amount of time a child spends in a seating device such as an infant carrier or bouncer chair as these devices also inhibit a baby’s movement and can impede development. A general rule of thumb is that no more than 15-20 minutes of an infant’s day should be spent in infant devices. What explanation have you used to help parents understand this issue?

For more information:

American Academy of Pediatrics. (2001). Injuries associated with infant walkers. Pediatrics, 108(3), 790-792. http://pediatrics.aappublications.org/content/10J8/3/790.full

Kermoian R. & Campos JJ. (1988). Locomotor experience: a facilitator of spatial cognitive development. Child Development, 59: 908-917.

DiLillo, D., Damashek, A., Peterson, L. (2001). Maternal use of baby walkers with young children: recent trends and possible alternatives. Injury Prevention, 7, 223-227.

Kauffman, I.B., Ridenour M. (1977). Influence of an infant walker on onset and quality of walking pattern of locomotion: an electromyographic investigation. Percept Mot Skills, 45, 1323–1329.

Siegel, A.C., Burton, R.V. (1999). Effects of baby walkers on motor and mental development in human infants. J Dev Behav Pediatr, 20,355–361.

 

— Jamie Holloway

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What Does Early Intervention Have to do With School Suspension?

Early Childhood Interventions April 01, 2015

Greater, Greater Washington featured an article highlighting the suspension of children from pre-kindergarten classes and how local early intervention and special education services may be part of the solution.

According to a report from the Office of the State Superintendent of Education (OSSE), 181 children in DC public and charter pre-kindergarten classes were given out-of-school suspensions in 2012-2013. (Note: This is just for certain types of suspensions required to be reported to the federal government. The actual number of pre-kindergarten suspensions was likely much higher.) A similar report from DC Lawyers for Youth found that one DC charter school pre-kindergarten program suspended more than 10% of their students in 2011-2012. Often, children are suspended for offenses like temper tantrums, toileting incidents and other developmentally appropriate behavior for 3- and 4-year olds.

The Greater, Greater Washington reporter raises the question of whether some of these suspensions may be due to undiagnosed disabilities and special needs. These young children may have significant developmental needs that cannot be adequately addressed by 1 teacher in a classroom of 15 or 20 students unless she is provided with support.

Ideally, children with special needs should be identified prior to starting pre-kindergarten, through the city’s Strong Start , DC Early Intervention Program or Early Stages, the DC Public Schools Child Find program. Eligible children can then receive supportive services at home and in school. But many children are not being identified early enough or may not qualify for services despite their challenges. Despite expanding the eligibility requirements for the DC Early Intervention Program and increasing access to eligibility evaluations for preschool through Early Stages, many are still unaware of these supports and services for children who have developmental delays or disabilities.

DC is poised to further expand access to services for young children with developmental delays and disabilities, by lowering the threshold for developmental delay. New legislation will require Strong Start, DC Early Intervention to lower the eligibility requirements and to decrease the evaluation time for determining eligibility for pre-school special education through the DC Public Schools.. While there are some questions about Strong Start DC’s or the DC Public School’s ability to handle the potential influx of newly eligible children, we can all agree that identifying children in need of early intervention services or preschool special education services earlier and getting them the support they need will benefit DC’s children and schools. There are few reasons why a 4-year-old should be suspended, but many reasons why the child and their family may need extra support to succeed in pre-kindergarten and beyond.

Lindsay Ferrer GU Certificate in Early Intervention Student

References:

Rothschild, A. (2014, September 22). Wondering why a preschooler would ever need to be suspended? Here’s an explanation. Greater Greater Washington. Available at http://greatergreaterwashington.org/post/24282/wondering-why-a-preschooler-would-ever-need-to-be-suspended-heres-an-explanation/

District of Columbia, Office of the State Superintendent of Education. (2014). Reducing out-of school-suspensions and expulsions in the District of Columbia and Public Charter Schools. Washington, DC: Author Available at http://osse.dc.gov/sites/default/files/dc/sites/osse/publication/attachments/OSSE_REPORT_DISCIPLINARY_G_PAGES.pdf

DC Lawyers for Youth (2014). District discipline: The overuse of school suspension and expulsion in the District of Columbia. Washington, DC. The Every Student Every Day Coalition. Available at http://d3n8a8pro7vhmx.cloudfront.net/dcly/pages/64/attachments/original/1371689930/District_Discipline_Report.pdf?1371689930

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iGood, the iBad, and the iUgly of Screen Time for Young Children

Early Childhood Interventions March 02, 2015

When I was a youngster we had two screens in our house: a television screen and the screen door. Now with computers, laptops, iPods, iPads, iPhones, and everything else that begin with the letter “i” in its name, screens are ubiquitous in our children’s lives.

I could not believe my eyes as I watched my 4 year old cousin unwrap her touch screen cellphone Christmas morning of last year. Unfortunately for her she is unable to make quick phone calls during circle time, for the device does not have a service plan, it is only wifi enabled. But that does not stop her from taking selfies all day long. Although she cannot read yet, I find that since she started tapping away on her touch screen device her digital literacy has increased tremendously. She can associate the symbols of the ‘back’ button to their corresponding functions.

Clearly, young kids find electronic devices engaging. But what happens when you put one of these devices in the hands of a child under the age 2? Here is the iGood, the iBad, and the iUgly of these media devices; and the actions professionals suggest parents take to make sure their children get only the iBest out of their media experiences.

Sandra Calvert the Director of Georgetown University’s Children’s Media Center (http://cdmc.georgetown.edu/) reports that four major tends have emerged from the research undertaken over the last decade on children’s use of media:

  1. there is an increasing amount of child oriented media available,
  2. there is an increase in the development and use of media for very young children (under 2 years of age),
  3. there is an increase in multitasking even for young children, and
  4. interactive media platforms are easier to use even for very young children.

We all recognize that media is here to stay but what does the research say about young children’s use of media. According to Common Sense Media (2011):

  • 65% of children under 8 watch TV every day. Preschoolers average 2 hours/day.
  • 66% of children under 2 are exposed to TV content.
  • 30% of 6 month-24 month old infants and toddlers have a TV in their room. This suggests that very young children are watching video content alone.
  • 37% of children under 2 are exposed to screen media every day.
  • 21% of children use 2 use a computer (calvert, Rideout, Woolard, Barr, & Strouse, 2005)

According to PBS (2014) 18% of infants and toddlers spend the day watching either videos or DVDs. In fact, children of this age group spend double the amount of time with screens as they do reading books (PBS, 2014). That is too much Sesame, and not enough Seuss.

The American Academy of Pediatrics advises against screen time for infants and toddlers under the age of 2. Physicians believe that children learn best when interacting with people, not iPods. But in this age of ubiquitous media use is this realistic or even necessary? The key to media use as a benefit to young children is how it is used. And like all toys or tools young children benefit from their use when they are used interactively with another person. It seems no matter what—children still learn best person to person even if media is incorporated into the interaction.

A series of studies showed how 2 year olds find it challenging integrating information from a video and applying it to real life situations (Troseth, 2006). On the other hand, Troseth Has also found that Skype may actually be beneficial. Although a Skype call does include a screen, there is an active component to the call and the active interaction between the child and who is on the screen can be beneficial to a child’s development. Troseth believes that Skype calls, with a parent or grandparent, show children that what is on the screen is connected to their lives and builds upon social interaction (HU, 2013).  Thus, beneficial screen time includes an active interaction in real time with another person.

Other research (Calvert, Richards, Kent, 2014) indicates that when toddlers are exposed to media characters who were personalized they learned more from those characters than the non-personalized ones. The children exposed to the personalized characters also showed more parasocial, nurturing behaviors during play sessions,

Although adults are encouraged to interact with young children without electronic devices, the reality is that young children are growing up in the digital age and they find these devices attractive. So can parents call on technology to support development? According to National Association of the Education of Young Children (NAEYC) we should “allow children to explore digital materials in the context of human interactions, with an adult as mediator and co-player” (NAEYC). Too often, children are using the technology in isolation. Too often, parents are using the technology as a “teacher” not as a tool to assist the parent as teacher.

The National Association for the Education of Young Children and the Fred Rogers Center has developed a list of ways parents can use media to engage with their children:

  • Use a digital camera or computer to show images and video of family, friends, animals, or events to children, especially when children might not otherwise have exposure to them. Talk to the child about the pictures, who the people are, the sights, etc.
  • Treat the experience of reading an e-book the same as reading a print book: put the child in your lap, point to objects on screen, talk with the child, and introduce new vocabulary.
  • Video chat with a loved one.

So—what about children with disabilities? How does this research apply to children with disabilities? What do you think? What does your experience tell you? How do you coach families to use assistive technology? Does the AAP recommendations hold-up? If my 4 year old cousin is typical, then screens are here to stay—How do we control the screen?

Let’s start a dialogue! 

References

Calvert, S. L., & Wartella, E. A. (2014). Children and electronic media. In E.T. Gershoff, R.S. Mistry, D.A. Crosby (Eds.).Societal contexts of child development: Pathways of influence and implications for practice and policy, (pp.175-187), New York: Oxford University Press.

Calvert, S. L., Richards, M. N., & Kent, C. C. (2014). Personalized interactive characters for toddlers’ learning of seriation from a video presentation. Journal of Applied Developmental Psychology35(3), 148-155.

Calvert, S.L., Rideout, V.J., Woolard, J.L., Barr, R.F. & Strouse, G.A. (2005). Age,

ethnicity, and socioeconomic patterns in early computer use: A national survey.

American Behavioral Scientist, 48, 590-607.

Common Sense Media. (2011, October 25). Zero to Eight: Children’s Media Use in America. Retrieved October 13, 2014. 

Hu, E. (2014, October 28). What You Need To Know About Babies, Toddlers And Screen Time. Retrieved October 13, 2014. 

PBS. (n.d.). TV and Kids under Age 3. Retrieved October 13, 2014. 

Technology and Young Children | National Association for the Education of Young Children | NAEYC. (n.d.). Retrieved October 13, 2014. 

Troseth, G., Saylor, M., & Archer, A. (2006). Young Children’s Use Of Video As A Source Of Socially Relevant Information. Child Development, 786-799.  

Walter Kelly,
Georgetown University, COL’16

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