Lizzie Wortley and Stan Rom

Most of us have probably been asked by parents whether we have kids ourselves, and had varying responses to our replies.  

The comments from parents and colleagues will always continue, and we’ve all been part of an impromptu debate session – are you a better paediatrician if you are a parent?

My answer is that I’m a different paediatrician because I’m a parent.  I understand some things more, am interested in some different things, but my medical skills and knowledge are the same.  Maybe I have become the n=1 idiot that all those with a personal connection to their work are in danger of being.  

So, if you aren’t a parent, what should you know, and how can you inspire the kind of confidence in parents that male gynaecologists and slim bariatric surgeons give their patients? 

First off – this is an opinion-based piece and we’d love to hear your own thoughts.

Let’s be honest – parent or not, everyone has differing abilities to imagine the lives of others, and so for many this isn’t going to add anything new.  But we’re all prone to lapses of empathy sometimes and we ourselves are never going to cover every viewpoint.   The links and resources here are to help build up a knowledge base that goes beyond pathophysiology and hopefully stimulates some deeper thought about the role we play in the lives of our patients.  

Part two is a deep dive into parenting styles and modern lingo to help keep consultations on track.

 

Why do people even care if you have kids?

You don’t have to be a parent for very long before you end up upset, frustrated, or in awkward circumstances with well-meaning non-parent individuals who don’t seem to understand. Examples such as asking you for dinner ten days post-delivery, saying “of course you can bring them”, and getting upset when you say no.  It makes sense that this feeling is heightened at times of difficulty and therefore parents ask the question meaning “can you empathise with this”? 

Or maybe they don’t.  No one seems to have asked the question.  All I can find is a non-published (ie. non-peer reviewed) study that people pick paediatricians based on their communication skills.  

(Confused as to why dinner is hard?  Correct answer is to switch all social activities to daytime until new parent asks you for an evening activity.  Those that disagree see this)

 

So what is it that happens to people when they become a parent?

Basic biology makes becoming a parent anything from an accidental reality to a long, drawn out, complex, all-consuming mission that may end in being a parent to a child who doesn’t share your DNA. 

The first thing to understand with regard to that is that there is baggage around being a parent before they even are one. 

No one can share another’s experience and so conversations about how “precious” a child is are reductive.  But the way a parent acts, makes decisions, and responds to parenthood, potential harm/risk/illness in their child, and contemplates their future are likely to be coloured by experiences pre-conception and during pregnancy. 

Birth experiences and Early days:

After pregnancy comes the birth, where parents write birth plans and third-party groups encourage partners to be a woman’s advocate.   But we all know they can’t consent or refuse interventions for their partner.  Many couples come out of the birth experience confused about their intentions versus what really happened.  We know about postnatal depressionand postpartum psychosis.  But did you know paternal PND is also a significant problem?  

And matrescence (the process of becoming a mother) is equivalent, but less understood, than the changes of adolescence (both involve significant hormonal, body development, neurological and social/cultural shifts). 

This may lead to a few different interactions with you the “paed” – both parents need to come to terms with what happened as well as the consequences.  Subsequent increased or decreased health seeking behaviour, withdrawal, change in interactions etc aren’t necessarily pathological – it’s part of the shock of new parenthood.   However good the birth and however well-prepared people are, the reality of being responsible for keeping a tiny being alive is big – there is no equivalent.

Then comes the feeding up and downs but remember that even those choosing to formula feed probably have a story, and that many people struggle with “decisions” around feeding and can have a grief reaction to it with the impact lasting a lifetime.  Mothers assume they will be able to feed their baby, sometimes it’s a very fundamental visceral feeling and it can be a huge shock to come to terms with not doing so.  So please tread carefully there.  You really are walking in shattered dreams sometimes.  And we are part of the engine that encourages breastfeeding, but often can’t then practically support it.  

 

A touch of parenting know-how 

We have a whole other piece on parenting styles to come, but whilst you wait, there are some basics that are important for paediatricians, GPs and anyone interacting with parents to know.

Style aside it comes down to: oxytocin = good.  Adrenaline/cortisol = bad.  

Not quite that simple as need some minor stressors to socially and psychologically prepare for life outside the family, but excessively stressful environments for children are harmful.

Environment gets translated into hormonal and neurological responses that get ingrained as the bodies coping mechanism – impacting DNA imprinting, immune system and subsequent health and life outcomes.  

So whilst parents may not be able to control some elements of stress, they can know that cuddles, love, chatting about feelings, accepting no one can behave perfectly all the time etc are a big and vitally important part of being a parent.

If you haven’t heard of the first 1000 days or the ACEs study – now’s the time to get in the know. 

As Max Davie said in another paediatricFOAM piece – good parenting requires good parental physical and mental health – it is an exhausting task, so helping them know and feel how to be “good enough” is part of your role. 

 

Coping with an ill child and parental concerns

Being a parent is wonderful and shit scary at the same time. Yes there is lots of love and laughter and babies are designed to grab your attention, but so are lots of other things.

You still need a relatively clean house, clean clothes, food and all the other parts of Maslow’s hierarchy.   As a parent you also need to provide them for someone else.  Keeping employment when extra chaos and unpredictability has arrived is hard.  Our legal protection for parents exists, but it doesn’t stop some families losing income when their child is sick.    

“Chats about crazy hormonal new mums are just mean “

– imagine doing a marathon, having a painful procedure straight afterwards and then being put on nights with no recovery time.  Oh, and you’d still have to cover clinic in the daytime.  Hormones sustain life, allow pregnancy, maintain pregnancy, give birth and provide nourishment.  Hormones give parents their super-powers. 

A significant diagnosis or concern for a child plays havoc on a parents’ well-being, and even potentially their mental health.  There are emotions of guilt (should I have picked this up earlier? am I wasting everyone’s time?); grief for what they thought would be and now may not be; confusion in trying to understand what’s happening and what it means; difficulties in knowing how to protect their precious child from unnecessary hurt via the professionals, but also not wanting anything important missed, or things to get worse without treatment.  It is a fine line that not everyone is able to walk and we will see the best and worst of it.  

For everyone it is an internal struggle however well they seem to be coping.  Knowing that the emotions are contradictory and all over the place is important.  Knowing that they want to be strong and protective of the child, but also need their own time to have their own response to a diagnosis is also important.  Others have written about this much more sympathetically, knowledgably and expressively.   Take an interest in this – it will make you work much easier.  

Parents look to professionals to provide guidance and clarity on what is a hugely complex time and has natural peaks and troughs.

There is often no right answer, so hone your listening skills and unless you are hearing, seeing or presented with red flags, try and understand how easily the construct can crack when Illness, worry, mental health or money concerns upset the balance of home life.

In the same way that you don’t want to be reduced to whether or not having your own kids as a professional is important, parents should not be reduced to good/bad/lazy/difficult.  We are all of us more complex, more nuanced and more skilled than we can appear in fifteen minutes.  

 

Beware of:

Problems relating to sleeping and eating and appearing judgemental/prescriptive etc– they inspire a lot of emotions in parents.  No one is at their best without sleep, and just a few days can make one seem obsessive about it before it becomes the weeks and months of disrupted sleep most parents experience. 

 If you can find someone with a child who doesn’t sleep more than a few hours who isn’t talking about it to people – then you have found a rare individual. 

 Sleep “problems” become all-consuming for families – but it may not actually be abnormal.  Managing expectations is important.  (see resources)

Eating is another thing that feels fundamental as a parent.  I finally understood why parents got so antsy about ill children not eating, despite adults doing the same, when my 10-month-old got flu.  He didn’t eat more than two mouthfuls for 2-3 weeks.  Having very confidently told everyone who asked that it was normal during/after infections to be off food for a while, by week 2 or 3 I became the mum prowling the cupboards looking for something to tempt my child with.   I knew it was a bad habit to get into, and that it was probably fine.  But it takes a particularly resilient and stubborn individual to be able to stick to their knowledge-base in the face of constant questions from loved ones and an uneasy feeling in yourself.   

Remember – a lot of parenting advice takes time to take effect – it’s not immediate.  And it won’t lead to perfection.  

No one acts perfectly all the time, and yet so often as parents we expect our children to always be well behaved.  So there is plenty of time to doubt yourself (see breastfeeding, weaning, behaviour, learning any skill!) and it is in the moments of doubt that the moments of defensive certainty rise up.  We can all get defensive when we feel uncertain.  

Again – a reasonable comparator here is thinking about your own attempts to change – exercise, smoking, drinking or eating habits – the difference between your knowledge base and what you actually do. 

  

In Summary – whenever you are outside your “experience zone”:

• Somethings you won’t have experience in a problem, but your job is to help someone through it. 
• The following approach is one Stan takes for breast-feeding, but could be applied to many elements of life with children:
  • “I’ve never done it, but might I offer some insight from those who have successfully?”
    • Acknowledge your experience gaps
  • Your aim is to give a confidence boost at just the right time – boosting self-belief when it gets tough
  • Offer alternative routes if someone’s not doing so well (the successful management of a perceived failure)
  • Share in the struggle, don’t have people feeling they have to cope alone
  • Give permission to seek and share the responsibility for finding another way of doing things successfully (many people use professionals as their “permission” to change to a course they already know they want to take)
  • There is no single right way. The right way for the individual parent is the right way
  • You do this by matching the professional knowledge base with the parents need
  • We augment our internal and external resources over time by what parents share with us.  

Resources:

Fertility:

• Male perspective on  miscarriage:  https://www.motherpukka.co.uk/miscarriage-of-injustice-3/ (experience not advice)
• https://www.miscarriageassociation.org.uk
• https://www.tommys.org/pregnancy-information/planning-pregnancy/fertility-and-causes-infertility

Birth:

• Kiera knightly piece on birth (experience not advice)
• Swansea bf videos and normal baby
• the postpartum stress centre

Crying:

• Purple crying
• Our own piece on crying

Eating & weaning

• Infant and toddler forum
• Nhs weaning

Potty training – see below

• ERIC website (some resources need paying for)

Emotions and feelings

• Reading well who recommend book prescriptions for adults now has a child list
• Norfolk has great online resources to help
• Screentime rcpch

How might parents feel after diagnosis of chronic disability?:

• Welcome to Holland (experience not advice)
• Why its not always “welcome to Holland” (experience not advice)
• Attachment styles and the impact on the doctor-parent relationship

Sleep:

• ADC piece Mike Farquar
• Swansea youtube video

Adolescents:

• Association for Young People’s Health resources
• The Act for Health resources for parents and young people to understand what happens during adolescence, and therefore manage issues arising.  

Note – the resources in the resources section are NHS endorsed or have been used in training.  Other links are to sites explaining concepts etc – they still require critical appraisal by the reader.  These are the websites from which your parents are getting their information.

 

Join the debate on twitter @PaediatricFOAM or in the comments below.  

 

March 2020

 

Originally called – “How to be a paediatrician without being a parent”.  Title changed after the insightful comment below.