Prepping for new babies in the family

If I were only to give a few bits of advice to families preparing for a new baby, while physical health problems in the mother or child are the biggest concerns of prospective parents, my coaching also would be aimed at safeguarding relationships in the new family constellation.

I find that having a prenatal visit at least by 34 weeks’ gestation for first-time parents is invaluable to getting to know them so that you are not a stranger after delivery and you can communicate more effectively if there are difficulties.

As for other topics that may not seem like a topic to be raised with a pediatrician, pregnancy fears may need to be prompted. You might say, "Most mothers in the second trimester have scary dreams about their future baby. Has this happened to you?" This gives parents a chance to express concerns, often about birth defects, but sometimes about how they or their partner will be caring for the baby. This can be a chance to ask about how the pregnancy has affected their relationship so far, and how they hope it will change once the baby comes.

The prenatal visit is a time to inform parents about practical matters such as your office’s practices regarding on call, insurance, your website, and the expectation for previsit questionnaires. After taking pregnancy and family histories, the other main topics are plans for circumcision and breast-feeding. This is the time for recommending prenatal labor and delivery classes for both fathers and mothers.

Possibly the most important topic for prospective parents, however, is quite different from these issues so clearly related to health – it is about building relationships. Fathers can be easily engaged on the topic about whether to circumcise or not, but having fathers sign on to supporting breast-feeding may not seem as obviously important. Not only do some couples have low comfort in talking about or exposing the mother’s breasts, but some fathers are even possessive of them and unwilling to share with the baby. A discussion about how the father can be the one to bring the baby from the crib for the middle-of-the-night breast-feeding and then burp, change, and return the infant to the crib is a way to support the (exhausted) mother.

Fathers need to know how important their help and support are to the new mother. Mothers need to be heard by the father (and anyone else who will listen) about their fears and pain during delivery, for as many times as it takes. He needs to tell her how brave she was and how grateful he is. Our son bought his wife a "push present" to acknowledge this marathon achievement!

Fathers also need to understand that things don’t just go back to "normal" once the baby has arrived. The support of the father at this special time is symbolic to the mother of the future of their relationship. I can’t tell you how many mothers, disgruntled with their marriages years into parenting, will call up examples of lack of support in the newborn period as the beginning of the deterioration of their relationship. The mother is exhausted from the well-termed "labor," literally and figuratively "drained" by breast-feeding and the interrupted sleep of the first months. She needs her partner to step up with both hands to help – and express sympathy – to show that he is part of the new parenting team.

I think it is important to emphasize that relationships do change – have to change – when a baby arrives. This can be a coming-together in sharing the chores as well as joys of parenting, or a splintering from lack of the communications co-parenting requires. Egocentricity that sufficed in a marriage without children no longer works when the exponential increase in life demands begins. Lack of social support is the number one risk factor for marital discord and child behavior problems; the main social support in American families is the spouse/partner. A golden rule for each parent to follow is, "Ask what you can do to help."

Other supports in addition to the spouse/partner are important, too. To start this topic you might ask: "How are you going to involve others in and out of the family with this child?" There is a need for both engagement and sometimes limit-setting on others that can be a new kind of task and stress for the couple. The task may involve at first negotiating visits and time with grandparents from each side versus privacy for the parents, then later determining family dietary practices for the new child as she grows; compromising on cultural discipline styles; deciding on how religious practice will be conveyed or not; and even setting limits on toys and gifts.

I encourage parents to engage commitment from other, unrelated adults as "godparents" as an important adjunct to biological family support. This can be especially useful for small or isolated families or those distancing themselves from their own relatives. Such early engagement can begin a lifelong bond that provides both the parents and child significant support over the years. In the case of future divorce (greater than 50%) or death of a parent, a godparent becomes an even more valuable source of stability.

For parents having their first child, the advice is much different than for families having a second child. For second-time parents, I am sometimes asked about when to tell the siblings about sleeping arrangements or how to ease the change when a new baby is coming. But one special opportunity to foster a positive relationship between the siblings occurs in the narrow window between the time of telling the child (second trimester is probably best due to the high rate of early miscarriage) and the birth. This is a time current children can attend so-called "sibling preparation" classes. Along with a strong relationship with the father, expression of empathy, optional involvement in caring for the baby, avoidance of gory details of the delivery and not forcing photos, attendance at these classes has been shown to improve sibling adjustment to the baby.

Parents who can’t take the older child to a sibling class can follow some of the principles themselves. The important points are to tell the sibling that a new baby is coming "because we love children," not as a playmate (since they are not much fun for a long time); that babies cry and sleep and spit up a lot in the beginning (realism), but eventually will be able to smile and play; and especially that "we (the parents) took care of you when you were little, and we will do the same for this baby." A review of the older child’s baby pictures can be a good way to start the conversation.

Siblings who are told in strong ways about the new baby’s point of view (Boy, he sure is hungry! Hungry enough to scream!) have more positive relationships later. While some behavioral regression (50%) and jealousy are common, most children quickly come to care about their new baby, and become loving, protective, and the best playmates and models for new skills a child ever has.

Finally, don’t forget to recommend daily "special time" for each parent with the older child(ren) starting prenatally and continuing forever, to reduce jealousy and provide reassurance that he is still loved no matter who else joins the family!

Dr. Howard is assistant professor of pediatrics at the Johns Hopkins University, Baltimore, and creator of CHADIS (www.CHADIS.com). She has no other relevant disclosures. Dr. Howard’s contribution to this publication was as a paid expert to Frontline. E-mail her at pdnews@frontlinemedcom.com.

If I were only to give a few bits of advice to families preparing for a new baby, while physical health problems in the mother or child are the biggest concerns of prospective parents, my coaching also would be aimed at safeguarding relationships in the new family constellation.

I find that having a prenatal visit at least by 34 weeks’ gestation for first-time parents is invaluable to getting to know them so that you are not a stranger after delivery and you can communicate more effectively if there are difficulties.

As for other topics that may not seem like a topic to be raised with a pediatrician, pregnancy fears may need to be prompted. You might say, "Most mothers in the second trimester have scary dreams about their future baby. Has this happened to you?" This gives parents a chance to express concerns, often about birth defects, but sometimes about how they or their partner will be caring for the baby. This can be a chance to ask about how the pregnancy has affected their relationship so far, and how they hope it will change once the baby comes.

The prenatal visit is a time to inform parents about practical matters such as your office’s practices regarding on call, insurance, your website, and the expectation for previsit questionnaires. After taking pregnancy and family histories, the other main topics are plans for circumcision and breast-feeding. This is the time for recommending prenatal labor and delivery classes for both fathers and mothers.

Possibly the most important topic for prospective parents, however, is quite different from these issues so clearly related to health – it is about building relationships. Fathers can be easily engaged on the topic about whether to circumcise or not, but having fathers sign on to supporting breast-feeding may not seem as obviously important. Not only do some couples have low comfort in talking about or exposing the mother’s breasts, but some fathers are even possessive of them and unwilling to share with the baby. A discussion about how the father can be the one to bring the baby from the crib for the middle-of-the-night breast-feeding and then burp, change, and return the infant to the crib is a way to support the (exhausted) mother.

Fathers need to know how important their help and support are to the new mother. Mothers need to be heard by the father (and anyone else who will listen) about their fears and pain during delivery, for as many times as it takes. He needs to tell her how brave she was and how grateful he is. Our son bought his wife a "push present" to acknowledge this marathon achievement!

Fathers also need to understand that things don’t just go back to "normal" once the baby has arrived. The support of the father at this special time is symbolic to the mother of the future of their relationship. I can’t tell you how many mothers, disgruntled with their marriages years into parenting, will call up examples of lack of support in the newborn period as the beginning of the deterioration of their relationship. The mother is exhausted from the well-termed "labor," literally and figuratively "drained" by breast-feeding and the interrupted sleep of the first months. She needs her partner to step up with both hands to help – and express sympathy – to show that he is part of the new parenting team.

I think it is important to emphasize that relationships do change – have to change – when a baby arrives. This can be a coming-together in sharing the chores as well as joys of parenting, or a splintering from lack of the communications co-parenting requires. Egocentricity that sufficed in a marriage without children no longer works when the exponential increase in life demands begins. Lack of social support is the number one risk factor for marital discord and child behavior problems; the main social support in American families is the spouse/partner. A golden rule for each parent to follow is, "Ask what you can do to help."

Other supports in addition to the spouse/partner are important, too. To start this topic you might ask: "How are you going to involve others in and out of the family with this child?" There is a need for both engagement and sometimes limit-setting on others that can be a new kind of task and stress for the couple. The task may involve at first negotiating visits and time with grandparents from each side versus privacy for the parents, then later determining family dietary practices for the new child as she grows; compromising on cultural discipline styles; deciding on how religious practice will be conveyed or not; and even setting limits on toys and gifts.

I encourage parents to engage commitment from other, unrelated adults as "godparents" as an important adjunct to biological family support. This can be especially useful for small or isolated families or those distancing themselves from their own relatives. Such early engagement can begin a lifelong bond that provides both the parents and child significant support over the years. In the case of future divorce (greater than 50%) or death of a parent, a godparent becomes an even more valuable source of stability.

For parents having their first child, the advice is much different than for families having a second child. For second-time parents, I am sometimes asked about when to tell the siblings about sleeping arrangements or how to ease the change when a new baby is coming. But one special opportunity to foster a positive relationship between the siblings occurs in the narrow window between the time of telling the child (second trimester is probably best due to the high rate of early miscarriage) and the birth. This is a time current children can attend so-called "sibling preparation" classes. Along with a strong relationship with the father, expression of empathy, optional involvement in caring for the baby, avoidance of gory details of the delivery and not forcing photos, attendance at these classes has been shown to improve sibling adjustment to the baby.

Parents who can’t take the older child to a sibling class can follow some of the principles themselves. The important points are to tell the sibling that a new baby is coming "because we love children," not as a playmate (since they are not much fun for a long time); that babies cry and sleep and spit up a lot in the beginning (realism), but eventually will be able to smile and play; and especially that "we (the parents) took care of you when you were little, and we will do the same for this baby." A review of the older child’s baby pictures can be a good way to start the conversation.

Siblings who are told in strong ways about the new baby’s point of view (Boy, he sure is hungry! Hungry enough to scream!) have more positive relationships later. While some behavioral regression (50%) and jealousy are common, most children quickly come to care about their new baby, and become loving, protective, and the best playmates and models for new skills a child ever has.

Finally, don’t forget to recommend daily "special time" for each parent with the older child(ren) starting prenatally and continuing forever, to reduce jealousy and provide reassurance that he is still loved no matter who else joins the family!

Dr. Howard is assistant professor of pediatrics at the Johns Hopkins University, Baltimore, and creator of CHADIS (www.CHADIS.com). She has no other relevant disclosures. Dr. Howard’s contribution to this publication was as a paid expert to Frontline. E-mail her at pdnews@frontlinemedcom.com.

If I were only to give a few bits of advice to families preparing for a new baby, while physical health problems in the mother or child are the biggest concerns of prospective parents, my coaching also would be aimed at safeguarding relationships in the new family constellation.

I find that having a prenatal visit at least by 34 weeks’ gestation for first-time parents is invaluable to getting to know them so that you are not a stranger after delivery and you can communicate more effectively if there are difficulties.

As for other topics that may not seem like a topic to be raised with a pediatrician, pregnancy fears may need to be prompted. You might say, "Most mothers in the second trimester have scary dreams about their future baby. Has this happened to you?" This gives parents a chance to express concerns, often about birth defects, but sometimes about how they or their partner will be caring for the baby. This can be a chance to ask about how the pregnancy has affected their relationship so far, and how they hope it will change once the baby comes.

The prenatal visit is a time to inform parents about practical matters such as your office’s practices regarding on call, insurance, your website, and the expectation for previsit questionnaires. After taking pregnancy and family histories, the other main topics are plans for circumcision and breast-feeding. This is the time for recommending prenatal labor and delivery classes for both fathers and mothers.

Possibly the most important topic for prospective parents, however, is quite different from these issues so clearly related to health – it is about building relationships. Fathers can be easily engaged on the topic about whether to circumcise or not, but having fathers sign on to supporting breast-feeding may not seem as obviously important. Not only do some couples have low comfort in talking about or exposing the mother’s breasts, but some fathers are even possessive of them and unwilling to share with the baby. A discussion about how the father can be the one to bring the baby from the crib for the middle-of-the-night breast-feeding and then burp, change, and return the infant to the crib is a way to support the (exhausted) mother.

Fathers need to know how important their help and support are to the new mother. Mothers need to be heard by the father (and anyone else who will listen) about their fears and pain during delivery, for as many times as it takes. He needs to tell her how brave she was and how grateful he is. Our son bought his wife a "push present" to acknowledge this marathon achievement!

Fathers also need to understand that things don’t just go back to "normal" once the baby has arrived. The support of the father at this special time is symbolic to the mother of the future of their relationship. I can’t tell you how many mothers, disgruntled with their marriages years into parenting, will call up examples of lack of support in the newborn period as the beginning of the deterioration of their relationship. The mother is exhausted from the well-termed "labor," literally and figuratively "drained" by breast-feeding and the interrupted sleep of the first months. She needs her partner to step up with both hands to help – and express sympathy – to show that he is part of the new parenting team.

I think it is important to emphasize that relationships do change – have to change – when a baby arrives. This can be a coming-together in sharing the chores as well as joys of parenting, or a splintering from lack of the communications co-parenting requires. Egocentricity that sufficed in a marriage without children no longer works when the exponential increase in life demands begins. Lack of social support is the number one risk factor for marital discord and child behavior problems; the main social support in American families is the spouse/partner. A golden rule for each parent to follow is, "Ask what you can do to help."

Other supports in addition to the spouse/partner are important, too. To start this topic you might ask: "How are you going to involve others in and out of the family with this child?" There is a need for both engagement and sometimes limit-setting on others that can be a new kind of task and stress for the couple. The task may involve at first negotiating visits and time with grandparents from each side versus privacy for the parents, then later determining family dietary practices for the new child as she grows; compromising on cultural discipline styles; deciding on how religious practice will be conveyed or not; and even setting limits on toys and gifts.

I encourage parents to engage commitment from other, unrelated adults as "godparents" as an important adjunct to biological family support. This can be especially useful for small or isolated families or those distancing themselves from their own relatives. Such early engagement can begin a lifelong bond that provides both the parents and child significant support over the years. In the case of future divorce (greater than 50%) or death of a parent, a godparent becomes an even more valuable source of stability.

For parents having their first child, the advice is much different than for families having a second child. For second-time parents, I am sometimes asked about when to tell the siblings about sleeping arrangements or how to ease the change when a new baby is coming. But one special opportunity to foster a positive relationship between the siblings occurs in the narrow window between the time of telling the child (second trimester is probably best due to the high rate of early miscarriage) and the birth. This is a time current children can attend so-called "sibling preparation" classes. Along with a strong relationship with the father, expression of empathy, optional involvement in caring for the baby, avoidance of gory details of the delivery and not forcing photos, attendance at these classes has been shown to improve sibling adjustment to the baby.

Parents who can’t take the older child to a sibling class can follow some of the principles themselves. The important points are to tell the sibling that a new baby is coming "because we love children," not as a playmate (since they are not much fun for a long time); that babies cry and sleep and spit up a lot in the beginning (realism), but eventually will be able to smile and play; and especially that "we (the parents) took care of you when you were little, and we will do the same for this baby." A review of the older child’s baby pictures can be a good way to start the conversation.

Siblings who are told in strong ways about the new baby’s point of view (Boy, he sure is hungry! Hungry enough to scream!) have more positive relationships later. While some behavioral regression (50%) and jealousy are common, most children quickly come to care about their new baby, and become loving, protective, and the best playmates and models for new skills a child ever has.

Finally, don’t forget to recommend daily "special time" for each parent with the older child(ren) starting prenatally and continuing forever, to reduce jealousy and provide reassurance that he is still loved no matter who else joins the family!

Dr. Howard is assistant professor of pediatrics at the Johns Hopkins University, Baltimore, and creator of CHADIS (www.CHADIS.com). She has no other relevant disclosures. Dr. Howard’s contribution to this publication was as a paid expert to Frontline. E-mail her at pdnews@frontlinemedcom.com.