Dad to Dad

Parenting Like a Pro

By David L. Hill, Anthony Alex LeTourneau

American Academy of Pediatrics

Copyright © 2012 David L. Hill, MD, FAAP
All rights reserved.
ISBN: 978-1-58110-650-3

Contents

Acknowledgments,
Foreword,
1. Welcome to the Club,
2. When Can He Play Ball? Infant and Child Development,
3. Infant Feeding for the Mammary-Challenged: What Your Baby Will Eat and When,
4. The Pit Crew: If You Can Change the Oil,
5. Crying Foul: Why Is My Baby Crying and When Will It Stop?,
6. That Wasn’t There Yesterday: Colors, Spots, Bumps, and Rashes,
7. A Good Shot: Vaccines and Common Sense,
8. The Big Sleep: Helping Your Child Learn to Sleep, Over and Over,
9. The Air Force: Congestion, Coughing, and Wheezing in Babies,
10. Eye, Captain: Eye Boogers, the Red Eye, and When to Worry,
11. Keep It Down: Infant Spitting Up and Vomiting,
12. Heating and Cooling: Fevers and What to Do About Them,
13. Ear, Ear: How to Tell if Your Child Has an Ear Infection and What to Do About It,
14. Food Fight: Why Your Toddler Won’t Eat Anything,
15. It’s My Potty: When Changing Diapers Just Isn’t Fun Anymore,
16. Time-out: Rules of the Game,
17. Snot Funny: Colds, Allergies, Sinusitis, and Who Nose What Else,
18. How Much Does It Cough? When Breathing Doesn’t Come Easy,
19. I Don’t Feel So Good: Vomiting, Diarrhea, and Bellyaches,
20. Water, Water Everywhere: Is This Wetting Normal?,
21. Hard to Swallow: The Sore Throat,
22. What’s the Heading? Headaches and When to Worry,
23. Making the Grade: When to Worry About ADHD,
24. Electronica: Television, Computers, Video Games, and Mobile Phones,
25. Uh, So, It’s Like This: Talking to Your Children About Sexual Development,
26. It’s Complicated: Dealing With Nontraditional Parenting Relationships,
Conclusion: Father Time,
Index,

CHAPTER 1

welcome to the club

like many expectant fathers, there was little else I could talk about in the months leading up to my daughter’s birth. Someone might say, “Looks like we’re about to get some rain,” and then I’d say, “Yep. I hope it’s not raining in 5 weeks when my first child is due.”

When I told people I was going to be a father, I got a lot of different reactions, but the most predictable came from those who were already parents. They would cock their heads knowingly, smile a little, and say, “Your life is going to change.”

“Ya think?” I wanted to ask. “Did you all get together and rehearse this answer? Will you invite me to practice it with you once I’m a dad, and if so, will there be beer? I sort of figured my life would change, what with the baby and all. You want to be a little more specific?”

And then it happened. As a medical student I’d helped deliver plenty of babies, but this one was mine. It was her water that splashed on the floor, her purple face suddenly visible, her tiny hands and feet waving in the air. There she was, my little girl! My life had changed.

The first call I made was to my mom to apologize for how much I must have frightened her. I never knew I could love someone as much as this baby, which means I never knew how scared I could be that something would happen to her. Would she keep breathing? Would she have a happy childhood? Would she be accepted into a good graduate school? OK, too soon for that last one. Better to just start with the breathing part.

Over the next week I spent hours holding the wondrous being that was my daughter. Everything she did fascinated me. I was enthralled at the way she slept, the way she sucked on her hand, even the way she pooped. And pooped again. And again. OK, the hand-sucking was more interesting.

By her second week of life my new daughter could lift her head and sort of squirm around my chest. She’d squirm, drop her head, and wiggle her face back and forth, then she’d squirm a little farther and repeat the process, almost like she was looking for something; food, maybe. When she did this to her mommy she’d soon be happy, but with me it was an exercise in futility. As her rooting became more frantic and she began to whimper, I could almost hear her thoughts: “This isn’t getting me anywhere! Dad, what are good you for?”

As I gazed down at her little scrunched-up nose I whispered gently to her, “Oh, precious girl, one day you will know what I’m good for. There will come a day, sooner than you or I can imagine, a day when you will really badly want to open a pickle jar. When that day comes, there I will be, to hand that jar to your mom, along with that jar-opening gadget someone gave us as a wedding present.”

I don’t know a father alive who has not wondered what his role is in his child’s life and whether he’s doing a good enough job of it. (OK, there is this one guy I met, but seriously, he’s a complete jerk.) As a father it’s common to feel some ambiguity about your role in nurturing your child. After all, she didn’t grow inside your body, and you can’t nurse her, at least not without the sorts of secret, experimental steroids available only to certain major league batters and Tour de France contenders.

dads: who are we, and what are we good for?

The answers to these questions are not, as you might imagine, straightforward. The US Census Bureau counted 70.1 million fathers in 2011, meaning the 85.4 million mothers outnumber us (one of many good reasons not to upset them). Of those fathers, 25.3 million (well under half) live as members of a married couple in a house with their children. Another 1.8 million are single fathers, accounting for around 15% of all single parents.

In 2010 about 154,000 married fathers stayed home for at least 1 year to care for their children while their wives worked. They were busy — collectively these dads watched 287,000 kids. But you don’t have to be a stay-at-home dad to provide primary care for a child. In 2006 fathers cared for a total of 2.7 million preschoolers while their mothers worked. That number represents nearly a quarter of all children in that age group.

Families are growing more complex, and fathers include many people whom the Census Bureau might not have counted. They may be stepfathers, foster fathers, uncles, grandfathers, mothers’ romantic partners, or 2 male partners who share in the primary care of a child. If you’re the main guy on whom a child depends for security, guidance, and love, congratulations, you’re a dad!

Dads, as it turns out, are good for a lot, and our positive effect spans the life of the child. Premature babies gain weight better if their dads are involved in their care. Those same preemies score better on developmental and psychological tests over a year later as a result of dad’s involvement. Mothers are more likely to successfully breastfeed their babies when dads help. Children with involved fathers have better language skills, make better grades, enjoy better self-esteem, and suffer substantially less psychiatric disease, including depression and anxiety. Positive paternal involvement can even reduce conflict among siblings. Children whose fathers are involved in their care are less likely to wind up in jail, use drugs and alcohol, or become pregnant in their teen years.

Dads are not good for kids just because we do the same stuff moms do. That’s not to say doing that stuff isn’t important; it’s critical! Mothers and fathers have a similar effect on their children’s moral development, social competence, school performance, and mental health. There is a reason, after all, it takes 2 parents to make a baby, and not just because it’s more fun that way.

Probably the most accurate generalization about dads versus moms is that fathers play more. In the first 4 years of a child’s life we tend to focus on activities that involve touch and stimulation, like tickling, wrestling, and playing airplane. It’s our job, in other words, to get kids all wound up so they won’t go to bed, to make them laugh until they pee on themselves. (Note: If this happens, be a good sport and help with the clothing change; after all, it is your fault.) During middle childhood, we’re more likely than mothers to get out and do stuff, like take walks, go fishing, or see a ball game. Are you surprised? No, you are not. You already knew that from watching sitcoms.

You might not have guessed, however, that dads also engage in a lot of private talks, and not just the Big Talk. We also have a major effect on our children’s sense of their gender roles, both sons and daughters. (What this means in practical terms is that you may at times have to wear a dress,especially if your son is wearing one.) We tend to focus more than mothers on risk-taking and problem-solving. (Wearing the dress can provide an opportunity to model both behaviors.)

The realm of discipline holds another surprise: while fathers and mothers often choose different discipline roles in a given family, the differences are not broad enough to generalize. It seems that for every mother who says, “You just wait until your father comes home,” there is a father somewhere saying, “Just wait until your mother hears about this!”

your life is going to change

I am not allowed to reveal the secret location where we parents practice saying this line to soon-to-be parents, but I can tell you this: someone often brings beer. That said, I can be specific about some other stuff. Presumably if you’re a dad or you’re going to be a dad, at some point in your relationship you’ve had sex. This is one part of your life that will change, but you also knew that from watching sitcoms.

Pregnancy and sex are not incompatible, but they don’t always go together well, either. Many women experience levels of fatigue and nausea in the first trimester of pregnancy that put them in a mood, just not the mood. By the second trimester of pregnancy some women start feeling better, and changes in their hormones and blood flow may actually renew their interest in sex. Then again, they may not, so prepare to be understanding. In the third trimester sex is still often fine, although between weight gain and back pain, finding a comfortable position may require a level of creativity usually reserved for yoga instructors. Look for positions that give the woman a lot of control over the depth and frequency of penetration in case she experiences unexpected discomfort.

Sexual activity is generally safe during pregnancy, but there are some exceptions. Most critical is the presence of sexually transmitted infections (STIs). HIV, hepatitis B and C, syphilis, and herpes are all transmissible during pregnancy and childbirth, and any of those diseases can be lethal to the baby. Chlamydia and gonorrhea can cause severe eye infections and even blindness if the baby gets them during birth, and chlamydia can also cause dangerous pneumonia. The mom’s doctor will test her for some STIs, but that doesn’t mean she cannot contract them after testing. If you are not in a monogamous relationship with the mother of your baby, it is critical you wear a condom whenever you have sex. You should also visit your own doctor to find out if you carry one of these diseases. Remember, people transmit STIs all the time without having any symptoms whatsoever.

There are other special circumstances where the mother’s doctor might advise her to avoid sexual intercourse. If she is at risk of preterm labor, if she has unexplained vaginal bleeding, if she is leaking amniotic fluid, if her cervix is opening too early, or if the placenta is covering the cervix, it may not be safe for her to have sex.

One danger of sexual activity during pregnancy and the first several weeks following birth is so bizarre it sounds like an urban legend. If you blow air into the mom’s vagina during oral sex you run a small risk of the air blocking an artery in her body, which can be deadly. I told you it was weird — but seriously, don’t do that. You don’t want to explain that one. The other alternative sexual activity to avoid during pregnancy is anal sex. I’m not saying you’d do that, but just be aware it can introduce bacteria into the vagina that may infect the baby at birth.

For 4 to 6 weeks after delivery sex is pretty much off limits. Whether she delivers vaginally or by cesarean delivery, the mother’s uterus, cervix, and vagina have undergone profound physiologic changes and they need some time to recover. In most cases her doctor will want to examine her and clear her before she resumes sexual intercourse.

This is also a period when you’re both probably exhausted and stressed, and intimacy is likely to suffer. The hormonal changes associated with pregnancy, childbirth, and nursing are not always conducive to the libido, so don’t be too concerned that the sort of activity that got you this baby is slow to resume. That said, there may not be any more important time to practice communication and to enjoy intimate contact that does not necessarily involve sexual intercourse. Many people find their sensual lives grow deeper and more stimulating as they explore novel ways to make each other happy. Even if that’s not necessarily your experience, be patient. When your sex life does return it will carry with it a deeper bond than ever before.

dads can get postpartum depression — really

It’s hard to overstate the difference a child makes in your relationship. No detail of your lives remains untouched. There are the obvious things — you can’t sleep when you want, you can’t leave the house without a truckload of stuff, you can’t even watch a ball game without interruptions during the best parts (why is it babies never cry during commercials?). There’s also the laundry that piles up, the dishwasher crowded with bottles or breast pump parts, and the danger of lacerating your face trying to shave while holding a baby.

Then there’s the really big stuff: you have to spend more money, but you also have more demands on your time. Your partner may feel differently about her body now. You may feel guilty about having made her pregnant, or you may feel jealous of the affection she shows the baby. Most importantly, there is now a whole new human being who is incredibly important to both of you, who literally redefines the meaning of the word love. Should it surprise you, then, that this time can be a little stressful?

Doctors are now paying more attention to postpartum depression in mothers and fathers. While it’s normal for mothers to become emotional in the week or two following birth, these symptoms should clear up pretty quickly, usually by the end of the first month. Some women, however, don’t recover. They may actually feel worse over time. About 12% to 20% of women develop depression or anxiety following a delivery, and up to 10% of fathers suffer depression as well. Parental depression affects children profoundly, causing developmental delays, social problems, and behavioral issues. Depressed fathers are much more likely to spank their children than fathers without depression, and they are less likely to play games, sing songs, or read to their children. On the other hand, for children whose mother is depressed, having an involved and nurturing father protects them from some of the negative effects of mom’s depression.

The most widely used tool to screen mothers for postpartum depression is called the Edinburgh Postnatal Depression Scale. Recently doctors have begun using the same questionnaire to evaluate dads (see next page for a sample of the scale).

Edinburgh Postnatal Depression Scale (EPDS)

As you have recently had a baby, we would like to know how you are feeling now. Please underline the answer which best describes how you have felt in the past 7 days, not just how you feel today. Here is an example, already completed:

I have felt happy:

Yes, most the time
Yes, some of the time
No, not very often
No, not at all

This would mean: “I have felt happy some of the time during the past week”. Please complete the other questions in the same way.

In the past 7 days:

1. I have been able to laugh and see the funny side of things:

As much as I always could
Not quite so much now
Definitely not so much now
Not at all

2. I have looked forward with enjoyment to things:

As much as I ever did
Rather less than I used to
Definitely less than I used to
Hardly at all

3. *I have blamed myself unnecessarily when things went wrong:

Yes, most of the time
Yes, some of the time
Not very often
No, never

4. I have been anxious or worried for no good reason:

No, not at all
Hardly ever
Yes, sometimes
Yes, very often

5. *I have felt scared or panicky for no very good reason:

Yes, quite a lot
Yes, sometimes
No, not much
No, not at all

6. *Things have been getting on top of me:

Yes, most of the time I haven’t been able to cope at all
Yes, sometimes I haven’t been coping as well as usual
No, most of the time I have coped quite well
No, I have been coping as well as ever

7. *I have been so unhappy that I have had difficulty sleeping:

Yes, most of the time
Yes, sometimes
Not very often
No, not at all

8. *I have felt sad or miserable:

Yes, most of the time
Yes, quite often
Not very often
No, not at all

9. *I have been so unhappy that I have been crying:

Yes, most of the time
Yes, quite often
Only occasionally
No, never

10. *The thought of harming myself has occurred to me:

Yes, quite often
Sometimes
Hardly ever
Never

© 1987 The Royal College of Psychiatrists. The Edinburgh Postnatal Depression Scale may be photocopied by individual researchers or clinicians for their own use without seeking permission from the publishers. The scale must be copied in full and all copies must acknowledge the following source: Cox, J.L., Holden, J.M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786. Written permission must be obtained from the Royal College of Psychiatrists for copying and distribution to others or for republication (in print, online or by any other medium).

Translations ofthe scale, and guidance as to its use, may be found in Cox, J.L. & Holden, J. (2003) Perinatal Mental Health: A Guide to the Edinburgh Postnatal Depression Scale. London: Gaskell.

become an emotional genius in 3 easy steps

Until you have a baby you may not even be aware of some of your own assumptions about parenting. You might fall back on whatever skills you learned from your own parents, even if time has proven those practices ineffective. On the flip side, you may be so determined not to repeat your own parents’ mistakes that you overcompensate. Regardless, you’ll almost certainly find your partner has some different ideas than you do, setting the stage for conflict. How the 2 of you resolve those differences will have a profound effect on your child’s well-being and also on the future of your relationship. Having 2 parents who cooperate well is one of the strongest factors ensuring children’s healthy development, even when those parents are separated or divorced.

(Continues…)Excerpted from Dad to Dad by David L. Hill, Anthony Alex LeTourneau. Copyright © 2012 David L. Hill, MD, FAAP. Excerpted by permission of American Academy of Pediatrics.
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