How Pediatricians Can Support Mothers & Premature Children after Preterm Birth
Please Note: If you or a loved one recognize that you’re experiencing postpartum depression or anxiety symptoms, reach out to your OB/GYN for support. If they are less familiar with postpartum mental health issues, they can connect with VMAP for Moms+ to speak with experts about your care.
The Impact of Premature Birth on the Child and Parents
Prematurity is defined as birth before 37 weeks of gestation, and can be further divided by the World Health Organization (WHO)'s distinctions:
- Late preterm (32 – 37 weeks gestation)
- Very preterm (28 – 32 weeks gestation)
- Extremely preterm (under 28 weeks gestation)
About 1 in 10 babies are born prematurely worldwide, and improvements in neonatal medicine mean that even those extremely preterm babies have a chance to survive. Having a baby at less than 32 weeks can be a very stressful and traumatizing experience for both parents. Premature birth involves potential health risks, additional stress, often traumatic birth experiences, and separation between infants and parents if the baby needs to stay in the neonatal intensive care unit (NICU).
There is increasing literature surrounding the vulnerability of premature infants to mental health difficulties in childhood and adolescence. By age seven, children who were born very preterm were three times more likely to have a psychiatric disorder. The difficulties they tend to face appear to present as increased rates of autism spectrum disorder (ASD), attention deficit/hyperactivity disorder (ADHD), and anxiety disorders.
This vulnerability exists in adulthood as well, with one study finding that adults born late preterm had an increased risk of psychiatric hospitalizations, as well as diagnoses of psychosis (1.6x likely), depression (1.3x), or bipolar disorder (2.7x). Those who were very or extremely preterm were even more likely to have psychosis (2.5x), depression (2.9x), or bipolar disorder (7.4x).
Mothers and fathers of preterm babies are significantly more likely to experience comparable rates of depression, anxiety, and post-traumatic stress after their child's birth. One study found that 40% of parents reported depressive symptoms and 50% experienced anxiety symptoms during this time. Another study found that about 33% of mothers and fathers dealt with post-traumatic stress in the months after a very preterm birth, with nearly 20% continuing to report these symptoms two years later.
How Does a Parent’s Mental Health Affect Their Child?
With the many factors that lead to preterm birth being difficult or impossible to prevent, the focus shifts to how we can support parents after they have a preterm baby. A parent’s mental health can have a major impact on their children, often becoming a key source of stress for their child and has been linked to worse mental health and behavioral health issues for them into adulthood. This is particularly true for postpartum depression, which can elevate the risk of a child developing mental health problems and attachment issues.
When a study is observing the differences in children who have parents with mental health conditions and those who don’t, they’re looking at the way a parent manages their children and their household. Children thrive with a sense of stability, consistency, and safety. If a parent is not being treated for a mental health issue and is in a dysregulated state, they come off as harsh, cold, disorganized, or disconnected from their child. Most often, this is what makes the difference between the two groups.
In short, if you are a parent with a mental health issue that you are in treatment for or coping with well, there is no reason your home can’t have that stability, consistency, and safety that makes for a healthy and happy childhood!
All that being said, focusing on supporting parents with their mental health after a preterm birth is critical, both for their well-being and their child’s. Reducing their distress and improving their coping skills will help mitigate the mental health risks associated with preterm birth.
How Pediatricians Can Support Parents & Children After Premature Birth
The clinician with the most contact with a parent after birth is their child’s pediatrician. This is because within their first 15 months, 78.2% of children visited their pediatrician six or more times, most often with their mother.
When it comes to supporting both parents and their preterm babies, a pediatrician will need to be well-versed in how to identify and manage postpartum mental health concerns, as well as the intricacies of preterm infant health and wellness. This may sound like a tall order, but there are plenty of resources here to support you. Let’s break it down!
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Supporting Children After Preterm Birth
To increase your confidence in caring for preterm infants during their well visits, there are a few continuing education resources that AAP recommends pediatricians read through.
- Primary Care Framework to Monitor Preterm Infants for Neurodevelopmental Outcomes in Early Childhood
As you continue to care for this child throughout their early childhood, remember that they have an increased risk of developing mental health difficulties. If you or their parents observe these, you can work with the Virginia Mental Health Access Program (VMAP) for support.
VMAP offers free, same-day mental health consultation and care navigation regarding your pediatric patients. You can speak with Child & Adolescent Psychiatrists, Developmental Pediatricians, and Licensed Mental Health Professionals to get their insight, or go straight to our care navigation team to have them work with the family and find local resources that work for them.
Our early childhood expansion means that you can also "press 6 for under 6" when you call to access our early childhood hub. This will connect you with consultation and care navigation services with experts that are familiar with this stage of development and can help you and your patient's family manage their care.
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Supporting Parents After Preterm Birth
Only 53.9% of pediatricians consistently screen mothers for postpartum depression (PPD), despite the American Academy of Pediatrics (AAP)’s recommendation to screen at their child’s 1, 2, 4, and 6-month well visits. Screening is especially important among mothers. While AAP doesn’t have a specific recommended screening tool, the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire are commonly employed in these settings. These are both validated for use with mothers and fathers.
It’s important to note that universal screening and referral without follow-up does not improve treatment access or outcomes for the mother and child. A “screen and manage” versus a “screen and refer only” approach has been found to be more helpful. The “manage” piece of this includes helping mothers access counseling and external resources, providing psychoeducation about PPD, and motivating them to seek help and engage in social support.
While this may sound like a lot to add to your itinerary, it’s important – and VMAP can help!
VMAP has an expansion program called VMAP for Moms+, and it’s designed for prescribers who care for pregnant/postpartum individuals or their children. Just like the VMAP Line, you can access mental health consultation and care navigation, but on behalf of your pediatric patient’s parent. Perinatal psychiatrists and licensed mental health professionals are available to consult you on how to support your patient’s parent, or care navigators can work with the family directly to get them the help they need.
All of VMAP’s services are free for you and your patient (or your patient’s parent!). Calls are returned same-day within 30 minutes, so you can expect a quick response and timely support.
