Fathering in the Early Years: How family physicians can help

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Fathering in the Early Years How family
physicians can help

• FIRA conference
• Toronto, October 24, 2008
• Bill Watson, MD, FCFP
• St. Michaels Hospital
• University of Toronto

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Role of the Family Doctor
Ante partum Intra partum Post partum
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Antepartum

• Prenatal visits
• General health assessment

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Intrapartum

• Acknowledgement
• Keeping in the loop
• Jobs to do

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Postpartum

• The biggest task by far!!!!!!!

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Case 1

• Bill, a 32 yo father, has a difficult year with
  his son having frequent bouts of bronchiolitis
  and hospital admissions. In addition, his
  workplace has been very stressful for him.
• While his son is in for a check-up, the doctor
  notices that Bill has gained a lot of weight. It
  turns out that he has gained 40 pounds over the
  past year and his blood pressure is elevated.

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Mens health postpartum

• Increased use of HCP
• Increased incidence of overweight, hypertension,
  diabetes and heart problems
• Increased incidence of mental health issues, and
  substance use

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Father Involvement

• Implications for men on their own developmental
  path
• Implications for mothers in co-parenting
  relationship
• Implications for children (social, emotional,
  cognitive development)

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Research on Father Involvement

• Fathers typically relate to children differently
  than Mothers do
• This promotes development of different
  competencies in the children
• Fathers are important for healthy child
  development

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Playing with Children

• Fathers seem to influence children primarily
  through play
• Different styles of play
• Talked less, touched more
• More rough and tumble style of play
• Helps children learn about emotions
• Practice point suggest to your dads to get down
  on the floor for 15 minutes each day to play with
  your child

Allen Daly 2003, Yogman Kindlon 1995,
Brazelton, 1995, Lamb, 1998, Head Start Bulletin,
2004
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Emotional Development

• 5 month old boys more comfortable with strangers,
  vocalized more, cried less
• More securely attached
• Less depression, fewer negative emotions
• Better self acceptance, personal and social
  adjustment
• Practice point before bed, ask about your
  childs day

Allen Daly 2003
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Talking to Children

• Mothers explain more, fathers use fewer words
• Fathers more tactile and physical, mothers more
  verbal and didactic
• Time for bed exercise
• Practice point Make a point of talking to your
  child daily

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Social Development

• Fathers involvement is positively correlated
  with
• Social competence, maturity, relatedness with
  peers
• Empathic concern
• Positive peer relations
• Popular and well liked by peers
• Positive sibling interactions

Allen and Daly 2003
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Absent fathers

• 35 of all families in Canada are single parent
• 2/3 of all black families are single parent
• Children growing up without 2 parents have 2-3
  times risk serious problems in the future

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Absent Fathers

• Boys are more likely to have
• Behaviour problems, bullying
• Problems with academics, delinquency
• Lower measures of internal moral judgment, guilt,
  accepting blame, rule conformity

Allen and Daly 2003
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Absent Fathers

• Girls are more likely to have
• Cheating
• Lying
• Not feeling sorry for misbehaving
• Bullying
• In boys and girls
• Higher incidence of mental health problems
  (anxiety, hyperactivity, depression, suicide)
• Practice pointask your absent fathers about
  their children and educate them about the
  importance of their contact!

Allen and Daly 2003
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Co parenting Relationship

• Fathers seem to withdraw from children when not
  getting along with their mothers
• Optimal conditions for children occur when father
  lives with their mother, in a good partnership

Allen and Daly 2003
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Case 2 Ted, Jane and Ashley contd

• Family visit
• Ted says the house is in turmoil, Jane is
  rejecting of his help or affection
• Ted says Jane is coping well but busier
• Jane says she is overwhelmed
• Ted feels on the periphery of family

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Effect of childbirth on Marital Relationship

• Less communication
• Changes in Sexual relationships
• Changes in sharing of household chores
• 73 of parents reported feeling stressed and worn
  out following the birth of their first child
• 55 felt they had received enough emotional
  support
• 15 to 20 of marriages end up separated or
  divorced by the childs 4th birthday

King, Rogers, Walters Oldershaw 1995, Oldershaw
2002
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Causes of Marital Conflict
(Cowan 1992 )

• Lack of fathers involvement in household chores
• Jealousy of maternal preoccupation with the baby
• Difficulty adjusting to the changes in the
  marital relationship
• Loss of intimacy
• Decreased self esteem

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Risk Factors for Couple Conflict after the Birth
of a Child

• Communication problems
• Parents low self esteem or depression
• Lack of readiness to become parents
• Partners negative views of each other
• Disagreement over division of family labour
• Discontent of arrangements of child care
• Pessimism about meeting the needs of both
  partners
• Dissatisfaction with marriage overall
• Unresolved issues of own childhood experience
• Illness
• Problems at the workplace
• Practice point ask couples how they are doing?

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Divorced and Separated Fathers

• Need to separate parental from spousal roles and
  responsibilities
• Encourage to stay strongly involved with children

Baum 2004
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Case 3 Hassan and Bindu

• Both parents come for 2 week well baby check
• Baby and Mom doing well
• Mom is concerned about Dads lack of interest in
  the baby
• Hassan seems sad and quiet, is having
  difficulties at work, depression 5 years prior
• He feels child care is not part of his cultural
  role

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Mens Passage into Parenthood

• Priorities remain same as pre birth
• Increased sense of responsibility
• Change in relationship with spouse, decreased
  communication
• May feel isolated , with shifting perceptions of
  self, spouse, parents and friends
• Often feel shut out of babies lives by mothers
  and by health professionals
• Can experience blues, depression (1 to 25 in
  community, 24 to 50 in partners of women with
  PPD)
• Family of Origin issues are very important

Belsky and Kelly 1994, Cowan and Cowan 1992,
Brandt 1989, Osofsky 1985, Goodman 2004
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Do men get postpartum depression?

• 1-20 in community studies, double in maternal
  PPD
• Often associated with pre-morbid depression, or
  depression in their partners during pregnancy or
  postpartum
• PPD in fathers can be significant and should be
  treated
• Practice point screen for depression in fathers

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Case 4 Joey and the temper-tantrums

• John and Marie bring their 18 month old son,
  Joey, to your office for his check-up and
  immunization. They have done the Nipissing and it
  scores normal except for some difficulty with
  consonants. During the course of the examination,
  which was normal, both parents mention that they
  are becoming frustrated with Joeys behavior.
  They cite biting, temper tantrums and screaming
  and his saying no to everything he is asked to
  do. John seems exasperated and asks you how to
  discipline his child. He seems a little
  embarrassed that his child is behaving this way.
  Both parents work and share equally in the child
  care and appear genuinely concerned.
• What is Joeys stage of psychological
  development?
• What other information would you like to know
  about the family in this case?
• How would you counsel Joeys father about
  discipline.
• What further information or resources could you
  provide for this family?

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Fathers and discipline

• One of the biggest challenges for fathers is
  selecting appropriate discipline for their
  children.
• Discipline is all about modifying behavior, not
  about anger or retaliation.
• Discipline is better understood as guidance and
  teaching, not controlling and punishing.

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If you can answer yes to even one of the list
below, this newsletter is for you.  It will,
quite simply, transform your lifeWhich of
these apply to your children?

• Rude and defiant
• Frequent temper tantrums
• Won't take NO for an answer
• Won't settle to bed
• Won't do as they are told
• Treat you like their personal slave
• Won't do their homework
• Aggressive or violent
• Lying and/or stealing
• Hyperactive, always on the go and into everything
• Constantly in trouble at school
• Sullen and moody
• Poor self esteem, depressed, anxious
• Won't go to school

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And to you?

•  
• Tired and stressed
• Feel like you are failing as a parent
• Find yourself constantly shouting at your
  children
• Arguing with your partner about how to manage the
  kids
• Feel blamed or criticised by your friends,
  neighbors, school teachers, even doctors and
  therapists
• Feel hopeless that you will ever have a normal,
  happy family life
• Every day you fear that phone call from the
  school about yet another problem
• Worried that your children will drop out, or be
  expelled from school
• Worried that your children will end up on drugs
  or in jail
• Considered putting the children into care as you
  simply cannot cope

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Recurring questions from parents

• Is there some way to get those kids of yours to
  behave?
• Is there some way to replace stress, anger and
  chaos with fun, laughter and love?

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Consequences of good discipline

• Children learn appropriate behavior and
  self-control
• Engagement in fun play, conversation and use of
  fair consequences are times when discipline can
  be used in positive, nurturing ways
• Head Start Bulletin, 2004

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Consequences positive and negative

• Consistency important
• Promises important-do what you say
• Especially important when father does not live at
  home
• Time-outsallow parent and child to cool down

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Teenage Fathers

• Tended to be involved significantly in the lives
  of their children
• Fathering helped them to have a more positive
  sense of self
• Remember their life cycle tasks of maturation
  need completion

Glikman 2004
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Areas that could be explored by the Family
Physician

• Expectations of the parenting roles for
  mother and father
• Renegotiation of the couples relationship (time,
  affection, intimacy)
• Issues around sexuality in pregnancy and post
  partum
• Division of household responsibilities
• Couple communication and conflict resolution
  skills
• Anticipatory guidance about life after baby
• Practical advice and education (medical and
  psychosocial)
• Support systems available (family, friends,
  parent groups etc.)

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Practical Suggestions for New Dads

• Take one to two weeks off work
• Take a regular turn caring for baby (baths,
  diapers, walks etc.)
• Limit visitors
• Monitor Mom and Baby for problems (PPD etc)
• Support breastfeeding
• Increase household chores, errands etc.
• Anticipatory guidance (development, etc)

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Case 5 Ed, Sarah, and Anthony

• 35 yr old Dad, 30 yr old Mom
• Both come to 2 week well baby check
• Baby is growing well
• Both parents are enchanted with baby
• No concerns

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Case 5contd

• Parents have 3 other children in care of CAS
• History of Alcoholism in both parents, they have
  both attended treatment, and have abstained for 6
  months

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Children of parents with substance use disorder
(SUD)

• Increased risk of childhood antisocial
  personality and conduct disorder
• Decreased salivary cortisol response to an
  anticipated stressor among sons of SUD fathers
• Hyporeactivity as an adaptation to chronic stress
  may be salient to the intergenerational
  transmission of substance abuse liability.

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Community Resources-what/where are they?

• Prenatal classes
• Fathers programs
• Parenting classes
• Ontario Early Years Centres
• Practice point check out community resources, go
  to a OEYC

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Balancing the dual role of father/employee

• Increased workplace stress
• Fathers dont talk about it
• Paternity leave is available but still frowned
  upon in the corporate world

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Tips to keep connected with your children while
working

• One on one with each child
• Lots of hugs and physical affection
• After work, enter the childs flow
• Talk about their day
• If traveling, share details about the journey and
  what you are doing there, and call a lot

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Summary

• Evidence suggests that fathers are important for
  healthy child development
• Physicians should make efforts to involve fathers
  in the care of children and provide role modeling
  where possible

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Questions??