"Three strikes and you're OUT"...or "In"...Trouble, that is!

I was really ready to see eight-week-old, JT. In addition to several office visits, I had spoken over the phone to Howard, his Dad, numerous times since the child's birth. I was starting to dread the moment his cell number would appear on my desk. I had it memorized.

J. T. is in for his routine visit and is growing at the 80% in height and the 60% in weight. He cackles once when I palpate his abdomen and looks up at his dad when I listen to his lungs. Though I'm finding this behavior delightful, Howard hardly notices. He looks worried. "Is his head big enough?" "Does it hurt J. T.'s back if he lies on his stomach?" "He always strains his face when he poops. Is that ok?"

Worry seems to be on the job description of most new parents. Each of Howard's questions alone seems resonable; however, this dad has an extraordinarily long list of questions and can't be reassured. He is an attentive father who reads everything about babies on the Internet. He collects ideas from friends and family. He is hypervigilant in his care: getting up several times at night (while the baby sleeps!) to be sure everything is ok, counting every calorie the baby eats, keeping an elaborate diary of the child's sleep, eating, and elimination. Though the data piles up, the questions and worries keep coming. "Anxious attachment," a term used by some professionals, describes the budding relationship between Howard and his baby. Though J. T. is thriving now, babies can eventually sense this anxiousness and over time can look and even act anxious themselves.

Anxious attachment is seen as a form of postpartum depression and can occur in either the mother or the father. This conditiion does not look like classic depression: a "slowed down" parent who becomes teary and sad, has trouble concentrating, appears distracted, and becomes less involved with their baby. Howard is super involved but cannot trust his instincts or learn to read his baby's behavior accurately. When asked, Howard will state that he is "not depressed." "I'm just worried," Howard explains. He, and others like him, need help: frequent contact and support, counselling, and sometimes medication.

When I care for young families I follow the "rule of three." If a parent asks a third question and cannot be reassured, but follows with yet another concern, I start looking for anxious postpartum depression. See the next blog for some strategies to help Howard cope with this situation.