Literature review for - Flourish Paediatrics

Firstly, confounding factors may not have been adequately accounted for (Stewart 2007). In
some studies the association between postnatal depression and under nutrition was not
significant after adjusting for confounding factors including poverty, socio-economic status,
parental education levels and birth weight. However, the association remained significant
after adjustment in the studies in Goa, India, and Rawalpindi, Pakistan (Patel, DeSouza et al.
2003; Rahman, Iqbal et al. 2004). Secondly, the effects of depression such as tiredness,
worthlessness and psychomotor slowing can affect the mother’s ability to provide proper
nutritional care, proper hygiene and appropriate health care seeking behaviours so that the
children’s growth is affected (Stewart 2007). In addition, symptoms of depression are
associated with decreased breastfeeding duration, increased breastfeeding difficulties, and
decreased levels of self-efficacy (Dennis and McQueen 2009). Thirdly, the association
between stunted growth and postnatal depression may be due to the stress caused by both
internal and external factors in bringing up a child who is slow to develop and grow (O'Brien,
Heycock et al. 2004; Stewart 2007). Fourthly, the environment in developing countries is
more hostile and less favourable for child health so that postnatal depression affects infant
nutrition and growth more severely (Patel, DeSouza et al. 2003; Stewart 2007). More
prospective studies, including adjustment for potential confounders are needed to understand
the influence of postnatal depression on infant growth in developed countries (Stewart 2007).
Academy of Breastfeeding Medicine Protocol (Academy of Breastfeeding Medicine
2008)
Recommendations for Identifying Women with Postpartum Depression
• The preferred method for identifying women with postpartum depression is the systematic
use of a validated screening tool such as the Edinburgh Postnatal Depression Scale or the
Postpartum Depression Screening Scale at the obstetrical postpartum visit and at well
childcare visits in the postpartum year.
• Ask mothers if they feel down or anxious. Many women with postpartum depression report
anxiety as a primary symptom rather than depressed mood. Excessive worrying about the
baby’s or mother’s health should be explored.
• Ask mothers if they are having trouble sleeping even when they are exhausted and their
child is sleeping or if they are sleeping all the time and are unable to get out of bed.
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