Job Aid 1: True/False Questions and Answers

May 2006 1

Directions: Compare the assessment items you completed in Module 1 with the facts presented in Module 2.

Assessment Item Correct Response

1. Perinatal depression is the same as postpartum depression.

False. These two terms are related but are not interchangeable. Postpartum depression is one of several forms of perinatal depression. It can occur anytime during the first year after giving birth.

2. Untreated perinatal depression has significant negative consequences for mothers but not their families.

False. Perinatal depression affects everyone close to the mother, including her spouse, FOB, extended family members, and children.

3. Perinatal depression is often undetected or overlooked and therefore not diagnosed.

True. The symptoms of perinatal depression are overlooked, undetected, and misdiagnosed because women commonly experience symptoms similar to those of perinatal depression during pregnancy and the postpartum periods. These symptoms may include fatigue, feeling overwhelmed, sleep disturbances, eating problems, trouble concentrating, irritability, and moodiness. Moms often say, “I thought it was normal to feel this way.” When they mention their feelings to medical personnel, family, or friends, the response is often, “Oh, that’s common for a pregnant or new mom.” As a result, women often ignore their symptoms until they worsen or until they can no longer cope. Perinatal depression is also frequently undiagnosed because medical professionals often don’t ask a woman how she is feeling.

4. If a woman with perinatal depression really tries, she can change her outlook and feel better.

False. Perinatal depression is a biological and mental illness that affects approximately 9 to 13 percent of all women. It is a myth that a woman with perinatal depression can just “snap out of it.” Most women cannot overcome depression without some form or combination of medical and non­medical treatments.

5. Perinatal depression can begin during pregnancy or anytime during the first year after giving birth.

True. Perinatal depression can occur during pregnancy as well. Perinatal depression includes the entire time frame from conception through pregnancy and anytime during the first year after giving birth.

6. Sadness and crying are signs of perinatal depression but anger and irritability are not.

False. Sadness, crying, anger, irritability are all signs of perinatal depression. Other signs of perinatal depression are feelings of guilt and worthlessness, anxiety, insomnia, loss of appetite, and fatigue.

Job Aid 1: True/False Questions and Answers

May 2006 2

Assessment Item Correct Response

7. Women who are breastfeeding shouldn’t take antidepressants.

False. Many of the currently available antidepressants are considered acceptable for treating depression during pregnancy. Studies show that there is little risk to the infant of ingesting the antidepressant through breast milk. In addition, birth defects are not known to be associated with the most commonly used antidepressants. A pregnant mom should always discuss the risks and benefits with her healthcare provider. Ultimately, it is the mom’s decision whether to take medication.

8. Some cultures don’t have words or expressions to describe symptoms of depression.

True. There are many cultural differences in how depression is viewed and treated. Some cultures do not acknowledge depression as a medical condition, while others may not believe in medical treatment for the disorder. Some cultures do not use the same words or phrases to describe depression as you might use. Because of this, many cultures describe depressive symptoms in terms of physical pain and discomfort.

9. Physical complaints can be a cue that a woman is depressed.

True. Physical discomforts are very common with perinatal depression. Headaches, chest pains, numbness or tingling in the hands or feet, or fast and shallow breathing are all physical symptoms of perinatal depression.

10. As a home visitor, it is my responsibility to tell a mom I’m worried about her and I think she may be depressed.

True. Perinatal depression affects up to 28 percent of women living in poverty. This means that approximately one out of every five moms you visit may have perinatal depression. As a home visitor, you need to:

• Recognize the signs of perinatal depression.

• Assess the mom and educate her about perinatal depression.

• Provide appropriate assistance and support.

Job Aid 2: Risk Factors for Perinatal Depression

May 2006 3

Perinatal depression

• A young and/or single mother • History of mental illness or substance abuse • Living in poverty • No high school diploma or GED • Financial or marital difficulties or other stressful life events • Previous pregnancy, birth, or postpartum difficulties • Feeling unsure about the pregnancy or motherhood

Postpartum depression Physical/biological reasons • Thyroid changes • Hormone fluctuations • History of PMS • History of frequent miscarriages • History of fertility treatments • Fatigue or lack of sleep • Appetite changes • Pain • Multiple births (twins, triplets, etc.) • Health issues for mom or baby

Psychological reasons • History of abuse (physical, emotional, or

sexual) • Unwanted or unplanned pregnancy • Traumatic or disappointing birth

experience • History of previous depression • History of bipolar disorder • History of schizophrenia • Prenatal depression or prenatal anxiety

Social/relationship factors • Mother issues or other unresolved

issues • Father of baby unknown • Marital stress or conflict • Childcare or job stress • Life stress or loss • Lack of social support • Single parenting • Multiple children under the age of

five

Postpartum panic disorder • Past history of anxiety disorder • Depression during pregnancy • Personal or family history of mood disorders and mental illness • History of severe PMS • Social isolation • Poor support system

Job Aid 2: Risk Factors for Perinatal Depression

May 2006 4

Post­traumatic stress disorder • A traumatic birth experience • History of sexual abuse • Victim of sexual assault

Postpartum obsessive­compulsive disorder • Personal or family history of OCD • Personal or family history of anxiety disorders

Postpartum psychosis • Personal or family history of bipolar disorder • Personal or family history of psychosis • Difficult labor

Possible risk factors: • Advanced maternal age • Premature delivery • Low birth weight baby • Unmarried mother • First child • Perinatal death

Job Aid 3: Assessing Signs and Symptoms of Perinatal Depression

May 2006 5

Symptoms of Perinatal Depression Emotional symptoms

• Feeling restless or irritable • Crying a lot or crying for no apparent reason

• Hopelessness and sadness • Uncontrollable mood swings • Feeling overwhelmed and unable to cope

• Fear of harming the baby, her partner, or herself

• Fear of being alone

Behavioral symptoms • Lack of interest in the baby or overly concerned for the baby

• Poor self­care • Loss of interest or pleasure in activities • Decreased energy and motivation • Withdrawal or isolation from friends and family • Inability to think clearly or make decisions • Risk­taking behavior such as having unprotected sex and using addictive substances, such as alcohol and cigarettes

Physical symptoms • Exhaustion, sluggishness, and fatigue

• Sleep and appetite disturbances not related to care of the baby

• Headaches, chest pains, hyperventilation (fast and shallow breathing), heart palpitations (the heart beating fast and feeling like it is skipping beats)

Signs of Perinatal Depression to Look and Listen For Emotional signs

• Is the mom crying? Does she cry for no apparent reason?

• Does she appear irritable, sad, fearful, or anxious?

• Does she mention feeling overwhelmed?

• Does she mention thoughts of harming herself, her partner, or her baby?

• Does her mood change dramatically during your visit?

Behavioral signs • Does she appropriately attend to her baby’s needs? • Does she smile at the baby and talk to the baby? How does the baby respond?

• Does the baby seem indifferent to attention? Does the baby smile and “brighten up” when approached?

• Is she dressed in clean clothes? Has she showered?

• Is her home clean or as clean as it usually is? • Does she smile or laugh? Is she able to smile or laugh?

• Does she seem to be confused?

Physical signs • Does she appear rested? • Does she appear to be in physical distress (experiencing fast breathing or pain)?

• Does it look like she’s gained or lost an unusual amount of weight?

• Is there food in the kitchen? Is it healthy food?

• Does she mention appetite or stomach problems?

• Does she complain of headaches or chest pains?

Job Aid 3: Assessing Signs and Symptoms of Perinatal Depression

May 2006 6

Questions to Ask When Assessing a Mom Questions related to emotional signs and symptoms

• Tell me, are you feeling loved by your family, friends, baby? When you’re with your friends, do you feel all alone?

• What kinds of things have gone wrong for you? • Would you say you’re feeling guilty about

something? • It’s not unusual for new mothers to be worried. What

are you worried about? • When you feel this way, what do you do to help

yourself feel better? • What thoughts or urges have you been having that

scare you? • What’s so overwhelming? What’s frustrating you? • You seem a bit irritable. Tell me, does your family or

do your friends tell you that you’re irritable or moody? • Would you say you’re experiencing mood swings? • Being a new mom can make you feel nervous and

anxious. Tell me, how nervous does being a new mom make you?

• It sounds like you feel you can’t do anything right. Do you feel like you need to get away?

• Some women have said they have scary thoughts or urges about their baby. I’m wondering if you ever have any scary thoughts or urges. Do you?

Questions related to behavioral signs and symptoms

• When you doing something that used to be fun, do you feel happy and are able to laugh?

• Can you laugh and see the funny side of life?

• Are you having sex? Are you able to experience pleasure when you have sex?

• How do you feel about your baby? • When the baby won’t stop crying,

even after you’ve fed her and changed her diaper, what do you do?

• Are you finding time each day to shower? Fix your hair? Keep up with the household chores?

• Are you able to find a few minutes for yourself each day to relax or to do something pleasurable?

• I’m wondering if you might be having a hard time taking care of things. How hard is it for you to take care of yourself? Your baby?

• Have you had any visitors lately? • When was the last time you were

out of the house?

Questions related to physical signs and symptoms

• How have you been sleeping? Are you able to sleep when the baby is sleeping?

• When you go to bed at night, are you able to fall asleep?

• If you get up with the baby during the night, are you able to go back to sleep?

• Tell me, have you noticed any changes in your appetite? How do your feelings affect your appetite?

• How much weight have you lost (or gained) since your baby was born?

• What did you have for dinner last night? For breakfast this morning? For lunch today?

• Are you eating regular meals? • Are you having headaches,

chest pains, or shortness of breath? Does it feel like your heart is racing?

Job Aid 4: Intervention Strategies for Perinatal Depression

May 2006 7

1. Provide frequent, regular visits.

Ongoing contact enables you to assess warning signs, respond to them, and follow up. Frequent visits are opportunities to strengthen a mom’s interactions with her children, so she can still form strong attachments with her children while battling depression.

• Allow moms to set the pace for the relationship, which shows moms you respect them and value their feelings.

• Be consistent and dependable. Consistency over time shows moms that you are reliable. Moms may test you multiple times to see if you will continue to be consistent and dependable even when they are being difficult.

• Provide ongoing support to help the mom comply with any prescribed medical or non­medical treatment plans, continue prenatal care, and foster her relationship with her baby.

2. Reassure mom constantly.

Moms who have perinatal depression need social support of all kinds, including someone who will be there and listen. As a home visitor, you can provide that much needed emotional support to moms and help meet their needs.

As a home visitor, you can help meet moms’ emotional needs by:

• Listening more than you talk.

• Verbally reassuring moms that they are not alone and that you want to help them.

• Behaving in a way that moms perceive as helpful rather than authoritative.

• Reminding moms that there is no shame in depression and that depression is treatable.

• Sharing success stories of other moms who have been depressed so she knows she is not alone.

• Letting moms know that what they are experiencing has a name and a treatment.

• Showing patience. Moms who feel they are being pushed into treatment will retreat.

• Providing gentle and consistent encouragement. Always find something positive to say to the mom at each home visit, no matter how small.

3. Acknowledge depression’s effects on relationships.

Remember that those close to a depressed mom often feel guilty, frustrated, and helpless.

• Ask about a mom’s newborn.

• Ask about other family members, including her spouse or partner, father of the baby, parents, and other children.

• Provide information to other family members and include them in planning.

Job Aid 4: Intervention Strategies for Perinatal Depression

May 2006 8

4. Tap into community resources.

As a home visitor, you are a connector, helping moms find the resources that will be most helpful to them. When you visit a mom, you need to:

• Find out what resources the mom already uses, such as WIC, healthcare, public transportation, and counseling agencies.

• Based on the mom’s needs, spend time researching what resources are available within her neighborhood and community. Consider services offered by churches, neighborhood centers, Boys and Girls Clubs, a local YMCA, or a community­based mental­health center. Also consider parenting programs offered through local school systems.

• Wherever possible, connect moms to resources that are culturally relevant.

5. Emphasize the importance of social support.

Moms have social needs. Relationships with other adults, especially other new or expectant moms, can satisfy a mom’s needs for nurturance, dependence, attachment, and affiliation. This is not a quick­fix intervention. It may take lots of time to get a mom to attend a meeting or a social gathering sponsored by a neighborhood center or church. Encourage outreach as a way to meet mom’s social support needs.

6. Help find moms support in dealing with special needs children.

Having a special needs child is a risk factor for perinatal depression. Moms need to know that support and guidance are available to help her care for child so she can also care for herself.

• Help moms connect to support groups for moms who have children with disabilities.

• Identify in­home services that may be available to a mom. (Example: Early Intervention provides assessment and therapy options for moms with children who have a variety of delays or disabilities.)

• Identify any potential respite­care resources designed to give parents a break from daily care­taking tasks. A church or other volunteer group might offer these programs.

• Identify emergency respite­care resources. Where can a mom go if she feels completely overwhelmed or out of control?

7. Suggest ways moms can foster child development and improve parent­child interactions, even while battling depression. A mom can still foster her relationship with her child(ren) while battling depression.

• Encourage a mom to “fake it until you make it” by interacting with her baby even when she doesn’t feel up to it.

• Share simple, inexpensive ways mom can interact with her baby while she overcomes her depression.

• Provide information and coaching on positive parenting strategies and techniques, such as use of time­outs, redirection (in older babies and toddlers), and distraction.

• Demonstrate activities moms can do to foster their children’s development. Explain the “why” behind activities.

Job Aid 4: Intervention Strategies for Perinatal Depression

May 2006 9

8. Encourage moms to accept help from others.

• Healthy moms recognize the need for outside support. Encourage moms to reach out to other family members, neighbors, and friends for support.

• Encourage moms to use self­help groups, such as Parents’ Anonymous or church groups designed for moms, such as MOPS (Mothers of Preschoolers).

9. Encourage moms to minimize stress and lessen the likelihood of crisis.

• Help moms find ways to meet basic needs for food, shelter, and clothing.

• Help moms connect to government agencies, programs, and resources that can ease financial burdens and educate moms on how to access these resources.

10. Educate moms on possible available medical and non­medical treatment options. You are not a clinician, but you can educate moms on the medical treatment options a clinician may prescribe. Non­medical treatment options are also important and sometimes forgotten, so you should explain ways moms can feel better without medication.

• Brainstorm realistic ways to get more exercise, eat healthy and regular meals, adjust sleep habits, and rethink expectations for being a “good mom.”

• Help moms set realistic expectations for taking medication. Explain to moms that they will not feel better immediately once they start taking medication. Typically it takes about two weeks. Some antidepressants work better for some moms than for others, so it is common to have to change medication or adjust the dosage.

• Remind moms that taking medication while drinking alcohol or taking illegal drugs is dangerous and can be deadly.

Refer to the list of treatment options found on the next page, and use them to educate mom on the most common medical and non­medical treatment options for perinatal depression.

Job Aid 4: Intervention Strategies for Perinatal Depression

May 2006 10

Perinatal Depression Treatment Options to Share with Moms

Medical treatment options

• Selective serotonin reuptake inhibitors (SSRI) are the most commonly prescribed medications for depression and anxiety. They have fewer side effects and carry less risk. Common names include:

1. Zoloft

2. Prozac

3. Paxil

• Tri­cyclic antidepressants are less expensive than SSRIs. Common names include:

1. Bavil

2. Aventyl

3. Norpramin

• Benzodiazepines are anti­anxiety agents that slow down the brain’s processing of information. Common names include:

1. Xanax

2. Valium

Referrals

• Group psychotherapy with a psychiatrist or counselor, such as:

1. Referral to a perinatal or postpartum depression support group.

2. Referral to a mental health center.

3. Referral to a bereavement group.

• Individual counseling and psychotherapy with a psychiatrist or counselor.

• Local or national telephone perinatal or postpartum depression support services.

• Perinatal or postpartum depression support Internet Web sites, including blogs and chat rooms with access to other moms and survivors of depression.

Job Aid 4: Intervention Strategies for Perinatal Depression

May 2006 11

Non­medical treatment options

• Talk with family members and friends who are supportive. Call, visit, or email them. Avoid being alone.

• Eat three healthy meals a day, including breakfast.

• Drink a quart of water a day (eight glasses).

• Eat healthy food and snacks.

• Try to get at least 15 minutes of exercise a day. Arrange time to go for a walk.

• Get at least 30 minutes of outdoor light a day: Sit by a window, keep plenty of lights on in the house, and open drapes and blinds.

• Do something that will make you laugh: read a funny book, watch a funny movie, or play a game.

• Get creative and take up a hobby: learn to knit or sew, paint a picture, or make jewelry.

• Get up at the same time every morning. Lying in bed can make you feel worse.

• Go to bed at the same time each night.

• Practice relaxation exercises such as breathing slowly and deeply.

• Reduce caffeine intake.

• Sleep when the baby sleeps.

• Listen to soothing music.

• Enlist family and friends for babysitting help.

Job Job Aid 5: Activities Parents Can Do With Their Children

May 2006 12

Directions: Use these handy charts to coach parents on activities they can do to foster their baby’s development. Use the Tell/Show/Watch approach to help caregivers learn each activity. The letter(s) next to each activity indicate what area or areas of development are affected. C = cognitive, L = language, S = social, G = gross motor, and F = fine motor.

Babies: Months 1 and 2

Month 1 • When baby is fussy, try to find out why and fix the cause. C, S

• Respond immediately when your baby cries. It’s his only way of telling you he has a problem. S

• Rock and cuddle your baby to soothe him. S

• Develop routines that baby can count on for bath time, feeding time, naptimes, and bedtimes. S

• Place your baby on her stomach for “tummy time” during her waking hours even if you start by doing so for just a few minutes each time. G

• Hang a mobile over baby’s crib so she can watch it. C, G

• Gently shake a colorful rattle or small stuffed toy about 12 inches in front of baby’s face. Slowly move it sideways so she can track its movement with her eyes. C, G, F

• Place small objects in baby’s hand so she can grasp them. F

• Gently rub a stuffed toy or a soft blanket against baby’s cheek or hand so she can feel different textures. C

• Talk, sing, and read to your baby a lot! Show lots of happy emotion when you talk with your baby. Sing, smile, and talk to your baby as you take care of him. C, L, S

Month 2 • Continue to respond to baby’s cries immediately. When baby is fussy, try to figure out why and fix it.

This builds trust. C, S

• Change baby’s position every so often. Place baby on his tummy every day to help build neck muscles and upper body strength. G

• Read nursery rhymes, simple poems, and short books to baby every day. Use books that have pictures of other babies or common things she sees. Make it part of baby’s routine before or after naps or before bed. Point out objects as you read. (“Look, there’s the kitty.”) C, L, S

• Continue to talk to baby frequently. Talk about what you are doing. Make eye contact with her. Call her by name. C, L, S

• Play a “game” with baby by watching her expressions and listening to her sounds. Then imitate her! Then make sounds and see if she can imitate you. C, L, S

• Show baby brightly colored objects, such as blocks or stuffed toys. Let baby feel or touch them. C, F

• Listen and sing to gentle, soft music together. It relaxes both baby and caregiver. C, L, S

Job Job Aid 5: Activities Parents Can Do With Their Children

May 2006 13

Babies: Months 3 and 4

Month 3 • Cuddle and hold baby. S

• Play “talking back and forth” with baby. Baby makes a sound and caregiver repeats it. Caregiver then makes the sound for baby to repeat. This can go on many times. C, L, S

• Place baby onto her back and let her reach for toys hanging from the side of the crib or playpen. C, G, F.

• Place baby on tummy (every day!) and let her reach for toys placed just at the edge of her reach. Show her how to reach for the objects. G, F

• Play “peek­a­boo” using hands or a blanket. C, L, S

• Continue talking with baby and reading to baby a lot! Point out and name objects in books or objects baby touches. (“Your blanket is soft.” “Feel the soft blanket.”) Make sounds to imitate animals you’re reading about. C, L, S

• If weather permits, take baby outside. Let her watch birds flying, leaves fluttering, and the shifts of light and shadow. Identify sounds baby can hear (“Hear the leaves in the trees.” “Listen to the airplane.”) C, L, S

• Hold a rattle and move it slowly from side to side. Encourage baby to track the rattle with her eyes. Let her grasp rattle, shake it, and mouth it. C, G, F

• “Show” baby how to roll by placing hands under her shoulders when she’s on her back. Gently rock baby back and forth, talking to her while rocking her. L, S, G

Month 4 • Cuddle and hold baby. S

• Let baby sit propped up on pillows, even if she can only do it for short periods at first! G

• Lay baby on tummy or back. Place toys just beyond his reach to encourage him to wiggle and reach for the toy. Place toy in his grasp if he isn’t able to get it after a few seconds of trying. G, F.

• Continue to encourage baby to roll over. Spread a baby blanket and lay baby on her stomach at one edge. Gently lift the blanket so she will roll onto her back. Praise her and reward her with a hug and kiss. L, S, G

• Prop an unbreakable mirror up next to baby as he lies in front of it. Let him look at himself. Point out his eyes, nose, and mouth. Lie next to him and smile into the mirror. C, L, S

• Take baby different places such as the library, the store, and the park. Let him see and hear different things. Talk to him about what you are seeing and doing. C, L, S

• Make sure baby has toys to play with, hold, and place in his mouth. This is how babies learn about their world, C, G, F

• Continue to play “talking back and forth” with baby, imitating her sounds and encouraging her to repeat sounds you make. C, L, S

Job Job Aid 5: Activities Parents Can Do With Their Children

May 2006 14

Babies: Months 5 and 6

Month 5 • Continue to cuddle and hold baby. Keep routines for feeding, bathing, naptime, and bedtime. Cuddle

baby before naps and bedtime and during feeding times. S

• Talk to baby. Talk about the toys baby is playing with. Show baby how to use the toys. Use complete sentences. C, L, F, G

• Hide toys under a blanket (with baby watching toy being hid). Encourage baby to look for toy. C, L.

• Place favorite toys just beyond reach to encourage baby to wiggle toward toy or reach for toy. C, L, G, F

• Make sure baby has plenty of time to play on the floor to strengthen muscles as he rolls, wiggles, and reaches for things. G

• Hold baby in front of the mirror. Point out baby and caregiver in the mirror. C, S

• Give baby a toy. After placing the toy in one hand, move it to the other. Baby will learn to transfer the toy from hand to hand. C, F

• Help baby stand by holding her under her armpits. G

• Read short stories to baby. Sing songs, and recite rhymes about his eyes, nose, and mouth. C, L, S

• Continue letting baby sit up propped by pillows. Place toys just beyond reach to encourage movement. G, F

Month 6 • Let baby play with pots and pans from the kitchen. Give her lids to fit onto pots and smaller pots to fit

within bigger pots. C, G, F

• Make sure baby gets lots of time on the floor so she can learn to creep and crawl. Play on the floor with her. S, G

• Continue to help baby stand by holding her under her armpits and letting her feet touch the floor. G

• Prop baby into a sitting position. Roll a soft ball toward her. Clap and praise her when she rolls it back to you. L, S, G, F

• Give baby two plastic cups or large spoons. Show her how to bang them together or on the floor. C, G, F

• Play “naming games” with baby. Point to her nose and say “nose.” Do the same thing with her eyes, mouth, ears, and toys. C, L, S

• Place several empty plastic cups, spoons, or other safe objects into a shoebox. While baby watches, take them out one by one. Then put them back. Baby will eventually imitate you. C, G, F

• Play “pat­a­cake,” “teensy­weensy spider,” or “piggy” with baby. C, L, S

• Read, read, and read. Make sure reading is part of every day. Re­read favorite books over and over. Get new books from the library. C, L, S

Job Job Aid 5: Activities Parents Can Do With Their Children

May 2006 15

Babies: Months 7 and 8

Month 7 • Continue offering lots of floor time to baby. Create a “safe” cabinet in the kitchen that contains items

she can play with, such as plastic cups, pots, and lids. Encourage her to remove things from the cupboard and put them all back. C, G, F

• Continue to help baby stand by holding her under her armpits and letting her feet touch the floor. G

• Help baby sit. Allow her to try sitting without propping. Place pillows around her to cushion falls. G

• Give baby two plastic cups or large spoons. Show her how to bang them together or on the floor. C, G, F

• Play “naming games” with baby. Point to her nose and say “nose.” Do the same thing with her eyes, mouth, ears, and toys. C, L, S

• Place several empty plastic cups, spoons, or other safe objects into a shoebox. While baby watches, take them out one by one. Then put them back. Baby will eventually imitate you. C, G, F

• Play “pat­a­cake,” “teensy­weensy spider,” or “piggy” with baby. C, L, S

• Read, read, and read. Make sure reading is part of every day. Re­read favorite books over and over. Get new books from the library. C, L, S

• Sit baby on the floor with several toys or objects such as a doll, a block, a spoon, a pan, and a ball. Hand each one to baby and name it. C, L, S,

• Sit baby on floor and put a large container in front of him. Hold a small ball over the container and drop it in. Do it a few times and then give him the ball. C, G, F

Job Job Aid 5: Activities Parents Can Do With Their Children

May 2006 16

Month 8 • Squeeze one of baby’s toys to make it squeak. Then hide it under a blanket while he watches. Let him

try to find it. C

• Give baby one end of a towel or blanket. Then gently pull on the other end. C, G, F

• Cut out colorful pictures from a magazine and glue them onto pages to make a “book.” Sit with baby in your lap and talk about each picture, pointing at the picture while doing so. C, L, S

• Read, read, and read! Cuddle with baby while reading. C, L, S

• Sing songs, play peek­a­boo, and be silly with him to make him laugh. C, L, S

• Continue playing floor games with baby. C, S, G, F o Roll a ball back and forth with baby. G

o Place interesting objects around a room to encourage baby to crawl to them. G

o Let baby crawl on things that have different textures such as carpet, a soft blanket, grass, or a beach towel. C, G

o Take turns playing a crawling game. Say, “I’m going to catch you” and chase baby. Then say “You catch me!” and crawl away slowly enough for baby to catch you. L, S, G

o Make a stack of blocks for baby. Let her knock the stack down. Laugh with baby when the blocks fall down. C, S

Job Job Aid 5: Activities Parents Can Do With Their Children

May 2006 17

Babies: Months 9 to 12

Months 9­12 • Build a mountain for baby to climb by stacking pillows and blankets on the floor. Sit on the floor with

baby so you can help steady him as he climbs. G

• Sing songs with your baby. CDs can be borrowed from the library. Dance with the music or do finger and arm motions that match the words of the songs. C, L, S

• Play hide­and­seek with people and objects. Ask baby, “Where’s______?” C, L, S

• Ask baby questions, such as “What is that?” Wait a few seconds, and then provide the answer. Pretty soon, baby will be able to give answers! L

• Keep playing the imitation game. Make a sound and encourage baby to repeat it. Listen to baby’s sounds and repeat them back to him. L

• Encourage baby to point out common objects and body parts. Say, “Where’s your nose?” and see if baby can point it out. C, L

• Keep up the reading. Make sure it’s a routine that occurs at regular times each day. Let baby help pick books from the library by showing her several. Read to her at the library. C, L, S

• Continue doing tower­building games with baby. Encourage him to place a block on the tower. C, S, F

• Talk to your baby, and encourage baby to imitate you. C, L

• Find new songs, games, and books to share together. Keep things from getting boring for baby by changing things. Keep some of the old games and books; add new. C, L, G, F

• Let your baby explore the park or the outdoors. Help her climb baby­sized things; encourage her to touch different textures such as grass, dirt, leaves, bark, and water. C, L, G

• Give her Cheerios as a snack. Let her pick them up from her high chair tray. G, F

• Provide toys where baby can see cause and effect. (Pushing the button makes music play). C, L, S

• Continue playing floor games with baby. C, S, G, F

• Give your baby simple directions: “Come to mommy,” “Come to daddy,” or “Put the blocks in the basket.” Praise her when she follows your directions. C, L, S

• Use cardboard boxes to make tunnels and play areas by cutting out two sides and taping boxes together. G

• Place toys just beyond reach on a sofa or table. Encourage baby to reach for the object. G, F

• Cook together! As you make dinner, give baby a pot and a wooden spoon. When you empty a container, give it to baby and encourage him to imitate your pouring and stirring actions. Talk to him about what he’s doing. C, L, S

• Give baby a variety of stacking toys in different shapes and sizes. Encourage baby to stack and nest things together. C, L, F

• Play ball with your baby by rolling it across the floor to one another. S, G

Job Job Aid 5: Activities Parents Can Do With Their Children

May 2006 18

Babies: Months 12 to 24

12­18 months • Encourage baby to walk. If baby is not yet walking, help baby “practice” by holding her hands while she

steps along. Make sure she has a safe place to “cruise” furniture (walking along while holding on to furniture for support). G

• Play ball with baby. Stand a few inches away and gently toss a soft ball to baby. Encourage baby to toss the ball back to you. As baby’s skills improve, gradually increase distance. G

• Take baby on trips. Encourage her to explore each environment. Help her do physical things, such as climb a slide, swing in a baby swing, jump, or run. Play with her rather than simply watching her play. If other children are around, include them in your games. C, L, S, G

• Encourage baby to tell you what she wants and needs. Prompt her to name things such as favorite foods, drinks, toys, and books. “Can you say juice?” “Can you say blanket?” L

• Visit people! Visit Grandma, an aunt, a playmate’s house, or church. Talk about the visits and what activities will happen during the visit. L, S

• Let baby pick books to “read” to you. Let him select the books she wants you to read to him. Encourage him to point out objects and name objects. Have him make the sounds that things make (cows go moo, pigs go oink). C, L

• Let baby help with simple pick up chores (“Let’s pick up our blocks.” “Let’s put away the books.” “Let’s put pillows on the couch.”) Be prepared for baby to take everything back out again! C, G, F

• Provide baby with the appropriate­sized Lego blocks or building blocks. Encourage her to build things. Even better, build things together. Talk about what you’re building. C, L, F

• Play “pretend” or “imagine” games with baby. Pretend to cook, shop, or wash dishes or clothes. Baby wants to imitate! C, L, S

18­24 months • Let toddler help with simple pick up chores. (“Let’s pick up our blocks.” “Let’s put away the books.”

“Let’s put pillows on the couch.”) Praise him when he cooperates C, L, G, F

• Provide toddler with the appropriate­sized Lego blocks or building blocks. Encourage her to build things. Even better, build things together. Talk about what you’re building. C, L, F

• Play “pretend” or “imagine” games with toddler. Pretend to cook, shop, or wash dishes or clothes. Toddler wants to imitate and to come up with ideas of his own! C, L, S

• Show toddler how to use simple tools around the house, such as a broom, a spoon to mix things, or a washcloth to wipe a table. C, G, F

• Point out colors and shapes. Tell toddler what they are and encourage him to name them back to you. C, L

• Provide a pan of water and a plastic cup or a sandbox and some plastic bowls and spoons. Allow toddler to pour things from one container to the next and to dig into the sand and make piles. G, F

• Talk to toddler before bedtime. Ask her about her day. Talk about what’s going to happen tomorrow. C, L, S

• Participate in story times at the library. Let toddler pick out books and music to check out of the library. C, L

Job Job Aid 5: Activities Parents Can Do With Their Children

May 2006 19

Babies: Months 24 to 36 Continue doing activities that you’ve already been doing. Consider adding these:

Month 24­36

• Read every day. Make reading time a special time of cuddling and talk. Select a wide range of books: books about animals, cars, people, and places. Include books that make toddler laugh and books that make toddler think about things. C, L, S

• Show toddler how to do things, such as throwing a ball overhand, playing tag, or playing other simple games such as Duck, Duck, Goose. C, G

• Play matching games: match colors, shapes, or like things (people, cars, soft stuff, cold stuff, hot stuff). C

• Encourage your child to tell you stories. Make up stories to tell her. C, L

• Encourage responsibility. Give child jobs, such as picking up toys, laying placemats on the table, or carrying cup and plate to the counter. C, S, G, F

• Provide simple puzzles for child to put together. What they can’t do at age two, they may be able to do at age two and a half or three! C, F

• Give two­step directions: “Wash your hands and then sit down.” Praise your toddler when he can follow directions. Don’t get discouraged if he can remember only a single step at first. Keep encouraging him! C, L

• Encourage your toddler to talk to you about how things feel: hard, soft, sticky, hot, or cold. Help him learn adjectives for describing feelings and sensations: “Does your tummy feel wiggly inside?” “Is it a big hurt or a little hurt?” C, L

May 2006 20

1. He podido reír y ver el lado bueno de las cosas:Tanto como siempre he podido hacerlo ____ 0No tanto ahora ____ 1Sin duda, mucho menos ahora ____ 2No, en absoluto ____ 3

2. He mirado al futuro con placer para hacer cosas: Tanto como siempre ____ 0Algo menos de lo que solía hacerlo ____ 1Definitivamente menos de lo que solía hacerlo ____ 2Prácticamente nunca ____ 3

3. Me he culpado sin necesidad cuando las cosas marchaban mal:Sí, casi siempre ____ 3Sí, algunas veces ____ 2No muy a menudo ____ 1No, nunca ____ 0

4. He estado ansiosa y preocupada sin motivo alguno:No, en absoluto ____ 0Casi nada ____ 1Sí, a veces ____ 2Sí, muy a menudo ____ 3

5. He sentido miedo o pánico sin motivo alguno:Sí, bastante ____ 3Sí, a veces ____ 2No, no mucho ____ 1No, en absoluto ____ 0

Escala Edinburgh para la Depresión Postnatal (Spanish Version)

Si su puntaje total es mayor de 12 quiere decir queusted se ha sentido deprimida durante las últimassemanas. Nos preocupamos por usted y lehablaremos durante su visita para determinar la mejorforma de ayudarle a que comience a sentirse mejor.

6. Las cosas me oprimen o agobian:Sí, la mayor parte del tiempo no he podido sobrellevarlas ____ 3Sí, a veces no he podido sobrellevarlas de la manera ____ 2No, la mayoría de las veces he podido sobrellevarlas bastante bien ____ 1No, he podido sobrellevarlas tan bien como lo hecho siempre ____ 0

7. Me he sentido tan infeliz, que he tenido dificultad para dormir:Sí, casi siempre ____ 3Sí, a veces ____ 2No muy a menudo ____ 1No, en absoluto ____ 0

8. Me he sentido triste y desgraciada:Sí, casi siempre ____ 3Sí, bastante a menudo ____ 2No muy a menudo ____ 1No, en absoluto ____ 0

9. Me he sentido tan infeliz que he estado llorando:Sí, casi siempre ____ 3Sí, bastante a menudo ____ 2Ocasionalmente ____ 1No, nunca ____ 0

10. He pensado en hacerme daño:Sí, bastante a menudo ____ 3A veces ____ 2Casi nunca ____ 1

No, nunca ____ 0

ESCRIBA EL TOTAL DE SU PUNTAJE AQUÍ:

Edinburgh Postnatal Depression Scale (EPDS). Texto adaptado del British Journal of Psychiatry, Junio, 1987, vol. 150 por J.L. Cox, J.M. Holden, R. Segovsky.

Fecha: Nombre de la Clínica/Número:

Su Edad: Semanas de Embarazo/Edad del Bebé:

Como usted está embarazada o hace poco que tuvo un bebé, nos gustaría saber cómo se siente actualmente. Por favor

MARQUE (√) la respuesta que más se acerca a cómo se ha sentido durante LOS ÚLTIMOS 7 DÍAS y no sólo cómo se ha

sentido hoy.

A continuación se muestra un ejemplo completado:

Me he sentido feliz:

Sí, todo el tiempo ____ 0

Sí, la mayor parte del tiempo ____ 1

No, no muy a menudo ____ 2

No, en absoluto ____ 3

Esto significa: “Me he sentido feliz la mayor parte del tiempo” durante la última semana. Por favor complete las otras preguntas de la misma manera.

ABOUT THE EPDS

Response categories are scored 0, 1, 2 and 3

according to increased severity of the symptom. Items 3,

5-10 are reverse scored (i.e., 3, 2, 1, and 0). The total

score is calculated by adding together the scores for each

of the ten items. Users may reproduce the scale without

further permission providing they respect copyright (which

remains with the British Journal of Psychiatry) quoting the

names of the authors, the title and the source of the

paper in all reproduced copies.

The Edinburgh Postnatal Depression Scale (EPDS) was

developed to assist primary care health professionals in

detecting mothers suffering from postpartum depression

(PPD); a distressing disorder more prolonged than the

“blues” (which occur in the first week after delivery), but

less severe than puerperal psychosis.

Previous studies have shown that PPD affects at least

10 percent of women and that many depressed mothers

remain untreated. These mothers may cope with their

baby and with household tasks, but their enjoyment of life

is seriously affected and it is possible that there are long

term effects on the family.

The EPDS was developed at health centers in

Livingston and Edinburgh. It consists of 10 short

statements. The mother underlines which of the four

possible responses is closest to how she has been

feeling during the past week. Most mothers complete the

scale without difficulty in less than five minutes.

The validation study showed that mothers who scored

above a threshold 12/13 were likely to be suffering from a

depressive illness of varying severity. Nevertheless, the

EPDS score should not override clinical judgement. A

careful clinical assessment should be carried out to

confirm the diagnosis. The scale indicates how the mother

felt during the previous week, and in doubtful cases it may

be usefully repeated after two weeks. The scale will not

detect mothers with anxiety neuroses, phobias or

personality disorders.

INSTRUCTIONS FOR USERS

1. The mother is asked to underline the response that

comes closest to how she has felt during the previous

seven days.

2. All 10 items must be completed.

3. Care should be taken to avoid the possibility of the

mother discussing her answers with others.

4. The mother should complete the scale herself, unless

she has limited English or has difficulty with reading.

5. The EPDS may be used at six to eight weeks to screen

postnatal women or during pregnancy. The child health

clinic, postpartum check-up or a home visit may provide

suitable opportunities for its completion.

Edinburgh Postnatal Depression Scale (EPDS) Scoring & Other Information

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. The Spanish version was developed at the University of Iowa based on earlier Spanish versions of theinstrument. For further information, please contact Michael W. O’Hara, Department of Psychology, University of Iowa, Iowa City, IA 52245, e-mail:mikeohara@uiowa.edu.