Clinical Report-Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice
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Guidance for the Clinician in
Rendering Pediatric Care
Clinical Report—Incorporating Recognition and
Management of Perinatal and Postpartum Depression
Into Pediatric Practice
Marian F. Earls, MD, THE COMMITTEE ON PSYCHOSOCIAL
abstract ASPECTS OF CHILD AND FAMILY HEALTH
Every year, more than 400 000 infants are born to mothers who are KEY WORDS
postpartum depression, perinatal depression, Edinburgh
depressed, which makes perinatal depression the most underdiag- Postpartum Depression Scale, medical home, dyad relationship,
nosed obstetric complication in America. Postpartum depression paternal depression
leads to increased costs of medical care, inappropriate medical care, ABBREVIATIONS
child abuse and neglect, discontinuation of breastfeeding, and family AAP—American Academy of Pediatrics
PCP—primary care provider
dysfunction and adversely affects early brain development. Pediatric
practices, as medical homes, can establish a system to implement The guidance in this report does not indicate an exclusive
course of treatment or serve as a standard of medical care.
postpartum depression screening and to identify and use community Variations, taking into account individual circumstances, may be
resources for the treatment and referral of the depressed mother and appropriate.
support for the mother-child (dyad) relationship. This system would This document is copyrighted and is property of the American
have a positive effect on the health and well-being of the infant and Academy of Pediatrics and its Board of Directors. All authors
have filed conflict of interest statements with the American
family. State chapters of the American Academy of Pediatrics, working Academy of Pediatrics. Any conflicts have been resolved through
with state Early Periodic Screening, Diagnosis, and Treatment (EPSDT) a process approved by the Board of Directors. The American
and maternal and child health programs, can increase awareness of Academy of Pediatrics has neither solicited nor accepted any
commercial involvement in the development of the content of
the need for perinatal depression screening in the obstetric and pedi-
this publication.
atric periodicity of care schedules and ensure payment. Pediatricians
must advocate for workforce development for professionals who care
for very young children and for promotion of evidence-based interven-
tions focused on healthy attachment and parent-child relationships.
Pediatrics 2010;126:1032–1039
BACKGROUND
Maternal and paternal depression affect the whole family.1 This report
will specifically focus on the impact of maternal depression on the
young infant and the role of the primary care clinician in recognizing
www.pediatrics.org/cgi/doi/10.1542/peds.2010-2348
perinatal depression. Perinatal depression is a major/minor depres-
doi:10.1542/peds.2010-2348
sive disorder with an episode occurring during pregnancy or within
All clinical reports from the American Academy of Pediatrics
the first year after birth of a child. A family history of depression, automatically expire 5 years after publication unless
alcohol abuse, and a personal history of depression increase the risk reaffirmed,revised, or retired at or before that time.
of perinatal depression.2 PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
The incidence of perinatal depression varies with the population sur- Copyright © 2010 by the American Academy of Pediatrics
veyed, but estimated rates for depression among pregnant and post-
partum women have ranged from 5% to 25%. Studies of low-income
mothers and pregnant and parenting teenagers have reported rates of
depressive symptoms at 40% to 60%. In general, as many as 12% of all
pregnant or postpartum women experience depression in a given year,
and for low-income women, the prevalence is doubled.1 The rate of
major and minor depression varies during pregnancy from 8.5% to
11.0%, and in the first year after birth of a child, the rate ranges from
1032 FROM THE AMERICAN ACADEMY OF PEDIATRICSFROM THE AMERICAN ACADEMY OF PEDIATRICS
6.5% to 12.9%; the rate of major de- substance abuse.5 The rate of paternal Infants who live in a setting of depres-
pression during pregnancy ranges depression is higher when the mother sion are likely to show impaired social
from 3.1% to 4.9%, and in the first year has postpartum depression, which interaction and delays in development.
after birth of a child, the rate ranges compounds the effect on children.5,6 A If the maternal depression persists un-
from 1.0% to 6.8%. The timing shows a nondepressed father has a protective treated and there is not intervention
peak of 6 weeks after birth of a child effect on children of depressed moth- for the mother and the dyadic relation-
for major depression and 2 to 3 ers and is a factor in resilience.7–9 ship, the developmental issues (partic-
months for minor depression.2 There ularly attachment) for the infant also
is another peak of depression 6 Family persist and are likely to be less respon-
months after birth of a child. Perinatal depression may be comorbid sive to intervention over time.17 Ad-
The spectrum of depressive symptoms with marital discord, divorce, family vi- dressing maternal depression in a
in the postpartum period ranges from olence (verbal and/or physical), sub- timely and proactive fashion is essen-
“maternity blues” to postpartum de- stance use and abuse, child abuse and tial to ensure healthy early brain and
pression and postpartum psychosis. neglect, failure to implement the child development and readiness to
Maternity blues affects 50% to 80% of injury-prevention components from succeed.18
new mothers and occurs during the anticipatory guidance (eg, car safety
In their evidence report, “Breastfeed-
first few days after delivery. Symptoms seats and electrical plug covers),10 fail-
ing and Maternal and Infant Health Out-
include crying, worrying, sadness, anx- ure to implement preventive health
comes in Developed Countries,”19 the
iety, and mood swings. Symptoms are practices for the child (eg, Back to
Agency for Healthcare Research and
usually gone after a few days or within Sleep),10–13 and difficulty managing
Quality reviewed 6 prospective cohort
1 to 2 weeks. It does not impair func- chronic health conditions such as
studies regarding postpartum depres-
tion and can be treated with reassur- asthma or disabilities in the young
sion and breastfeeding. It revealed an
ance and emotional support. Postpar- child.11,14 Families with a depressed
association between not breastfeed-
tum depression occurs in 13% to 20% parent (ie, any parental depression)
ing, or early cessation of breastfeed-
of women after birth. It meets the cri- overutilize health care and emergency
ing, and postpartum depression. The
teria of the Diagnostic and Statistical facilities.14 Studies of families of a per-
report noted that “it is plausible that
Manual of Mental Disorders, Fourth son with major depression that began
postpartum depression led to early
Edition (DSM-IV) for depression and is before 30 years of age demonstrate
cessation of breastfeeding as opposed
distinct from maternity blues.3 that the parent, siblings, and children
to breastfeeding altering the risk of de-
are 3 to 5 times more likely to have
Postpartum psychosis affects approxi- pression.” It also noted that both ef-
major depression themselves. It is
mately 1 to 3 mothers of 1000 deliver- fects might occur and that further in-
likely that some types of depression
ies and most often occurs in the first 4 vestigation is needed to assess the
have genetic determinants.
weeks after delivery. Mothers with nature of this association.
postpartum psychosis are severely im- THE IMPACT OF MATERNAL The consequences of maternal depres-
paired and may have paranoia, mood DEPRESSION ON THE INFANT sion include negative effects on cogni-
shifts, hallucinations, delusions, and tive development, social-emotional de-
Maternal postpartum depression
suicidal and homicidal thoughts. This velopment, and behavior of the child.
threatens the mother-child (dyad) re-
is a serious condition that requires im-
lationship (attachment and bonding) Language acquisition depends on the
mediate medical attention and usually
and, as such, creates an environment number of words used by the family,
hospitalization. Preexisting bipolar
for the infant that adversely affects the playing, and having fun and cuddling
disorder is a risk factor for developing
infant’s development. The processes with the infant and child,20 which are
postpartum psychosis.
for early brain development— likely to occur less frequently in the
Depression: A Family Issue neuronal migration, synapse forma- family of a depressed mother. As early
tion, and pruning—are responsive to as 2 months of age, the infant looks at
Fathers and directed by environment as well as the depressed mother less often,
Paternal depression is estimated at genetics. For example, it is known that shows less engagement with objects,
6%.4 Eighteen percent of fathers of an infant living in a neglectful environ- has a lower activity level, and has poor
children in Early Head Start had symp- ment, which is common with de- state regulation. Infants are at risk for
toms of depression. In an 18-city study, pressed mothers, can have adverse failure to thrive, attachment disorder
depressed fathers had higher rates of changes visible on MRI of the brain.15,16 (deprivation/maltreatment disorder
PEDIATRICS Volume 126, Number 5, November 2010 1033of infancy as defined the Diagnostic toms and improved functioning in the ternal depression on behavior out- Classification of Mental Health and De- offspring.”24,25 comes for children at the ages of 3 and velopmental Disorders of Infancy and 4 years. The researchers concluded Early Childhood: DC0-3R21), and devel- THE ROLE OF THE PRIMARY CARE that “reductions in maternal depres- opmental delay on the Bayley Scales of PROVIDER sion mediated improvements in both Infant Development at 1 year of age. Many experts see a role for primary child externalizing and internalizing Such infants are at risk for insecure care practices in screening for de- problem behavior.”23 attachment, which is associated with pression, in general, and specifically The majority of pediatricians agree later conduct disorders and behavior for postpartum depression. The 1999 that screening for perinatal depres- problems. Maternal depression im- report of the Surgeon General on men- sion is in the scope of pediatric prac- pairs parenting skills and can affect tal health,26 the 2000 report of the Sur- tice.34 In a survey by Olson et al,35 few of attention to and judgment regarding geon General’s Conference on Chil- the pediatricians felt that they were re- child supervision for safety and health dren’s Mental Health,27 and Bright sponsible for diagnosis and manage- management. The presence of other Futures guidelines28 call for early iden- ment, but the majority reported that risks to healthy parenting, such as pov- tification and treatment of mental they had provided brief interventions. erty, substance abuse, domestic vio- health problems and disorders. In a re- Most of the pediatricians indicated lence, and previous trauma, in addi- cent policy statement, “The Future of that they had insufficient training to di- tion to depression, creates an Pediatrics: Mental Health Competen- agnose and treat maternal depres- increased cumulative risk. The infant’s cies for Pediatric Primary Care,” the sion. The Parental Well-being Project of temperament is another factor, which American Academy of Pediatrics (AAP) Dartmouth Medical School, which in- may increase parental stress (difficult also recognized the unique advantage cluded 6 community pediatric prac- temperament) or impart resilience for of the primary care clinician for sur- tices in New Hampshire and Vermont, the infant (easy temperament). Mater- veillance, screening, and working with showed that pediatricians, using a nal depression in infancy predicts a families to improve mental health out- simple 2-question screen, could effec- child’s likelihood of increased cortisol comes.29 The AAP Medical Home Initia- tively screen for perinatal depression. levels at preschool age, which in turn tive30 and the AAP policy statement on In the 6 months of the pilot, screening has been linked with internalizing the family31 addressed family-centered was performed at 67% of well-child problems such as anxiety, social wari- pediatric care. The President’s New visits. ness, and withdrawal.22 Behavior prob- Freedom Act of 2004 states that early As with other screening (developmen- lems, attachment disorders, depres- screening, assessment, and treatment tal and behavioral, psychosocial) initi- sion, and other mood disorders in of mental health problems must be- atives in practice, there have been per- childhood and adolescence can occur come a national goal.32 Using data ceived barriers to implementation, more frequently in children of mothers from the National Evaluation of Healthy including lack of time, incomplete with major depression. Steps for Young Children (in the training to diagnose/counsel, lack of Treating a mother’s depression is as- Healthy Steps practices, mothers were adequate mental health referral sociated with improvement of depres- assessed for depression), the effect of sources, fear that screening means sion and other disorders in her child.24 maternal depressive symptoms on the ownership of the problem, and lack The STAR*D–Child (Sequenced Treat- children’s receipt of well-child care of reimbursement.36 However, since ment Alternatives to Relieve Depres- was assessed. Minkovitz et al con- 2000, there have been many successful sion–Child) project is a study that be- cluded that “Increased provider train- models of screening in primary care gan in December 2001 and followed ing for recognizing maternal depres- practices, including developmental 151 mother-child pairs in 8 primary sive symptoms in office settings, more and behavioral screening, maternal care and 11 psychiatric outpatient clin- effective systems of referral, and de- depression screening, and psychoso- ics across 7 regional centers in the velopment of partnerships between cial screening. In these projects, strat- United States. The children were as- adult and pediatric providers could egies have been implemented to inte- sessed every 3 months. The research- contribute to enhanced receipt of care grate screening into office flow, to ers concluded that “continued efforts among young children.”33 improve reimbursement, and to assist to treat maternal depression until A recent study from the University of practices with identifying and collabo- remission is achieved are associated Pittsburgh followed 731 families to ex- rating with community resources, in- with decreased psychiatric symp- amine the effect of intervention for ma- cluding mental health resources.37 The 1034 FROM THE AMERICAN ACADEMY OF PEDIATRICS
FROM THE AMERICAN ACADEMY OF PEDIATRICS
ABCD (Assuring Better Child Health and ing the mother and facilitating her ac- ship. Perinatal/postpartum depres-
Development) Project, funded by the cess to resources to optimize the child’s sion is an early risk to the infant, to the
Commonwealth Fund and adminis- healthy development and the healthy mother-infant bond, and to the family
tered by the National Academy for functioning of the family. For the mother, unit. Surveillance and screening for
State Health Policy, now involves 28 the infant’s PCP provides information for perinatal/postpartum depression is
states and their AAP chapters. The family support, therapy resources, part of family-centered well-child care.
Medicaid agency in Illinois, one of the and/or emergency services as indicated. Including postpartum depression
ABCD states, pays pediatricians who The PCP does provide guidance, support, screening in the practice’s preventive
use the Edinburgh Postpartum Depres- referrals, and follow-up for the infant services prompting system can help
sion Scale. Details of the various state and the dyad relationship. ensure a reliable process for address-
initiatives and practice and parent ing risk.
materials are available at www. IMPLEMENTATION
The new Bright Futures guidelines in-
abcdresources.org and www.nashp. Over the course of routine well-child clude surveillance regarding parental
org. Heneghan et al,38 in their discus- care, the PCP and the family are devel- social-emotional well-being. The US
sion of factors associated with manage- oping a longitudinal relationship. Com- Preventive Services Task Force has en-
ment of maternal depression by pedia- munication at each visit is tailored to dorsed the Edinburgh Postnatal De-
tricians, reported that in their sample, the developmental process for the pression Scale as well as the general
511 of 662 pediatricians reported identi- child and for the family. Anticipatory 2-question screen for depression.2,41
fying maternal depression and address- guidance addresses this dynamic de- Given the peak times for postpartum
ing it in practice. They discussed the velopmental process. A crucial part of depression specifically, the Edinburgh
practice characteristics and attitudes this communication is eliciting parent/ scale would be appropriately inte-
related to this and the need for changes family/child strengths and risks. Both
in attitude and practice to improve iden- grated at the 1-, 2-, 4-, and 6-month vis-
parental and provider concerns
tification and management. In their arti- its. The Current Procedural Terminol-
determine the anticipatory guidance
cle about the legal and ethical consider- ogy (CPT) code 99420 is recommended
discussion.
ations of postpartum depression for this screening, recognizing the Ed-
Screening and surveillance for risk inburgh scale as a measure for risk in
screening at well-child visits, Chaudron
and protective factors are an integral the infant’s environment, to be appro-
et al concluded: “We believe that from the
part of routine care and the relation- priately billed at the infant’s visit.
perspective of feasibility, and now from
ship with the child and family. This
the legal and ethical standpoints, the The Edinburgh Postpartum Depression
communication includes discussion of
benefits of screening outweigh the Scale is a simple, 10-question screen
family support systems and other psy-
risks.”39 that is completed by the mother. A
chosocial factors such as poverty, pa-
The primary care provider (PCP) has a score of ⱖ10 indicates risk that de-
rental mental health, and substance
particularly important role in the early pression is present. An affirmative re-
use. It begins as early as the prenatal
identification of maternal depression visit. According to a recent AAP state- sponse on question 10 (suicidality indi-
and facilitation of intervention to pre- ment, a prenatal visit allows for getting cator) also constitutes a positive
vent adverse outcomes for the infant, to know the parent(s) and is an oppor- screen result. The screen is in the pub-
the mother, and the family. The PCP tunity to identify any high-risk condi- lic domain and is freely downloadable.
may be the first clinician to see the in- tions to anticipate special care It is available in English and Spanish.
fant and mother after the infant is needs.40 In this statement, the AAP also The 2-question screen for depres-
born; therefore, the PCP has very early recommended that pediatricians com- sion41 is:
access. In addition, it is the PCP who municate with obstetricians in their Over the past 2 weeks:
has continuity with the infant and fam- community to inform them of their pre-
ily, and by the nature of this relation- 1. Have you ever felt down, depressed,
natal visit policies so that obstetri-
ship, the PCP practices with a family or hopeless?
cians might refer patients for the pre-
perspective. natal visit. This would also provide an 2. Have you felt little interest or plea-
Screening for postpartum depression opportunity for the pediatrician to be- sure in doing things?
does not require that the PCP treat the come aware of depression during the One yes answer is a positive screening
mother. The infant is the PCP’s patient. pregnancy and to plan for support and result. This screen is suitable to indi-
However, the PCP has a role in support- follow-up of the mother-infant relation- cate risk of depression for adults in
PEDIATRICS Volume 126, Number 5, November 2010 1035general and is not specific to postpar- When the mother needs specific symptoms who need support, it may be
tum depression. Beyond the postpar- follow-up for herself, there are often enough to refer them to a parent sup-
tum period, incorporating surveillance access issues because of uninsured port organization.
for parental mental health is war- or underinsured status. Community There are research-based programs
ranted as well and might be accom- mental health programs may also for treatment of the dyad to promote
plished by use of this 2-question provide limited services for these healthy attachment and relationship.
screen. mothers. Care for the mother is an These programs include the Circle
Responses to a positive postpartum advocacy issue for all who serve chil- of Security, parent-child interactive
depression screening result range dren and their families, and it is an therapy, and child-parent psycho-
from reassurance (maternity blues) issue for state AAP chapters to ad- therapy.44,45 The Circle of Security is a
to supportive strategies (maternity dress in states where access for parent education and psychotherapy
blues, minor depression) and refer- mothers is limited because of state program. It is an individualized
ral for specific interventions (minor policy and service and payment video-based intervention based on
and major depression). In the situa- structure. attachment theory to strengthen the
tion of milder symptoms, demystifi- If suicidality or psychosis is a concern, parents’ ability to observe and
cation and parent education may be or the score on the Edinburgh scale is improve their caregiving capacity.
effective in addressing concerns. De- greater than 20, accessing crisis inter- Child-parent psychotherapy is a ther-
mystification lets the mother know vention services for the mother is nec- apeutic treatment for mothers and
that (1) she is not alone (postpartum essary. In this instance and for other young children to increase attach-
depression happens to many women mental health emergencies, the prac- ment security.45
to varying degrees), (2) she is not to tice should know and use the referral
Referral to early intervention (Part C of
blame (hormonal changes play a big process for local public mental health
the Individuals With Disabilities Educa-
role), and (3) she will get better. Pro- crisis/emergency services.
tion Act) services can provide general
vision of extra return visits for sup- Treatment must address the mother- developmental intervention (educa-
port may be all the family needs and child dyad relationship. For the child tion), which, if performed in the home,
can build a strong foundation for the and mother together, there are gener- also provides mentoring for healthy in-
ongoing relationship between physi- ally more referral options. If the child teraction. If the infant exhibits specific
cian and family. Given the associa- is in an environment of maternal de- delays, specific therapies can also be
tion with cessation of breastfeeding, pression, he or she is at risk for provided. (To identify lead agencies
particular promotion and encour- attachment issues, failure to thrive, and contacts according to state, see
agement of breastfeeding is indi- abuse/neglect, and, ultimately, devel- www.nectac.org and www.nichcy.
cated. When concerns are significant opmental delay. At the very least, close org.)
enough to warrant referral, there follow-up of the child in the medical
are several options and consider- For many families, referral to Early
home is warranted. Specific screening
ations. For the mother, particularly if for social-emotional development, as Head Start, Mother’s Morning Out pro-
the depression is more than mild, re- well as for general development and grams, or child care is an effective
ferral for therapy and/or medication behavior, should be included. Pilowsky option as well. Mothers may receive
may be needed. In some models, et al, in the STAR*D–Child (Sequenced services through Healthy Families
mothers have been referred to their Treatment Alternatives to Relieve America, a Nurse-Family Partnership
obstetricians for follow-up; in oth- Depression–Child) study described (if the referral occurs prenatally),
ers, mothers have been referred to above, recommended that children of other evidence-based home-visiting
mental health providers or their depressed mothers be followed and programs, or local volunteer organiza-
PCPs. It is important for pediatri- assessed.42,43 The infant (with the tions. (To locate Head Start programs,
cians to communicate with the moth- mother) can be referred to a mental see http://eclkc.ohs.acf.hhs.gov/hslc/
ers’ obstetricians and/or PCPs when health clinician (with expertise for HeadStartOffices.)
these situations arise, because the treatment of very young children) to Whatever the treatment and referral
obstetricians/PCPs will want to know address the dyad relationship. (Note options implemented, follow-up of the
about the mother’s depression and that, depending on the family situation, infant and mother by the PCP (to mon-
may have a better understanding of this referral might be for the father or itor progress and to support the fam-
the mental health system for adults. both parents.) For women with mild ily) is necessary.
1036 FROM THE AMERICAN ACADEMY OF PEDIATRICSFROM THE AMERICAN ACADEMY OF PEDIATRICS
The AAP Task Force on Mental Health the Virginia chapter of the AAP, the Children” (January 2008) that is an
and the Committee on the Psychoso- state Early Periodic Screening, Diag- excellent source for pediatricians
cial Aspects of Child and Family Health nosis, and Treatment (EPSDT), Re- and AAP state chapters.
have promoted collaborative, colo- source Mothers, and Healthy Fami- ● Bright Futures (http://brightfutures.
cated, and integrated models for men- lies Virginia47 and recommends aap.org).
tal health services within primary care adopting perinatal depression
● The American College of Obstetri-
medical homes. In such settings, social screening guidelines in the state
cians and Gynecologists recom-
work staff or mental health providers, budget.
mends psychosocial screening of
who are colocated in the practice as ● Parental Depression Screening for pregnant women at least once per
part of the care team, can provide im- Pediatric Clinicians: An Implementa- trimester (or 3 times during pre-
mediate triage for positive screening tion Manual, by Ardis Olson, MD natal care) by using a simple
results, support and follow-up for (available on the Commonwealth 2-question screen and further
mothers, and linkage and referral for Fund Web site at (www.cmwf.org): screening if the preliminary
more specialized services. Colocated In her studies, Olson has found that screen result indicates possible
and integrated mental health provid- a 2-question paper-based screen, depression.49
ers can perform secondary screen- followed by a brief discussion with ● The National Women’s Health Infor-
ings and collaborate with the PCP for the mother and the pediatrician, mation Center (www.4women.gov)
ongoing care. was both feasible and effective in is a federal government source for
Concurrent with the implementation of identifying women who needed women’s health information.
screening, the practice needs to iden- follow-ups or referrals. One of the
tify support and intervention re- studies examined the difference be- SUMMARY AND CONCLUSIONS
sources, both within the practice and tween a verbal interview and a pa- The primary care pediatrician, by vir-
in the community. Although it is often per form; the paper screen was tue of having a longitudinal relation-
the case that PCPs do not perceive that found to be far more effective.35,47,48 ship with families, has a unique oppor-
there are resources in the community, ● Depression During and After Preg- tunity to identify maternal depression
many public and private resources nancy: A Resource for Women, Their and help prevent untoward develop-
may be discovered in the process of Families, and Friends (www.mchb. mental and mental health outcomes
engaging community partners. Net- hrsa.gov/pregnancyandbeyond/ for the infant and family. Screening
working with community providers depression): This Web site has infor- can be integrated, as recommended by
may be a new activity for a primary mation for the woman and/or her Bright Futures and the AAP Mental
care practice. It can be accomplished family about the definition and Health Task Force, into the well-child
by invitation to a lunch meeting at the symptoms of postpartum depres- care schedule and included in the pre-
practice to discuss the planned sion and when to seek treatment. natal visit. This screening has proven
screening and referral activities, or a ● National Center for Children in Pov- successful in practice in several initia-
larger meeting called by a group of erty, Project Thrive (www.nccp.org): tives and locations and is a best prac-
practices may be possible. Sending out The Public Policy Analysis and Edu- tice for PCPs caring for infants and
a brief inquiry or survey to local men- cation Center for Infants and Young their families. Intervention and refer-
tal health providers or family support Children at the National Center for ral are optimized by collaborative rela-
groups may yield additional contacts. Children in Poverty has as its core tionships with community resources
Partnering with parents in finding mission increasing knowledge and and/or by colocated/integrated primary
community resources is the essence providing policy analysis that will care and mental health practices.
of the medical home. help states build and strengthen LEAD AUTHOR
comprehensive early childhood sys- Marian F. Earls, MD
MODELS AND RESOURCES tems and link policies to ensure ac- COMMITTEE ON PSYCHOSOCIAL
● Virginia Bright Futures has a train- cess to high-quality health care, ASPECTS OF CHILD AND FAMILY
ing Web site and has developed a early care and learning, and family HEALTH, 2009 –2010
new parent kit that includes infor- support. The National Center for Benjamin S. Siegel, MD, Chairperson
mation on perinatal depression and Children in Poverty has a document Mary I. Dobbins, MD
Marian F. Earls, MD
is given to 70% of new parents. Vir- entitled “Reducing Maternal De- Andrew S. Garner, MD
ginia Bright Futures partnered with pression and Its Impact on Young Laura McGuinn, MD
PEDIATRICS Volume 126, Number 5, November 2010 1037John Pascoe, MD Mary Jo Kupst, PhD – Society of Pediatric CONSULTANT
David L. Wood, MD Psychology George J. Cohen, MD
D. Richard Martini, MD – American Academy of
LIAISONS Child and Adolescent Psychiatry STAFF
Robert T. Brown, PhD – Society of Pediatric Mary Sheppard, MS, RN, PNP, BC – National Karen S. Smith
Psychology Association of Pediatric Nurse Practitioners ksmith@aap.org
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