During my vacation, Leah DeCesare from Mother’s Circle has been kind enough to write a guest post about an important topic. Enjoy!
How Pregnancy and Postpartum are Affected by Eating Disorders
by Leah Decesare,
Over the course of a single spring, I worked with three women struggling with postpartum anxiety. During our time together, I learned that they all had a history of eating disorders. This connection motivated me to research and talk to women about how eating disorders affected their pregnancy and postpartum experience. [Names have been changed.]
Eating Disorders as Related to Childbearing
The two most common eating disorders (EDs) are anorexia nervosa (AN) and bulimia nervosa (BN), estimated to affect 5 – 10 million females in the United States. Approximately 4.5% – 9% of women of childbearing age have a past or active eating disorder. AN is characterized by extreme calorie restriction, obsessive dieting and loss of periods. Symptoms of BN include repeated episodes of binge eating followed by purging, fasting, excessive exercise and abusing laxatives, diuretics and enemas. Both experience extreme fear of weight gain and distorted perception of body image.
Women struggling with EDs often exhibit perfectionism, obsessive behavior, extreme sensitivity, seriousness, anxiousness, self-consciousness, impulsivity, a feeling of being out of control, negative self image and a high level of self-blame. There is a strong correlation among perfectionism, anxiety and eating disorders.
While there are some contradictory study results, EDs have been linked to maternal and fetal risks including excessive vomiting during pregnancy, cesarean section, postpartum depression/anxiety, anemia, hypertension, pre-eclampsia, miscarriage, intrauterine death, preterm delivery, breech presentation, low Apgar scores, low birth weight, fetal growth restriction, small-for-gestational-age infants and slow weight gain.
Research also indicates a significantly greater incidence of anxiety and depressive disorders in women with EDs than in the general population. Shame and guilt about their illness can cause secretiveness, denial of a problem or reluctance to disclose symptoms to providers.
Eating Disorders and Pregnancy
Studies indicate that many women with EDs have a temporary remission during pregnancy which changes in the third trimester and the first three to six months postpartum, when symptoms often reemerge more severely than before pregnancy.
Women suffering with EDs fear losing control of eating and weight, causing damage to their baby and worry about being unable to cope. They often have unrealistic, idealized expectations of motherhood.
Postpartum Adjustment in Women with Eating Disorders
Studies show the majority of mothers with EDs have less favorable maternal adjustments and that attachment can be impaired.
Jennifer said that she felt bonded with her baby at the hospital, but “as soon as I realized that she was going to be a burden and that my life wasn’t going to be the way it was and how much it was going to change, I couldn’t connect with her. I don’t remember when that changed. I have regrets about how I spent the first couple of months.”
Heather, another mother afflicted with disordered eating and anxiety, described her experience of new motherhood saying, “I didn’t expect it to be such an assault on our marriage, an assault on everything that you know.”
With greater adjustment difficulty, the incidence of postpartum moods disorders rises.
Infant and Child Feeding in Women with Eating Disorders
Some studies indicated that women with EDs were less likely to breastfeed fearing changes in body shape, yet greater awareness that breastfeeding quickens weight loss can prompt women to breastfeed. Many women with EDs report low desire to breastfeed and many have difficulties when they try. Weaning is a cautionary time as they are vulnerable to binge eating and starvation.
Regarding feeding, Heather lamented, “I have to be concerned with what she’s eating and what I’m eating. When I’m really anxious, my hunger cues go away or I ignore them.” Jennifer commented, “I cannot totally separate it, when I’m feeding Sally, I’m over-worried about giving her a variety.”
When Sally was five months old, a doctor commented about her being chunky, which created angst and Jennifer started to reduce the number of daily bottles. Research found that 50% of mothers with EDs report being concerned their child will become overweight.
What Can Help?
How are you feeling as your body is changing with pregnancy? Do you have a history of anxiety, depression, or eating disorders? Do you have an exercise routine? Are you able to sleep/eat when the baby is sleeping?
Simply being aware can help a family, or Mom, seek needed extra support.
At risk Moms should prepare prenatally. Find a lactation consultant if you plan to breastfeed, join a new mom’s group, hire a birth and/or postpartum doula to help you transition confidently to motherhood. Jennifer said her new mom’s group “was very helpful. It was so nice hearing other moms feeling the same way I did. It was something to look forward to.”
Learn and practice techniques to relieve stress. Be aware of the signs of postpartum mood disorders and talk with a counselor before birth. Use the Edinburgh Postpartum Depression Scale to self-screen. Seek out nutrition and exercise education and support.
It is especially important for Moms with a history of, or active, ED to have realistic expectations and to make the baby as real as possible early in pregnancy. Take time through reading, classes, and talking to new parents, to expose the reality of life with a newborn.
Other effective strategies include cognitive behavioral therapy (CBT), medications, relaxation, meditation, yoga, and fish oil. Seek opportunities to explore worries and triggers for unhealthy behaviors and actively enlist a multidisciplinary support system.
Low spousal support is a risk factor in postpartum relapse of EDs. A Mom with an ED must set positive and healthy goals and strategize paths to achieve them; reaching goals can help nurture a sense of control and confidence in her ability to be a mother.
At prenatal checks, a Mom may decide whether she’d like to know her weight, if she prefers not to know, she should request to be weighed with her back turned.
She says she would have benefited from a direct approach of having someone prepare food, take the baby and have her sit to eat three times a day. “I felt pressure to eat, pressure to nourish someone else, I was too anxious to even swallow.”
Jennifer also said that having someone make food for her and caring for the baby while she ate helped her and she ate more at those times.
Mothers with EDs may need assistance improving their ability to recognize and respond to their child’s cues. It’s a Mom’s job to serve a variety of healthy options and it’s their child’s job to decide what and how much they will eat.
Breastfeeding difficulties often accompany EDs and it may be helpful for a Mom to have “permission” to stop nursing. Heather told me, “I did not like breastfeeding and the stress of being on the clock and being the only person to feed her, but I needed the assurance that it was okay not to breastfeed and that I would still be a good mom.”
The history or presence of an eating disorder in expectant and new mothers can create a multitude of issues that hinder the confident and strong basis of a new family.
Support is vital. Practical and emotional support, reassurance and praise for learning to be a capable parent are critical elements that benefit any new Mom, but are imperative for a new Mom with an ED or history of an ED.
Astrachan-Fletcher E, Veldhuis C, Lively N, Fowler C, and Marcks B. 2008. The Reciprocal Effects of Eating Disorders and the Postpartum Period: A Review of the Literature and Recommendations for Clinical Care. Journal of Women’s Health. 17(2):227-239.
Bansil P et al. 2008. Eating Disorders among Delivery Hospitalizations: Prevalence and Outcomes. Journal of Women’s Health. 17(9):1523-1528.
Cantrell C, Kelley T, and McDermott T. 2009. Midwifery Management of the Woman With an Eating Disorder in the Antepartum Period. Journal of Midwifery & Women’s Health. 54(6):503-508.
Koubaa S, Hallstrom T, and Linden Hirschberg A. 2008. International Journal of Eating Disorders. 41(5):405-410.
Leddy M, Jones C, Morgan M, Schulkin J. 2009. Eating Disorders and Obstetric-Gynecologic Care. Journal of Women’s Health. 18(9):1395-1400.
Martoz-Ordonez C. 2005. Pregnancy in women with eating disorders: a review. British Journal of Midwifery 13 (7):446-448.
Mazzeo S et al. 2006. Associations among Postpartum Depression, Eating Disorders, and Perfectionism in a Population-Based Sample of Adult Women. International Journal of Eating Disorders 39(3):202-211.
Stein A, and Fairburn C. 1996. Eating Habits and Attitudes in the Postpartum Period. Psychosomatic Medicine. 58:321-325.
Swinbourne, Jessica M. and Touyz, Stephen W. 2007. The Co-Morbidity of Eating
Disorders and Anxiety Disorders: A Review. European Eating Disorders Review
Leah DeCesare has been working with childbearing women and their families since 2002. Leah writes about perspectives on parenting from pregnancy through teens at www.motherscircle.net. In 2008, she co-founded Doulas of Rhode Island to provide support among doulas in the state and to educate the community about doulas. She serves on the DONA International Board as Northeast Regional Director and is a certified birth and postpartum doula, certified childbirth and postnatal educator and Certified Lactation Counselor. She is married and the mother of three children.
Last week, we reviewed the first eight affirmations from the Help 4 Your Family blog. This week, we can review the most recent seven affirmations. To review the context of the affirmation, you can click on the one you want. Enjoy, and please feel free to share the one you picked and why, or to share a different one that you use.
- I am impeccable with my words.
- I love the experiences, values, and principles that make the family I am creating unique. We celebrate our differences.
- I maintain healthy boundaries with my children.
- I nourish myself by joyfully eating healthy foods and sharing them with my family.
- I show my children how to love themselves and care for their body by exercising in ways I enjoy.
- I pay attention to my breathing. I am thankful for each breath.
- I care more about my child (or husband/wife, etc) than I care about this conflict.
For the next two weeks I will be on vacation, including a vacation from blogging. In the meantime, I thought this would be a good time to pick one of the affirmations we have worked on so far that might need reinforcing, or, if you are new, to catch up on the parent affirmations. This Monday, you will get the first eight to choose from. If you click on the one you want, it will take you to the original post in case you need to remember the context. Please share which one you chose in the comments. I would love to hear. Is there another affirmation you use that you would like to share? If you do, you might see it featured (crediting you of course) another week. Here goes, I hope you enjoy
- My children give me constant opportunities to learn and grow.
- I give my children age appropriate time and space to solve their own problems.
- Everything is happening at just the right time.
- I allow my child to explore his or her own unique talents and abilities. I work on finding mine as well.
- I give myself and my children realistic expectations for managing time.
- I am open to finding creative solutions to any problem.
- My children and I delight in each other, and in ourselves.
- I am letting go of anger and resentment. I allow myself the freedom of forgiveness.
Written by, Kate Oliver, MSW, LCSW-C
Based on a question I had from my parent affirmation about breathing last week, and because I teach people the mechanics of breathing several times a week, I decided to take a moment to really break this breathing thing down for everyone. Breathing is the first step in getting connected to our bodies and what our body is telling us. Before you think that you already know how to breathe, take a moment to ask yourself whether there were any times in the last week where you noticed you had been hungry and meaning to eat for several hours but did not get around to it. Or, alternately, did you find yourself mindlessly eating away at your child’s leftovers as you were doing the dishes? Maybe you realized you needed to go to the bathroom and just did not give yourself the time to take a quick break. If you did any of those, that indicates is that you, like most everyone else, have learned the art of neglecting your body. You or your child may have especially mastered this art if either of you has a history of abuse or neglect. In order to survive ongoing childhood trauma, people tend to cope by overriding their body’s system for communicating in order to survive the abuse. Anyone with a history of neglect, never learned to listen to their body in the first place. After all, babies learn to continue voicing discomfort because when they do someone responds with caring and, typically, an explanation. It usually sounds like, “Awww, what’s the matter? Are you hungry? Is your diaper wet?” Even before we understand this, we get the message that what we feel matters and that listening to our bodies is important. The attachment disturbed children I see have unlearned this lesson to the point that most of them have an issue with bed or daytime wetting, or soiling. They have learned to take on the neglect that was dealt to them in early childhood. The first step to getting reconnected to your body is paying attention to your breath.
Even if you do not have a history of trauma or neglect, I would argue that the vast majority of us have seen the art of listening to our bodies become devalued over the course of our lives. We are encouraged to “push through” pain, to “get over” discomfort, and to wait or delay gratification. These values all have their place. I’m certain Olympic athletes, world leaders, and good parents are required to do all of these things to one degree or another. Still, taking time to check in with the body that supports your ability to selectively push through, delay gratification, etc. is only fair, and in that spirit, I would like to teach you the art of breathing, which you may have forgotten since infancy.
In a recent training I went to with Pat Ogden, a well-known expert in somatic (body) psychotherapy, she said that our bodies predict what our brains think is going to happen next. Think about that for a moment. What does a child standing like this think is going to happen next?
How about these children?
Our breath predicts what we think is going to happen next as well. In fact, it gives our body a message about preparing for the next step. To get connected to your breathing, take a moment, without trying to change anything, to pay attention to your breathing. Which part of your body moves when you breathe? Is it your chest? Your shoulders? Your tummy? Your ribs? Most of the traumatized children I see are breathing from their shoulders. Whether or not you were breathing from your shoulders, take a moment to try it. How does it feel? When I say breathing from your shoulders, I mean that when you take the breath in, your shoulders rise. Some might also say it is breathing into your chest. You feel your chest expand, and your shoulders rise. Try that for a moment and see what emotions come up.
Now try this. When you breathe in, think about breathing all the way to your belly. In fact, put one or both hands on your belly. When you breathe in, think of filling your belly with air, like a balloon. When you breathe out, think of letting the air out of the balloon. This may feel awkward and take a moment if you are not used to it. Breathe in, fill the balloon. Breathe out, let the air out of the balloon. You may also feel your ribs expand a bit when you breathe this way. How do you feel now?
Why does the way you breathe matter? Just as the way you hold your body predicts the future, so does the way you breathe. When people breathe from their shoulders, it sends a signal to your body much closer to a fight/flight or freeze reaction. Think of how you would take in a breath just before a car hits your car, or how you breathe when you just went for a strenuous run. You breathe to your chest or shoulders. Your body is working hard to protect you at those times. Now think of how you breathe just before you are going to drift off to sleep. Or, if you have one handy, watch a relaxed baby. You will notice the breaths are belly/ rib cage breaths as opposed to shoulder/chest breaths. This signals to your body that you are calm, and that there is nothing to fear.
The first step to training your body into understanding that it is not under siege is paying attention to your breath. I teach my clients to do it. I encourage you to do it. I encourage you to teach your children to do it if you see they are struggling. I find simply noticing that a child needs to try a new way of breathing can help to ease anxiety. I introduce it by saying something like, “Can we try something?”or “I’m curious about something. Can we do an experiment?” Then I ask them to play around with their breathing, the same way I asked you to. It often changes the feelings in the room from tense to more relaxed. If the mood goes back to tense, I simply notice it out loud, “Wow, look, as soon as we started talking about that your breathing went back to the old way. What happened?” It gives me the opportunity to help a child or adult explore the feelings that go with the breathing and to teach a way to disconnect from the old intensity of the emotion that goes along with whatever they are remembering or anticipating.
Have you tried this exercise? How has it worked for you?
Written by, Kate Oliver, MSW, LCSW-C
I care more about my child (or husband/wife, etc) than I care about this conflict.
How often do we get into it with our kids over something little? Do you argue with your child about the right way to do something, or getting it done the way we want them to do it? This week, I am challenging you to pay attention to how much you do this and whether you may be able to pull back that behavior a little bit to allow your children (or your spouse) to do it their way.
A recent study came out that says that mothers who feel as though they are the most essential component of their child’s life (over fathers even) are more likely to feel overwhelmed and depressed. When we seek to control the actions of others (even our children), we are certain to get into a power struggle. Yes, common parent knowledge these days says that if you give an order, you must follow through. But how often are we demanding that things must be done only our way? There is a happy medium between the constant negotiations we know children are capable of and completely avoiding all conflict. Let’s try to find that for you with your children and with your adult relationships.
I distinctly remember when I realized my husband does some things better than I do with the children. Honestly, I was a little put off. My inner critic wanted to tell me I should know how to do everything better- being a child therapist and all, but, guess what? He is better at playing with them, joking them out of a funk and getting them into and out of the bath without argument among other things. This week, be open to the possibility that children and significant other adult relationships may do things differently in a way that might be just as good, or better than you expected.
- Raising Successful Children (nommimarlik.wordpress.com)
- Mother is Best? Why “Intensive Parenting” Makes Moms More Depressed (healthland.time.com)
When one of my mentors, Louise Fleischman, recently wrote and published her book, Rufus the Rapper (illustrated by Laurie Barrows), I was excited to get to read and review it. I first met Louise in 2003 as a participant in a year-long externship on attachment disorders that she and other staff developed at a local adoption agency. Louise has since opened a private practice in Howard County, Anchor Counseling & Training, and we continue to collaborate professionally. I think she is among the best in the field of clinicians working with attachment disordered children and their families. Louise and I are both find storytelling to be a wonderful way to help children to acknowledge their own struggles and find a way to see a better future.
Rufus the Rapper is a story about a dog that has a history of abandonment, abuse and neglect. He, like most of the children I have worked with, has little understanding of the hows and whys of all that has happened to him. Rufus learned to adapt by engaging in unpleasant behaviors designed to keep others, especially caregivers at bay. Through the gentle care of a family, Rufus finds a way to learn to connect again.
This book is a great book for children of all ages (I even use books like this with teenagers) who have been through the foster care system and/or who have been adopted at an older age and their siblings- even siblings without the same experience. It is also good for any children in families that care for abused or traumatized animals and is really safe story for all children to read as a way to help children build empathy for pets and people who have had a difficult road. With a non-threatening story with a non-judgmental stance toward Rufus, the story clearly shows how it is that animals and children sometimes take on undesirable behaviors in their efforts to survive. Unlike other adoption and foster related stories, Rufus does not sugar coat the harsh reality for a dog or child who has ambivalence about being adopted, nor does it paint a pretty picture that says that once he was adopted, everything was fine. Although parents of children adopted at an older age will wish it only took three weeks (like it does for Rufus) for the undesireable behaviors to subside, children will recognize themselves in this story and reading it with a child can lead to some great conversations and give kids a means to describe some of their experiences.
You can find out details for purchasing Louise’s book by clicking on the Amazon Widgets button at the top right of this page,* and you can contact Louise via email: Lfleischman1@comcast.net. She is an excellent clinician located in Woodstock, Maryland.
The Spectrum of Attachment (help4yourfamily.com)
Kate Oliver, MSW, LCSW-C
I usually get an eye-roll when I mention the idea of breathing or paying attention to one’s breathing in my office. It is so simple. We all breathe all day, everyday. As my dad would say, “It’s better than the alternative.” This week, I want to give you a simple task to go along with your affirmation. Pay attention to your breath. Notice how you are breathing at different times of the day. If each breath is felt most in your shoulders, try taking in a breath that fills your belly like a balloon, then lets the air out of the balloon. It only takes a moment.
Take a deep breath- through your nose if possible- and let it out slowly. You can even try the trick my meditation teacher taught me called the “mindsweep.” When someone has entered your space and left a bad feeling behind- you know, when you were fine when they walked in the room then not so fine after they have left, it means you took on some of their feelings, like anxiety, depression, anger, etc. This is what the mindsweep is for. Turn your head to the left. Take a deep breath in, telling yourself that you are breathing in to remind yourself who you really are. Hold the breath as you turn your head to the right. Once you are looking to the right, imagine that you are blowing their stuff right back out of you as you breath- or blow- out.
Just paying attention to your breathing is a form of body regulation. You can lower your heart-rate, increase oxygen intake, and reduce stress all with simple breaths.
I pay attention to my breathing. I am thankful for each breath.
If you would like, you can say the first sentance as you breath in and the second as you breath out to make a little feel-good meditation.
We can see how this helps you, but how does it help your children? When you regulate your body, you are teaching them to regulate their bodies. When they see you taking a deep breath as a way to stop from yelling, they will take on this behavior as well. Once you get good at this, you can teach them to breath deeply too and to pay attention to their breaths.
- 5 Ways to Return to Mindfulness with Your Children (meghannathanson.com)
Written by, Kate Oliver, MSW, LCSW-C
In last’s week’s post, I wrote about the underlying causes of children behaving in a nasty way toward adults. This week, I want to look at some ways I have found to address this behavior with children that can help them learn to change the way they speak to you and other adults. As I stated in my previous post, in order to know how to resolve an issue, knowing the origin of the issue is incredibly helpful. If, for example, the origin of your child’s nasty behavior has to do with being hungry or tired, then obviously, you get them some food (preferably one with protein, that regulates low blood sugar like a piece of fruit with plain greek yogurt, or veggies and dip), or make sure they get some rest. But what about when it is not a case of being hungry or tired? What if your child is in perfect health and they are just being rotten toward you? For young children, there is always distraction. Below are some other ideas to help you motivate your child to turn their behavior around. You may find one or a combination of several of them to be helpful. I cannot give you the answer because our children are not cookie cutter kids. Each child is different. Also, keep in mind that it is unrealistic to believe that you can always fix things for your child and sometimes, just like with adults, kids are just going to be in a bad mood, and the goal is not to put them into a good mood but to teach that when you are in a bad mood you want to do the least damage possible to relationships.
- Empathy. Empathy is when you let your child know you get how they feel. It’s when you remember a time you felt pretty rotten even if it didn’t make sense and you realize that if your child is feeling that way it is because they do not realize at that moment that they have another choice. Empathy does not mean telling a long story about when you felt the same way (a short one might work). It means having a moment where you genuinely connect with the way your child is feeling and express that you know they are having a hard time.
- Remind your child that they have a choice other than feeling spiteful and spreading the feeling out toward others. I detailed this technique in this post. Reminding your child they have another choice does not include lecturing them about how great they have it and how they should feel better than they do. When someone is stuck on the idea of feeling nasty, that lecture will have the opposite effect.
- If you believe there is a bigger, underlying issue that has them feeling mean, then later, when they have cooled down, try having a conversation about what happened and be curious about where the behavior came from. Think of saying something closer to, “Wow, I was worried about you earlier today when you said you hated me. You must have been so angry. Where did that come from?” A curious tone during this conversation will work better than a disciplinary one. This is especially true for children with attachment and trauma issues but it really works for all children. After all, if someone comes at you with a “what is your problem?” attitude, how likely are you to let them into your inner world where you may be feeling pretty vulnerable? I’m guessing someone expressing concern over your behavior is more likely to get, and keep, you talking than someone speaking to you in a judgmental tone. For this conversation, try questions or comments that start with, “I wonder what,” “I was confused by,” and “I’m curious about,” over questions that start with “Why did you.” This is a great conversation to have in the car alone with your child. Cars give children the ability to process with you while you are not looking directly at them. You can always pull the car over if the conversation turns into one that might be better off face to face.
- Teach your children how to treat you by modeling how you want to be treated when the nasties strike you- let’s not pretend that they don’t okay? Tell kids you need to walk away for a minute before you say something you are sorry about, apologize for poor behavior on your part, let children know your mood is not about them (if it is not), avoid blaming in the midst of anger. After your child has had a case of the nasties and you have debriefed them, tell them how you felt when they said or did what they said or did. Suggest things that could help you feel better, and allow children to make amends when you are ready- sometimes that won’t be right away.
- Be an active listener. What is your child really trying to say? Are they telling you that they need more time with you? Are they telling you that something is scary for them? State your belief to them, “I know you are so disappointed you can’t go to your friends party and you think I don’t understand how hard that is for you.” You might be amazed at what just saying something that shows you are listening can do. After all, if your child wants something and you ignored them, it would be a very rare occasion for them to just walk away without trying to repeat the request, usually at increasing volume until they feel heard. The older children get, the more they really want to be heard and you can show them you are listening by saying back what you heard. Sometimes you may find what you thought you heard was not what they were trying to say at all. Wonderful! By saying what you thought you heard and finding you were wrong, you get to know your child even better. Harvey Karp from “Happiest Toddler On the Block” suggests getting on your child’s level and matching their intensity with their voice and even their facial expression while you tell them what you are hearing. I have seen this snap a teenager out of a tantrum as well. After you have addressed the message, and your child has calmed down you can have the discussion about how they can tell you differently next time.
- Try to use the suggestions from my post Trash Your Behavioral Charts! by making a chart for yourself where you earn points by handling your child’s nasty behavior so you can go out and take care of yourself.
- Getting your child on a regular exercise routine doing something they enjoy and making sure they are eating a healthy diet are both wonderful overall approaches for avoiding the nasty behavior in the first place.
- Another approach could be to catch your child off guard. If you know your child is getting ready to throw a tantrum, calmly observe that you are expecting them to throw a tantrum. After all, if they are angry with you, they do not want you to be right about them, they may stop themselves just to spite you.
By making these suggestions, I want to be clear that my motive is to help you and your child get through the nasty behavior with the fewest regrets possible. I am not suggesting that the interventions I have recommended need to be the end of the discipline. In some cases they will be and others they will not depending on how far the behavior goes with your child and what your parental beliefs about discipline are. I also want to make sure you know that I believe whole-heartedly both as a clinician and a parent that we must be allowed to show negative emotion. My suggestion is not to thwart negative emotions, it is to suggest meaningful alternatives to behaviors that can be associated with anger, jealousy, frustration, irritation, etc. What are some ways you have ended the nasties?
- Taming the “Nasties” in Your Children- Part 1 (help4yourfamily.com)
- This is your brain on attachment
- Last Chance for Two Great Opportunities
- Mother’s Retreat Weekend- It’s Really Happening!
- Stopping the Parent Shame and Blame Game
- Making Peace With Your Inner Critic
- Putting together something fun for you!
- Quick Jobs for Kids
- Staying Strong as a Couple
- Letting Go of the Parent You Thought You Would Be
- Add a Little Awe to Your Life
- Upcoming Trainings
- Older Kids with Bathroom Issues: Why Does it Happen? How Can You Help? Part 2