With many grandparents baby-sitting their grandchildren during the day, researchers from the Johns Hopkins Bloomberg School of Public Health wondered whether those children might be at a higher risk of injury in the care of older people whose parenting lessons were learned in an era where car seats weren’t the law and child-proofing wasn’t a multimillion-dollar industry.

The findings, published yesterday in the journal Pediatrics, surprised its authors. In some cases, working parents who chose to have grandparents care for their children cut the risk of childhood injury in half. Even when compared with organized day care or care by the mother or other relatives, having a grandmother watch the child was associated with decreased injury for the child.

“There are some grandparents you would not leave alone with grandchildren,” he said. But “you’re not going to hurt them if you do the right selection.”

Among other findings: The odds of injury were greater among children of parents who never married compared with those whose parents stayed married. The odds of injury were greater for children living in homes without their father.

Bishai and colleagues analyzed data collected about more than 5,500 newborns in 15 U.S. cities in 1996-1997, with a follow-up 30 to 33 months later. Bishai said he does not know whether the information would be different had it been collected more recently.

Delores Miller, 63, said she gladly volunteered to provide child care for her granddaughter Imani when Miller’s daughter returned to work at a Baltimore credit union. She bought Imani a toy mop, broom and vacuum so when it was time for housekeeping they did it side by side. And during trips to the grocery store, she made sure Imani always stayed close.

“Children can get more one-on-one attention, rather than in a group of people,” said Miller, who cared for Imani for six years until she started first grade this fall. “Imani was more familiar with me than anyone else. I know more about her behavior and well-being than any stranger would.”

Source: Baltimore Sun, United States
http://www.baltimoresun.com/news/health/bal-te.grandparents04nov04,0,6701080.story

St. Louis University researchers have received a three-year, $1 million grant from the Centers of Disease Control to expand their education of doctors about the risks of drinking during pregnancy and fetal alcohol syndrome.

“Drinking during pregnancy increases the risk of birth defects, which have lifelong consequences and can easily be prevented,” said Leigh Tenkku, an assistant professor of family and community medicine at the university. “It is very important to get the message out to health care professionals and to include this information in academic training settings.”

Research has shown that advice from doctors and nurses is one of the most influential factors in determining whether or not women drink during pregnancy. Yet many health care professionals are uncomfortable talking to their patients about alcohol use, are unsure about current guidelines or lack the necessary resources, Tenkku said.

“Only 50 percent of health care providers give information about the consequences of drinking during pregnancy to all patients,” Tenkku said. “Our goal is to educate as many health care professionals as possible about the very real dangers posed by drinking during pregnancy and enable them to help their patients.

In 2002, St. Louis University worked with the University of Missouri–Columbia and St. Louis Arc to establish the Midwest Regional Fetal Alcohol Syndrome Training Center to educate health care professionals and students. The grant will allow the center to set up satellite faculty teams in each of the eight Midwest states served by the center, including Illinois. (…)

Source: Belleville News Democrat, USA
http://www.bnd.com/living/health/story/529994.html

It is a question which worries every parent – what is the best way to prepare your child for their first day at school?
Now a psychologist has devised a checklist of 22 skills she believes children need to learn before beginning their formal education.

According to her findings, nearly half of parents would like more advice and information to prepare children for their first day at school.

Fewer than one in six parents have a clear idea about this, while one in five said they had no idea what skills children should have by the age of four or five. Only 18 per cent said they knew where to go for official advice.

Dr Spencer said: “Ensuring a child is adequately prepared for school is one of the most important things parents have to do.

“But it can be very challenging and daunting if the guidance and information needed is not there.

“A lot of the available material on pre-school development is focused on teaching child carers the skills, but can be difficult for parents with young children to access and understand.”

The list of suggested skills, called the Curricu-mum, was commissioned by the children’s television show Hi-5 which is designed to reflect pre-school learning guidelines.

Cecilia Persson, programme director for the Cartoonito network, which broadcasts Hi-5, said: “We believe the Hi-5 Curricu-mum is exactly what parents of pre-school children have been looking for.”

The list suggests that by the time they start school, children should be able to recite the alphabet, to count and use number and to write their own names. It also suggests children should know how to share, how to play with others and be able to dress and feed themselves.

It also claims children should be able to join in conversations, learn to sing songs, know which foods are healthy and be able to differentiate between past and future events and actions which are right and wrong.

However, Judith Gillespie, development officer for the Scottish Parent Teacher Council said she was concerned the list could create more anxiety and pressure for parents of young children.

“To a parent that is an incredibly daunting list. I think the trouble is it will make some parents feel like failures,” she said.

“Saying these are things children should be able to do is incredibly unhelpful. It would be more helpful to say that these are the kinds of things that many children learn to do before they start school. Children learn differently and develop differently and making it a requirement that they should be able do all these things is very bad news.”

Ms Gillespie said teachers did not expect children to learn the alphabet or to be able to count and use numbers before they started school and the list did not take into account the fact that boys tend to be more boisterous and learn at a different pace.

“In many respects, the most important things on the list are social skills like sharing – it is far more important that children go to school with social skills.”

Alphabet and dressing among 22 target tasks

These are the 22 tasks the report says children should be taught by the time they reach school.

1 Write their own name – a useful skill that helps confidence.

2 Know the alphabet. Being able to recite the letters of the alphabet will be a help when children begin to learn to read and write.

3 Sing/recite songs. Learning simple songs and rhythms helps children develop their learning skills.

4 Take turns and share with other people without a fuss. Learning to get along with other children is crucial.

5 Complete simple activities on their own.

6 Be sensitive to others’ feelings and know the difference between right and wrong.

7 Dress and feed themselves (even if they get it wrong).

8 Join in group activities with other children.

9 Make up stories (even if they make no sense).

10 Join in general conversation at home.

11 Tell the difference between past and future.

12 Be able to focus their attention on one thing for a prolonged period without becoming restless.

13 Count basic numbers and answer number-based questions such as: “How many carrots are on your plate?”

14 Complete simple puzzles such as jigsaws.

15 Ask lots of questions. Curiosity is a great asset in a pre-school child.

16 Know the difference between different groups; eg cats and dogs.

17 Experiment with basic technology, such as typing their name on a computer.

18 Have fun outside and be active.

19 Tell the difference between healthy and unhealthy foods.

20 Play “make believe” and use imagination.

21 Make things and get messy with paints and crafts.

22 Make music with toy instruments and experiment with different sounds.

Source: Scotsman, United Kingdom
http://news.scotsman.com/latestnews/The-key-skills-that-make.4652933.jp

The number of children who take medication for chronic diseases has jumped dramatically, another troubling sign that many of the youngest Americans are struggling with obesity, doctors say.

The number of children who take pills for type 2 diabetes — the kind that’s closely linked to obesity — more than doubled from 2002 to 2005, to a rate of six out of 10,000 children. That suggests that at least 23,000 privately insured children in the USA are now taking diabetes medications, according to authors of the new study in today’s Pediatrics.

Doctors also saw big increases in prescriptions for high cholesterol, asthma and attention deficit and hyperactivity. There was smaller growth for drugs for depression and high blood pressure.

“We’ve got a lot of sick children,” says author Emily Cox, senior director of research with Express Scripts, which administers drug benefit programs for private insurance plans. “What we’ve been seeing in adults, we’re also now seeing in kids.”

Type 2 diabetes was once known as adult-onset. But Cox says her records show kids as young as 5 being treated with prescription diabetes drugs.

Cox based her study on prescription records of nearly 4 million children a year, ages 5 to 19, covered by Express Scripts. She says her findings may not apply to the 40% of children who are uninsured or covered by government health plans.

Unless these children make major changes — such as eating healthier and exercising more — they could be facing a lifetime of illness, Cox says.

“These are not antibiotics that they take for seven to 10 days,” Cox says. “These are drugs that many are taking for the rest of their lives.”

Cox couldn’t explain one surprising finding: Most of the increase in drugs for diabetes, attention deficit/hyperactivity and depression was seen in girls. The gender gap was most striking in diabetes: While the number of boys taking medication grew by 39%, the number of girls using them climbed by 147%, Cox found.

Source: USA Today
http://www.usatoday.com/news/health/2008-11-03-kids-meds_N.htm

Research shows that a walk in the park can be just as effective as drugs such as Ritalin for children with ADHD or excess energy levels.

It’s been a brilliant week off. Your children have adored Halloween; they’ve loved trick or treating, and have gorged themselves on sweets and goodies all week. You don’t mind. Isn’t that what the autumn break is all about? You may have noticed, though, that all the sugar has made your children hyper. It may have been tough getting them to relax and get ready for sleep.

And now that they’re back in their normal routine you need to calm them down a little, so they can concentrate through the school day.

Returning to a healthy diet helps. But what if your children remain hyper? What if their natural energy level borders on ADHD?

Attention Deficit Hyperactivity Disorder is a growing problem. Drugs such as Ritalin help ADHD children; and the number of children prescribed them has doubled in the UK since 2002.

New research, though, shows that there’s a more simple solution. And that a walk in the park is just as effective as a daily dose of drugs.

Walking

Researchers at the University of Illinois took 17 hyperactive children on a walk, dividing them between the park, a town centre and a residential area. They didn’t take their drugs that day, but those walking in the park showed hugely improved concentration. In fact, the effect was the same, or even better than the effect of their normal drugs.

“As little as 20 minutes in a park could potentially buy you an afternoon, or a couple of hours to get homework done,” said researcher Andrea Faber Taylor. And if it works for hyperactive children, think of the benefit to the normally boisterous child?

It’s something that Josephine Lara, mum to Thomas, 5, Max, 3, and Daisy, 8 months, has noticed.

“The boys have so much energy and sugar definitely makes them worse,” she says. “But if we’ve had a good walk, they are always calmer. I try to keep the TV off too. It can calm them down initially, but in the long run it makes them more hyper.

“The last Friday before Halloween the school said the children had eaten sweets all afternoon. I’d arranged to bring the boys to a playground. We were there for an hour and I didn’t have any problems with them. The parents who went straight home said their children were climbing the walls.

“We have family walks when we can. We’ll walk on a beach at Skerries or LoughShinny. Or we’ll go to a playground; there are some amazing ones around here; at Ardgillan Castle, Malahide and at Newbridge.

“We walk to school in the mornings. It’s not far and it’s a good start to the day. They’re allowed to run around at school — the Lusk Educate Together, so Thomas gets a good lot of exercise. And at home, if they’re hyper, I’ll send them out into the garden. That always helps.”

TOP REASONS FOR CHILDREN TO EXERCISE (From ACE- American Authority on Exercise)

1. Children who exercise are more likely to keep exercising as an adult.

2. Exercise helps children achieve and maintain a healthy body weight.

3. Regular physical activity helps build and maintain strong, healthy muscles, bones and joints.

4. Exercise aids in the development of important interpersonal skills.

5. Exercise improves sleep.

6. Research shows that exercise promotes improved school attendance and enhances academic performance.

7. Children who exercise have greater self-esteem and better self-image.

8. Exercise prevents or delays the development of many chronic diseases, including heart disease, diabetes and obesity.

Source: Herald.ie, Ireland
http://www.herald.ie/lifestyle/health-beauty/better-than-ritalin-1518888.html

Babies are a lot more perceptive than we think, who begin processing language much before they start articulating by 12 months. By then they already know hundreds of words.

A study by Pennsylvania University (PU) psychologist Daniel SwingIey said infants have a unique ability to discriminate speech-sound or phonetic differences, but over time they lose this skill for differentiating sounds in languages other than their own.

For example, six-month-old babies who were learning English were able to distinguish between similar-sounding Hindi consonants not found in English, but they lost this ability by the time they were 12 months.

Since the 1980s it has been known that infants start focusing on their language’s consonants and vowels, sometimes to the exclusion of non-native sounds. More recently, researchers have increasingly focused on how infants handle whole words.

Recent research has shown that during infancy, babies learn not only individual speech sounds but also the auditory forms of words; that is, babies are not only aware of the pieces that make up a word, but they are aware of the entire word, said a release of PU.

These auditory forms of words allow children to increase their vocabulary and help them to eventually develop grammar. Although they may not know what the words mean, children at eight months start learning the phonological (sound) forms of words and are able to recognise them - and just being familiar with the words helps increase the children’s vocabulary.

Studies have shown that 18-month-old children who are familiar with a word’s form are better at learning what it means and are also able to differentiate it from similar sounding words.

Knowing word forms may also contribute to children’s inferences about how their language works. For example, 7.5 month olds do not recognise words as being the same if they are spoken with different intonations or by a man and a woman.

However, by 10.5 months of age, babies recognize the same words despite changes in the speaker or the intonation used. Another interesting finding was that although children learning a language can distinguish between long and short vowels, they interpret this difference according to the rules of their language.

For instance, Dutch 18-month-olds considered tam and taam to be different words, while English 18-month-olds did not - showing children’s early learning of how each language uses vowel length.

This new research in language acquisition indicates that infants learn the forms of many words and they begin to gather information about how these forms are used. (…)

Source: Siliconindia.com, India
http://www.siliconindia.com/shownews/48251

I’m no authority on all kids. I only know my own.

But from observation, I have deduced a secret “kid language” exists that they sometimes speak and comprehend that makes (at best) surface sense to any adult.

Actually, that isn’t accurate. Any adult would be totally confused, but an adult that was a parent of similar-aged children at some point might retain surface comprehension of preschooler speech in that parent’s most lucid and flexible moments.

The phrases that jump out of my sons’ mouths are so otherworldly it takes me many seconds on my best day to categorize them. One current common saying they began is, “I’ll go Cheezee Puffs and Whacko Cream!” This is repeated often, out of the blue and at volume, with giggles to indicate it is amusing.

Analyzing the sentence gave me the insight that the Cheezee Puffs came from a book we’ve been reading, called, “Llama, Llama, Mad at Mama.” When my younger son speculated as to what Cheezee Puffs tasted like in the course of this book, I heard retired nurse Nana tell him only llamas ate Cheezee Puffs, but they weren’t the right food for little boys.

I’m not sure what sparked the fascination with this “llama” food, but it was incorporated into the most popular statement in our house. There simply is no explanation for the “whacko cream” part of the proverb.

When staring at my children and dissecting their bizarre phrase, I thought to myself that Whacko Cream has been liberally applied to them at some point, but the contact moment isn’t clear. The expression came from nowhere I can fathom.

Our 3-year-old began repeating a brand-new saying one evening after bath. As I attempted to smear petroleum jelly on his nose and lips, he started repeating, “Dewey, dewey; I don’t have a trunk!” This was accompanied by a plucking motion with one hand, as if he was raising his arm to pick pretend grapes off a vine.

Anyone who has had extended time with youngsters knows repetition is the main path to hilarity. Over and over the “dewey dewey” phrase went, getting funnier and funnier to both boys.

It came up again the next day at the same time, instigated by our 5-year-old and snowballing into family participation. I made the mistake of repeating it as “Zooey, zooey,” instead of “dewey dewey,” and was forcefully and instantly corrected. Such a crucial detail …

Yesterday, my older son told me he was in a “poshy” mood. When asked to give more detail, he looked at me like I must be joking, and said, “I just told you, Mama! I feel poshy!”

Both boys have a tendency to announce that their names no longer are the ones we assigned at birth, but rather some new fabrication that is as idiotic as can be imagined.

Earlier this week, my eldest insisted his new name was “Bleaah,” and he said it with his tongue out and in exactly the same tone as the castle “Aaaargh” in Monty Python’s “The Holy Grail.” His younger brother was enamored of this fun and rather offensive sounding word, and immediately I had not one, but two sons now self-named “Bleaah!”

Until they come out with a dictionary or template for understanding these foreign phrases, I guess I’ll just keep going Cheezee Puffs and Whacko Cream.

Source: The Newark Advocate, OH
http://www.newarkadvocate.com/article/20081102/LIFESTYLE/811020343

I suspected it would happen; I just didn’t think it would happen so quickly. Shortly after the historic achievement of Olympic swimmer Michael Phelps, and just before the historic nomination of Sen. Barack Obama at the Democratic National Convention, a major newspaper ran a full-page story celebrating the news that single moms succeed in raising accomplished sons.

The article cited Mr. Phelps, Mr. Obama and others, including cycling great Lance Armstrong, to make the case that boys raised by single mothers are doing just fine, thank you. It also quoted a number of supportive experts, including Peggy Drexler, author of a book called “Raising Boys Without Men.”

Interestingly, Mrs. Drexler, who has been married for more than 36 years to the father of her son, asserts quite firmly that although boys do need men, they do not need fathers. Her position is essentially that one should not fret about fatherless boys because they have a way of finding the male involvement they need.

Well, yes and no.

Boys certainly will find male involvement, but since boys will be, well, boys, they often do not make the right choices. Case in point is convicted D.C. sniper Lee Malvo, who selected John Muhammad. And there are countless boys who join gangs to find the male involvement they so desperately crave.

That said, my biggest problem was less with the article than with the “straw man” - or rather, “straw father” - argument that it is “news” that single mothers can and do raise successful boys. As one who was raised by a single mother and has undergraduate and master’s degrees from two Ivy League universities, I am a bit of a poster child on this point. (Thanks, Mom.)

However, “Can single mothers do it?” is not the right question. There are more thoughtful ways of viewing the issue.

First, should single mothers have to raise their children alone? Remember, every child has an “involved” father at conception. I do a lot of speaking about the importance of involved fatherhood. No parent has ever come up to me after a speech to say they hope their daughter will become a single mother.

Second, this issue is not about what kind of a man a boy will become but, also, what kind of a father he will become. It’s difficult to be what you don’t see. Accordingly, as a nation, we have to ask this question - how does a culture that promotes and, too often, celebrates father absence, create an environment in which boys develop a desire to become present and involved fathers?

Third, in addition to the well-documented social and emotional costs of father absence for our nation’s children, it is also expensive. Recently, National Fatherhood Initiative released a report called, “The One Hundred Billion Dollar Man - The Annual Public Costs of Father Absence.” The report measured the federal expenditures on child-support enforcement and 13 means-tested benefits programs that support father-absent homes. The $100 billion cost represents nearly 4 percent of the 2006 federal budget. Indeed, in these difficult financial times, we cannot afford father absence.

Finally, I believe the way we look at smoking is the most appropriate and thoughtful way to look at father absence and the resulting single motherhood. Specifically, it is pretty clear the majority of people who smoke do not immediately get lung cancer. This is why it is so difficult to curb teen smoking. Nonetheless, we spend millions of dollars on campaigns and efforts to reduce smoking. Why? Because we know that those who smoke are at a higher risk for cancer, heart disease or worse. Knowing this, would anyone support celebrating the fact that many smokers beat the odds? I doubt it.

Social science data assert overwhelmingly that boys in father-absent homes are more at risk to be poor, fail in school, use drugs or be involved in the criminal justice system. Therefore, we should encourage responsible fatherhood and discourage a culture of single motherhood for the same reason - the increased risk to our sons. In my view, we do not have a fatherless boy to spare.

Source: Washington Times, DC
http://washingtontimes.com/news/2008/nov/02/despite-successes-boys-need-fathers/

Conventional wisdom says low-income parents whose children attend low-performing public schools do not care much about their children’s education and, therefore, are not involved in their children’s schools and their children’s learning away from school.

Now, a new report, “One Dream, Two Realities,” commissioned by the Bill & Melinda Gates Foundation, turns conventional wisdom on its head. The report shows that instead of not caring, such parents are the most likely to see rigorous education and their own involvement as being essential to their children’s success.

The researchers argue that society needs to stop blaming parents when students in low-performing schools do not succeed and start considering how schools are failing both their charges and the parents.

To reach their conclusions, researchers conducted focus groups and a nationally representative survey of 1,006 parents of current and recent high school students in urban, suburban and rural towns and cities across the nation. Parents verified whether their children attend or attended high-performing schools, moderate-performing schools or low-performing schools, the major criterion being the proportion of students from those high schools who go on to college.

The report confirms what educators and scholars have known: Parents are the key to the educational success of their children.

One of the report’s critical findings is that most of the nation’s approximately 25-million parents with children in high schools want to be more involved but are frustrated when schools do not give them adequate information or opportunities to participate more effectively.

Not surprisingly, the report shows that 83 percent of parents with students in high-performing schools said their school was doing a very or fairly good job communicating with them about their child’s academic performance, compared to only 43 percent of parents with students in low-performing schools. Seventy percent of parents whose children attend high-performing schools say the school does a good job informing parents of the requirements for graduation and college admission, compared with only 38 percent of parents of students in low-performing schools.

Another key finding, again bucking conventional wisdom, is that most minority parents want their children to attend college. In fact, 92 percent of black parents and 90 percent of Hispanic parents consider going to college to be “very important,” compared to 78 percent of white parents.

As more students join the ranks of the estimated 1.2-million who do not graduate annually, educators are trying to find ways to get more parents involved. Among the report’s suggestions based on what parents said they want:

• Flexible parent-teacher conferences that consider the schedules of parents who work;

• Immediate notification when their children have academic problems, cut classes or skip school;

• Homework hot lines to assist both children and parents;

• More information about graduation requirements and college admissions;

• Conferences in eighth or ninth grade to discuss what it will take for their children to succeed in high school;

• One faculty adviser who tracks their student all the way through high school as a mentor and a personal point of contact;

• Incorporate homework assignments that involve families in every course.

The report concludes that “America itself has two school systems — one that is largely equipping children for the demands of high school, college and the workplace and another that is too often failing them; one that is effectively engaging parents in the education of their children and another that is failing to do so. … Schools and parents have clear pathways to begin to improve one element that we know has dramatic impact on the education of children — the sustained engagement of parents who play vital roles in educating their children and nurturing them into the future.”

“One Dream, Two Realities” may have flaws, but in light of the urgency it brings to the issue of parental involvement, those flaws can be forgiven. It correctly points out that the current state of our public school system is “inconsistent with America’s promise of equal opportunity.”

Source: Tampabay.com, FL
http://www.tampabay.com/opinion/columns/article884627.ece

We now have new evidence, after the publication of a study in Human Reproduction, that women who are severely depressed during pregnancy are at much higher risk of giving birth prematurely.

The recent report is one of a handful of scientific studies to document the association between maternal depression and premature birth. But it’s the most important to date because of its size and the large, representative group of women sampled.

Previous research suggests that 9 to 12 percent of women become clinically depressed during pregnancy. The question, of course, is why a mother’s mental state would affect the timing of a birth.

No one knows for sure. But experts speculate that depression affects a woman’s neuroendocrine system, which in turn affects the hormones circulating in her body, which in turn affects the functioning of the placenta that nourishes the infant.

“To sustain a healthy pregnancy, normal placental function is essential,” said Dr. De-Kun Li, a reproductive and perinatology epidemiologist at Kaiser Permanente in Northern California and lead author of the report. “Potentially, depression can lead to malfunction of the placenta,” he suggested.

Indeed, there is increasing evidence that something along these lines occurs with women who experience stress during pregnancy.

Dr. Diane Ashton, deputy medical director for the March of Dimes, notes that stress can alter a woman’s immune function, leading to “increased susceptibility to intra-amniotic infection or inflammation.” Research studies indicate these infections may play an important role in pre-term births.

Also, Ashton says, maternal stress can jump-start the production of “fight or flight” hormones like cortisol, which in turn can prematurely activate placental hormones that can set off a cascade of events leading to premature birth.

Even if a baby is born full term, being bathed in cortisol in utero can affect fetal brain development, research shows.

Dr. Laura Miller, director of the women’s mental health program at the University of Illinois at Chicago Medical Center, said research shows that children of stressed-out pregnant women can be affected at least to age 10.

These children often have hyper-reactive responses, physiologically and emotionally, and have “greater difficulty dealing with stress,” she says. Also, infants of stressed mothers can be “more irritable and difficult to soothe” and demonstrate “poorer growth and increased risk of infection,” she notes.

As for maternal depression, it may operate through similar mechanisms – by altering similar hormones and producing similar physiological responses – or it may not. The research necessary to clarify what’s happening hasn’t yet been done.

We don’t know, either, if it makes a difference at what point during a pregnancy a mom becomes depressed (the Human Reproduction report studied only moms who reported depressed symptoms in the first trimester) or how long the depression lasts.

Miller suggests the take-home message for moms is “depression during pregnancy can be prevented, and if a woman suspects she might be at risk she really should strongly consider pre-conception counseling.”

Factors that can put women at risk include previous bouts of depression and a family history of maternal depression.

For women who are considering pregnancy but have concerns about mental health, there are several therapeutic options, including psychotherapy, strengthening social supports, and medication, Miller notes. For those who become depressed during pregnancy, these options remain, but the profile of potential benefits and risks differs, depending on the type of depression a woman has and other factors.

Since surveys show that most ob/gyns don’t feel comfortable treating depression, it’s important to find a medical expert who is prepared to help. Be honest about what you’re feeling and ask your ob/gyn directly if she’s the right person to offer assistance.

Among the questions that Miller suggests: “Have you had experience treating depression during a pregnancy?” “Do you have special training in working with pregnant women who are depressed?” “Do you refer people with these kinds of problems to a psychiatrist – and, if so, can I get a referral?”

Source: Chicago Tribune, United States
http://newsblogs.chicagotribune.com/triage/2008/10/depression-and.html