From a Pediatrician, Lessons for Dads-to-Be
Posted June 18, 2018 1:44 p.m. EDT
CHICAGO — In a conference room at Northwestern Memorial Hospital on a recent evening, a group of men sat down for a class on pregnancy and childbirth led by Dr. Craig Garfield, a pediatrician who specializes in studying new fathers.
The class is one of many that Northwestern offers to new parents, including some that are designed for moms, for grandparents and — in the case of one class called “Bowser & the Baby” — for dog owners. Garfield’s parenting class is for expectant fathers, most of whom are here after their pregnant partners signed them up for it.
As the class got underway, the soon-to-be dads seemed uneasy. But with some prodding from Garfield, they began to open up, sharing some of their hopes and fears about becoming first-time fathers.
One man said he hoped to raise a strong and confident daughter. Another said he was fearful about holding his baby for the first time because babies are fragile and he had never held one before. Others said they worried about their finances, losing sleep, the health of their babies and their partners, and not having enough time to spend with their children.
“My hope is that you will all leave tonight having much fewer fears,” Garfield told the men.
While today’s generation of fathers is not the first to change diapers or be actively involved in child care, they are more likely to participate than their own fathers, and much more so than their grandfathers. But Garfield and his colleagues have found that many dads who are eager to be engaged are often uncertain about where to begin.
“This class serves as a ‘How-to’ or ‘Fatherhood 101’ to try and meet this disconnect between wanting to be involved and not being sure exactly what to do,” Garfield said. “Many new fathers really are scared of breaking their babies.”
The class is part of a broader effort he is leading to shed scientific light on the role that fathers play in child and family well-being. Garfield, an associate professor at Northwestern University’s Feinberg School of Medicine, has found that helping fathers benefits the children they raise.
“My message is to get in early and get in often,” said Garfield, who is also an attending physician at the Ann & Robert H. Lurie Children’s Hospital of Chicago. “When the baby is born, be there, get your hands on the baby, change the diaper, talk to the baby, hold the baby, feel the baby. Get involved and don’t be shy about it because it’s all about building your confidence and getting comfortable with your baby.”
Garfield explains to expectant dads how they can help if their partners breast-feed, whether it is positioning the baby at the right level or helping their partners stay hydrated. He shows them how to cradle their infants on their chests with skin-to-skin contact, a calming technique. And he encourages them to read and talk to their newborns often so their developing brains will benefit from hearing their voices.
These steps and others can get fathers more engaged and comfortable with their newborns, Garfield has found, and they may also be crucial to their long-term development. Studies suggest that children who grow up with more involved fathers acquire better language skills. They have higher self-esteem and better grades in school, and they suffer less depression and anxiety. They have lower rates of truancy and are less likely to become teenage parents.
“The data is pretty robust,” said Dr. Michael Yogman, an assistant clinical professor of pediatrics at Harvard Medical School. “The more involved fathers are early on, the better the child does academically and the less likely they’re going to have behavioral issues later on.”
In 2016, Garfield and Yogman published a report in the journal Pediatrics outlining ways that pediatricians and health care providers could engage new fathers in prenatal and postpartum care.
They argue that this is particularly important given the evolving nature of family dynamics, with many mothers and fathers no longer exclusively playing the roles of primary caregiver or provider. Garfield’s interest in studying fatherhood stemmed from his own experiences. When his first child was born in 1997, he was the first medical resident at Massachusetts General Hospital to ask for a month of family leave. A year and a half later, when his son was a toddler, he took time off to be a stay-at-home dad so his wife, who also became a pediatrician, could focus on her residency.
Garfield noticed that he was the only dad on the playground, at playgroups and in “Mom and Tot” classes. He and his wife found that their pediatrician ignored him during visits with their toddler, focusing on his wife. It dawned on him that he too had excluded fathers as a doctor, a revelation he wrote about in JAMA.
“With remorse, I realize that during residency I established more eye contact and directed most of my advice toward mothers, even if both parents were present,” he wrote.
Looking at the medical literature, he found that much of the research on child health and development was focused, appropriately, on maternal interventions. But he also felt that many populations of fathers were understudied: married and unmarried dads, single-parent fathers and gay fathers, adolescent dads, and even incarcerated fathers, who account for roughly 750,000 of the 72 million fathers in the United States.
“I was frustrated that my discipline of pediatrics was slow to recognize the role that fathers play in child health, and that plays out in the research that we do,” he said. “Fathers are a key player in families — for positive and negative.” In shaken baby cases, in most domestic violence cases, he noted, the perpetrator is often the dad.
In his research, Garfield found that some of the health issues new moms face also affect new dads. He discovered that new fathers gain significant weight and many experience a major increase in depressive symptoms, which could lead to them being neglectful of their children. And he found that fathers of premature babies experience higher levels of stress than their partners during the transition home. Garfield is developing an app to help parents of premature babies care for their infants, and he has called for wider health screening in new and expectant fathers, many of whom do not have primary care physicians.
To better understand their well-being, Garfield is working on a pilot study to track health behaviors in new fathers. It is expected to start in August.
In the meantime, he is trying to help individual dads through his expectant fathers’ class, which meets about once a month.
One of his former students is Saleem Hue Penny, 38, associate vice president of community and educational partnerships at Chicago Children’s Museum. Penny attended the class while his wife, Katie, was pregnant with their twins. The class prepared him for some of the hard realities of fatherhood, he said, and prompted him to speak up at doctor’s appointments and be more involved in the care of their newborns, who are now toddlers. Penny was so inspired that he and a group of colleagues and community partners created an event at the museum, called “PapaPalooza,” where fathers brought their children to play while also getting information on affordable housing, employment, community college and health and wellness resources.
“It was empowering,” Penny said of the class. “It gave us the encouragement we need to be hands-on and engaged and to not be off on the sideline. The message was that you and your partner are a team and regardless of what is happening, you are forever with this child.”