The Reality Many Mothers Face

Maternal mental health is simply how a mother is doing emotionally and mentally during pregnancy and the first year after birth. Maternal mental health is a critical but often overlooked part of women’s health. Pregnancy and the postpartum period bring major physical and emotional changes, and many women struggle silently with conditions such as postpartum depression, anxiety, birth-related PTSD, and other perinatal mood disorders. It’s more common than people realize for women to experience:

• Postpartum depression
• Anxiety
• Trauma from birth
• Mood changes triggered by hormones and stress

And here’s the part that too often gets ignored: about 1 in 5 women go through this, and a lot of them never get help. They’re expected to smile, show up, and “be strong.”

Why This Matters

When a mother is struggling, it doesn’t just affect her, it affects her baby, her partner, her work, and her overall life.

For mothers, untreated mental health issues can make bonding difficult, increase stress, and make everyday tasks feel overwhelming.

For babies, a mother’s emotional well-being can influence development, sleep, feeding, and even how safe and connected they feel in the world.

For families and communities, the impact can show up in stress at home, financial strain, and long-term social and healthcare costs.

Supporting mothers isn’t just “nice”, it’s necessary!

Why So Many Women Don’t Ask for Help

There are real reasons women stay silent:

• Fear of being judged or labeled a “bad mother”
• Feeling like they should be able to handle it
• Doctors not asking about mental health at routine visits
• Limited access to therapy or support
• Cultural beliefs that discourage talking about emotional struggles

A lot of mothers think they’re the only one going through it. They aren’t.

What Needs to Change

If we want healthier families and healthier communities, we need to support mothers better. That means:

• Making mental health screening a normal part of prenatal and postpartum care
• Talking openly about maternal mental health in homes, clinics, faith centers, and social media
• Providing support that respects different cultures, backgrounds, and experiences
• Expanding telehealth and flexible care options
• Creating workplaces that understand how challenging the postpartum period can be

What Mothers Need to Hear

Maybe someone needs this today:

You’re not weak.
You’re not failing.
You’re not alone.
And you deserve support and care not silence and pressure.

Signs to Watch for

A mother may need professional support if she:

• Feels persistently sad, anxious, or hopeless
• Loses interest in activities she once enjoyed
• Has trouble bonding with the baby
• Experiences extreme mood swings
• Has thoughts of harming herself or the baby

If these signs appear, reaching out for mental health care is courageous not a failure.

In Conclusion

Maternal mental health isn’t just a personal issue, it’s a public health issue. When mothers are supported, families are stronger, children thrive, and communities become healthier.

It starts with talking about it openly and refusing to pretend everything is perfect when so many women are suffering quietly.

Featured image credit: BiancaVanDijk on Pixabay

Preeclampsia and other hypertensive disorders of pregnancy contribute to many complications and death every year. In the United States, the rate of preeclampsia has increased 25% in the last two decades and is a leading cause of maternal and infant illness and death as stated by the Preeclampsia Foundation. Organizations like the Preeclampsia Foundation educate healthcare providers, parents, and families about preeclampsia complications and prevention.

Maternal Health and Racism

A report by Brynn Holland noted that people of Color have faced an extensive history of injustices in healthcare. James Marion Sims is known as the “Father of Modern Gynecology” made his mark in maternal health by performing experimental surgeries on numerous enslaved women in the 19^th century. These women were forced to have medical procedures against their will and without any form of pain medication.

Women of Color continue to be victimized, devalued, and silenced throughout history. In the present day, some healthcare providers do not believe that Black and Brown people feel pain. For instance, according to an article by Janice A. Sabin, PhD (Published by Association of America Medical Colleges), in 2016, 50% of white medical trainees believed one or more of the following: Black people have thicker skin, are less sensitive, and blood clots faster compared to white people.

As we acknowledge the crisis of maternal mortality, it is necessary to note that many past and modern-day occurrences are due to women being unheard. Echoes of impermissible fetal stories such as Kira Johnson, Shalon Irving, and many others tear at the fabric of communities and families.

Example of Success in Maternal Outcomes

Over the last decade, the California Maternal Quality Care Collaborative (CMQCC) displayed success with a preeclampsia-focused initiative that attributed to reversal of maternal mortality trends in California. CMQCC developed an evidence-based toolkit for providers, “Health Care Response to Preeclampsia”

What You Can Do

• Be an Advocate on a State and National Level

Advocate for maternal health care such as policies around the standard of care, provider bias training, and access to maternal health resources and services.

Check out: 4Kira4Moms, Black Mama Matters Alliance, and March of Dimes for advocacy opportunities.

• Educate Community Members and Colleagues

Share Black maternal health information with your network through articles, books, podcasts.

Books

• Killing the Black Body by Dorothy Roberts
• Medical Apartheid by Harriet A. Washington
• Reproductive Injustice: Racism, Pregnancy, and Premature Birth: Dana-Ain Davis

Podcasts

• NATAL podcast
• Dem Black Mamas podcast
• Therapy for Black Girls (sessions 43 & 76)
• Black Health Lit “Maternal Mortality: Black Pregnant and Dying”
• Listen & Share Black Maternal Health Messaging on Social Media

Social Media

Use the social media accounts below to learn about organizations that work to improve Black maternal health outcomes:

• @BlackMamasMatterAlliance
• @PerinatalEquityFoundation
• @MelaninedMoms
• @Ancientsongdoulas
• @theirthapp

Christine Ivery is the guest writer for the August 2021 Public Health Talks’ Blog. Connect with Christine on Instagram: @publichealthjawn

Christine holds a Bachelor’s degree in Exercise Science- Kinesiotherapy from Norfolk State University, a Master’s degree from Drexel University in Public Health, and Health Education Specialist Certification (CHES). She is a Prematurity Prevention Initiative Project Director for the Southern New Jersey Perinatal Cooperative (SNJPC). She is dedicated to addressing and mitigating issues of Black infant and maternal mortality.

Her passion is to help all walks of life through disease and disparity prevention, as well as making an impact in the communities she serves. Christine serves as Chair of the Public Health Young Leaders Association (PHYLA) in Philadelphia, Chair of Sisters in Public Health Philadelphia Chapter, and Community Health Planning and Policy Development (CHPPD) Section Counselor for the American Public Health Association (APHA).  She is a proud member of the American Public Health Association, Philadelphia’s Section on Public Health & Preventive Medicine, the Greater Philadelphia Norfolk State Alumni Chapter, and Alpha Kappa Alpha Sorority Incorporated.

Images Credit:

Christine Ivery ;

Geralt/23051 from Pixabay;

Mohamed_hassan/5238 from Pixabay

Everyone has experienced or know someone who has or is experiencing some form of bullying. Bullies scout their targets by picking on the ones they feel are vulnerable and weak. This could be as a result of religious affiliation, sexual orientation, gender, or color of the skin. Unfortunately, the bullied are the victims that suffer in various ways such as mental health disorders, depression, suicidal thoughts, isolation etc. Bullying behavior can unfortunately occur in different settings such as home, school, social gathering, workplace, place of worship etc.

Imagine parents dealing with their children enduring constant bullying at school and social gatherings and despite the efforts to stop it, too little was done by the authorities or the adults to stop this despicable act. There are far too many cases of young children, youth and young adults taking their lives as a result of bullying. To emphasize the connection between childhood bullying and mental health, I will shine a light on some of the stories of lives lost as a result of bullying:

• The case of a 10-year old boy from Houston Kevin Reese Jr who hanged himself in a closet after enduring months of physical, verbal, and cyberbullying. He was told by his bullies to “kill yourself” He was found by his 13-year-old sister.
• Another one is the case of a 13-year old Tabitha Otero who took her life after enduring physical bullying all year from other girls.
• A 9-year-old Colorado boy Jamel Myles committed suicide after being bullied for coming out as gay.

Bullying related suicide is becoming unfortunately quite an epidemic, and it’s not just limited to a particular place, it’s all over the globe. For instance:  A study by Quinlan et al. published in the Journal of Molecular Psychiatry indicated that bullying may cause physical changes in the brain and increase the chance of mental illness.

As crazy as it sounds, I have witnessed situations where parents and caregivers are the bullies and children in their care endure continuous bullying until their adult lives. In these cases, the bullies, parents, and the victim need professional help because bullies are hiding behind their personal problems and using bullying behavior to mask their emotional struggle. So, the focus shouldn’t be on the victims only, the bullies should also be the focus to stop the trend and prevent future occurrences.

Bullying is a major public health problem that demands the concerted and coordinated time and attention of health-care providers, policy-makers and families according to the World Health Organization. It is therefore important that families, communities, and schools collaborate in understanding bullying, its consequences (i.e. the long term effect on mental health) and develop effective bullying prevention programs that can be implemented in schools and different communities around the globe.  Combating bullying should be one of our main focus because a lot of damage has been done as a result of bullying.

If you have questions or need assistance related to the content of this blog, please contact us

Bullying: Tips for Parents & Caregivers

• Start early: Have an open dialogue with your children
• Teach your children how to be assertive: Encourage your children to express their feelings clearly. That is, No should be No and Yes is Yes
• Stop Bullying when you see it: Adults who remain silent when bullying occurs are encouraging it and making it worse.
• Listen and support children who speak up
• Recognize the signs of depression
• Tell your children to take action when they see bullying behavior
• Communicate clear policies and consequences: That is, send a clear message at school about the consequences of bullying
• (Source: Mental Health America)

Types of Bullying Behavior

• Physical Bullying: It may take the form of hitting, kicking, pushing, and pinching

• Verbal Bullying: Name calling, insults, teasing, intimidation, racist remarks, inappropriate sexual comments
• Social Bullying: Spreading rumors or intentionally embarrassing someone in public
• Cyber Bullying: Bullying behaviors through digital technologies such as computers and smartphones (Source: talkspace.com)

Long-Term Risks of Bullying for the Victim

• Chronic depression
• Increased risk of suicidal thoughts, suicide plans, and suicide attempts
• Anxiety disorders
• Post-traumatic stress disorder
• Poor general health
• Self-destructive behavior, including self-harm
• Substance abuse
• Difficulty establishing trusting, reciprocal friendships and relationships   (Source: Psycom)

Long-Term Effects of Bullying for the Bully

…Without proper treatment, bullying behavior is likely to continue into adulthood.
• Risk of spousal or child abuse
• Risk of antisocial behavior
• Substance abuse
• Less likely to be educated or employed (Source: Psycom)

One of the joyous moments in life is when a new life enters the world. It is an amazing period and the feeling of holding and embracing that precious one is indescribable. It is even a cherry on top for a first time mother. You want to do everything right i.e. exclusively breastfeed the baby because of the importance, protect and guard the precious one. Unfortunately life happens sometimes, such is the case with my family. Before the birth of our first child, the goal and plan was to exclusively breastfeed for the first 6 months but when our bundle of joy arrived, the level of bilirubin (jaundice) in his system was high. Although, I knew this occurs in babies and can be treated, I was understandably devastated and on top of this I did not produce milk immediately. I felt pressured by the doctor and nurses to feed the baby formula. I was told, because of his level of bilirubin that he needs liquid in his system so that he can excrete some of the bilirubin. I fought really hard to stay true to our original plan of exclusive breastfeeding but at some point, the situation was out of my control. My baby was kept overnight in the Neonatal Intensive Care Unit (NICU) for phototherapy- a treatment to lower his bilirubin levels, during which he was given formula.  After the whole ordeal at the hospital, we did both formula and breastfeeding interchangeably. I felt at the time and still feel now that the hospital did not do enough to support and encourage me to breastfeed. After all, breastfeeding is a learned behavior and all mothers especially first timers need constant support to establish and sustain appropriate breastfeeding practices.

I feel like breastfeeding campaign falls short in many hospitals when compared to how baby formula companies market their products to new parents i.e. given them free formula samples and coupons. Aside from pamphlets and paper information given at hospital about the importance of breastfeeding, I think public health educators should be physically present and making rooms round to educate and give short talks to new moms on the importance of breastfeeding. Such programs will show support and encourage mothers to adopt this amazing practice. For instance, the American Public Health Association stressed that health professionals have inadequate training, education, and resources to provide appropriate breastfeeding support. This clearly was the case for me during my birthing experience.

Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large, according to the World Health Organization. Furthermore, Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended by WHO as the perfect food for the newborn, and feeding should be initiated within the first hour after birth. It is important to note that there are mothers that cannot breastfeed due to health and other reasons. In those unique cases, mothers have no choice than to offer formula to their infants.

While there are breastfeeding guidelines and recommendations from organizations such as the WHO, there is still a lack of social, legislative, and policy support for breastfeeding. In most cases, disparities exist among women in different parts of the world in terms of practicing exclusive breastfeeding. Certain countries including Canada, and some European countries, offer paid maternity leave for up to a year to new moms. This kind of policy provides needed support for mothers to exclusively breastfeed and bond with their infants during this period. Meanwhile mothers in the United States and other countries don’t have that luxury of one year paid maternity leave, making it difficult to exclusively breastfeed. Another instance, is that, most companies don’t provide worksite lactation area for their employees. Adding to the difficulty, is the harassment women sometimes face for breastfeeding in public -a different topic on its own.

Bottom line is that effective legislations that support women breastfeeding practices such as paid maternity leave and policies that protect women from public scrutiny due to public breastfeeding are required for women to fulfill the breastfeeding guidelines from the WHO. Efforts (i.e. national campaign) should be geared toward promoting breastfeeding in hospitals, public places, and improving social and cultural acceptance of the practice.

WHO’s Guidelines for Breastfeeding

• It is recommended that mothers worldwide to exclusively breastfeed infants for the child’s first six months to achieve optimal growth, development and health.
• Thereafter, babies should be given nutritious complementary foods and continue breastfeeding up to the age of two years or beyond.
• To enable mothers establish and sustain exclusive breastfeeding for 6 months, follow these steps:
• Initiation of breastfeeding within the first hour of life
• Exclusive breastfeeding – that is the infant only receives breast milk without any additional food or drink, not even water
• Breastfeeding on demand – that is as often as the child wants, day and night
• No use of bottles, teats or pacifiers

Importance of Breastfeeding According to WHO

• Breast milk is the natural first food for babies, it provides all the energy and nutrients that the infant needs for the first months of life.
• Breast milk promotes sensory and cognitive development, and protects the infant against infectious and chronic diseases
• Exclusive breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhea or pneumonia, and helps for a quicker recovery during illness.
• Breastfeeding contributes to the health and well-being of mothers;
• It helps to space children
• Reduces the risk of ovarian cancer and breast cancer

Usually, I get ideas or inspiration for my blog from personal experiences, observations, and interaction with people of different backgrounds. Often times, I get questions about general public health concerns and some personal questions from people when I give talks. Recently, a question was asked of me and it brought about this write up. A mother came up to me and asked “Why is my 5 yr. old not reading yet? Should I be concerned about his developmental growth or any health-related issue? I had all these responses in my head but I knew I had to be as honest as I can be in my response i.e. not just tell her what she wanted hear. Below is the summary of our paraphrased conversation:

Mother: I have tried everything possible and nothing is working

Me: Do you know that children develop at different pace?

Mother: I know other 5 yr. olds who are fluent readers and mine just refused to pick up a book and read.

Me: You need to keep introducing books to your child by reading together and when he is ready he will start reading

Me: By pushing him hard, you might actually be stressing your child which can make him shut down all together.

Me: You need to let your child be and it is perfectly fine for a child not to read at age 5! There is no set time for this kind of development. It is a natural process that will happen when the time is right.

Stress is not always a good thing but it is not always bad either. There is good and bad stress. It is important to note the difference because good stress can actually help children to build confidence, self-esteem, rise to challenges, and resolve problems. This is the kind of stress that naturally, the body can manage and control. On the other hand, bad stress which is the focus of this blog can have negative lasting effects on a child’s developmental growth.

The Urban Child Institute (UCI) a non-profit organization dedicated to promoting the health of Mid-South children states “Stress endangers young children’s brain development. Persistent stress – sometimes called toxic stress – can interfere with the formation of the connections and networks that support thinking and learning.” In my opinion, this quote should be a guide for parents in terms of how we manage our children -especially children under age 10.

The encounter I had with the above parent made me realized that children are under immense pressure in today’s society when compared to when I was growing up. The high expectations, the back to back after school activities and the enormous pressure we put on these poor children are comparable to none.

No one is slowing down, parents have gotten carried away by bombarding the children with things that will trigger stress and are oblivious to the fact that we are doing harm to their critical stage of development. What happened to creating warm environment, positive parenting and let the kids be kids? So what, if the child is not reading at age 5? Who cares, if a child doesn’t know how to ride his bicycle at age 9? Who cares, if a child gets a D in math?

The point is that there is not set times for all these events, children grow at their own space and as the adult in their lives, we need to provide that love, support they need to reach each milestone in life. Prolong stress can result in anxiety!

Events in the early years of children are critical as they shape the development and future occurrences. It is therefore important to provide essential opportunities through services and programs to children and families that will shape lifelong health and improve overall outcomes. Children should be protected from prolong stress because it can lead to anxiety and have a negative impact on their mental and overall physical health.

I shared this exchange because I know this is a common practice amongst parents. I think we as parents get carried away most times by not focusing on what matter the most but instead comparing our children to others. If you noticed your child is withdrawn or showing signs of depression, please seek professional help!

Signs and Symptoms

Some behavioral changes include:

1. Mood swings
2. Acting out
3. Changes in sleep patterns

Some physical changes include:

1. Stomach aches and/or headaches
2. Trouble concentrating or completing school work
3. Spending time alone or withdrawn  ~Source: kidshealth.org

Common causes of childhood stress

1. Big Changes in the Family such as death in the family, divorce, moving etc.
2. Parental Instability such as parental agitation, money and job problems
3. Overly-Packed Schedules Such as back-back activities
4. Academic Pressure i.e. children experience stress and anxiety from wanting to do well in school
5. Popularity i.e. wanting to fit in with other groups
6. Bullying ~Source: verywellfamily.com

Stress can affect children developmentally and it is important to note that children respond differently to stress depending on their age, individual personalities, and coping skills.

Ways to help your child cope with stress

1. Make your home a calm, safe and secure place to come to.
2. Create a relaxed home atmosphere and commit to a routine. Family dinners or game nights can prevent anxiety and help relieve stress.
3. Involve your child in social and sports activities where they can succeed.
4. Allow for opportunities where your child can have control over a situation in their life.
5. Adopt healthy habits such as exercise and self-care to manage your own stress in healthy ways. Children often mimic their parents’ behaviors.
6. Provide affection and encouragement.
7. Use positive reinforcement and methods of discipline that promote healthy self-esteem.
8. Learn to really listen to your child without being critical or solving problems for them. Provide guidance to teach your child ways to understand and solve the problems that upset them.
9. Good nutrition and adequate rest ~Source: verywellfamily.com

As the World Health Organization indicated “worldwide about 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, primarily depression. In developing countries this is even higher, i.e. 15.6% during pregnancy and 19.8% after child birth. In severe cases mothers’ suffering might be so severe that they may even commit suicide”.

“Postpartum depression is a serious mental illness that involves the brain and affects your behavior and physical health” (Office of Women’s Health, OWH). According to the OWH, most women “get the “baby blues,” or feel sad or empty, within a few days of giving birth. For many women, the baby blues go away in 3 to 5 days. If your baby blues doesn’t go away or you feel sad, hopeless, or empty for longer than 2 weeks, you may have postpartum depression”. Also, “You might feel unconnected to your baby, as if you are not the baby’s mother, or you might not love or care for the baby. These feelings can be mild to severe” (OWH).

To all the husbands, uncles, men out there, I want you all to know that being a woman is not an easy task! During and after pregnancy, a woman’s mind and body goes through lots of changes that is beyond comprehension. Caring for and supporting women during and after pregnancy by loved ones is crucial! For instance, this can be done by listening, being physically and emotionally available and knowing all the signs and symptoms of maternal mental health disorder.

So, if you as a mother find yourself experiencing postpartum depression and/or ‘baby blues’, please, I urge you to seek help because according to WHO “maternal mental disorders are treatable. Effective interventions can be delivered even by well-trained non-specialist health providers”. Contact us for assistance.

Signs and Symptoms of Postpartum Depression?

• Feeling restless or moody
• Feeling sad, hopeless, or overwhelmed
• Crying a lot
• Having thoughts of hurting the baby
• Having thoughts of hurting yourself
• Not having any interest in the baby, not feeling connected to the baby, or feeling as if your baby is someone else’s baby
• Having no energy or motivation
• Feeling worthless, guilty, or like a bad mother
• Losing interest or pleasure in activities you used to enjoy
• Withdrawing from friends and family
• Having headaches, aches and pains, or stomach problems that don’t go away (Source: womenshealth.gov)

Contributing Factors to Postpartum Depression

• Hormonal changes
• Tired after labor and delivery
• Tired from a lack of sleep or broken sleep
• Overwhelmed with a new baby
• Doubts about their ability to be a good mother
• Stress from changes in work and home routines
• An unrealistic need to be a perfect mom
• Grief about loss of who they were before having the baby
• Less attractive
• A lack of free time (Source: womenshealth.gov)

Difference between ‘baby blues’ and postpartum depression

The “baby blues” lasts for about 3-5 days while the symptoms of postpartum depression last longer and more severe (DHHS). Some symptoms of “baby blues” are:

• Having mood swings
• Feeling sad, anxious, or overwhelmed
• Having crying spells
• Losing your appetite
• Having trouble sleeping (Source: womenshealth.gov)

What To Do, If You Have Symptoms of Postpartum Depression:

Call or have someone call your doctor, nurse, midwife, or pediatrician if:

• Your baby blues doesn’t  go away after 2 weeks
• Symptoms of depression get more and more intense
• Symptoms of depression begin within 1 year of delivery and last more than 2 weeks
• It is difficult to work or get things done at home
• You cannot care for yourself or your baby (e.g., eating, sleeping, bathing)
• You have thoughts about hurting yourself or your baby (Source: womenshealth.gov)

Postpartum Depression Treatment

• Therapy
• Medicine
• Electroconvulsive therapy (ECT) (Used in extreme cases) (Source: womenshealth.gov)

It is heart breaking to see that technology (e.g. TVs, computers, smartphones, digital tablets, and video games) is actually ‘raising’ our children.

Gone are the days when kids couldn’t wait to go out and play Ten – Ten (an outdoor game played by young girls in Nigeria) or Gboju Gboju (Nigerian Yoruba version of hide and seek). I still remember the good old days when my male friends and relatives would sneak out to play football or soccer instead of doing their homework.  These days children can’t wait to be allowed to own a smart phone while their parents allow them unlimited screen time from the TV to games on daddy’s phone. In some households, screen time is considered a ‘tool’ for allowing the parents to have a break from children as young as 6 months old. Indeed, it is not uncommon to come across parents in public who quickly push a smart phone into a crying toddler’s hands to maintain the peace.

 Are we parents oblivious to the fact that this dangerous trend can/will have a negative impact on our young children’s brain development and overall health? Don’t get me wrong, my children do have screen time but we reached an agreement to have it scheduled (i.e. weekends only and timed). The strict rules came in to place after we realized our first child behaved like a ‘zombie’ when given close to unlimited screen time. I guess the question is, where do we as parents draw the line to avoid excessive usage of electronics by our children (especially 0 – 5 year olds). We need to know that the potential harm outweighs the benefits of electronics usage especially during the early childhood developmental stage. This developmental stage is critical and it is our job as parents to protect it and help our children live a healthy lifestyle.

In newly released guidelines by the World Health Organization (WHO), it was indicated that “infants under 1 year old should not be exposed to electronic screens and that children between the ages of 2 and 4 should not have more than one hour of “sedentary screen time” each day”. Further, Dr. Fiona Bull at WHO indicated that “Improving physical activity, reducing sedentary time and ensuring quality sleep in young children will improve their physical, mental health and well-being and help prevent childhood obesity and associated diseases later in life,” The whole campaign is to bring ‘traditional’ playtime back by reducing and/or eliminating electronic screen time for young children and ensuring they get enough sleep each day.

As is my mantra on parenting, one size does not always fit all. The right formula is to take a stance on this issue and adopt a solution that works well for your family. However, whatever approach you take, be consistent and persistent!

Some guidelines from World Health Organization are:

• Children under 5 should also get more exercise and sleep in order to develop better habits that will stave off obesity and diseases in adolescence and adulthood
• Limited or no screen time for children under the age of 5yrs
• Children between the ages of 1 and 5 should get three hours of physical activity per day, and get at least 10 hours of sleep per night

And the American Academy of Pediatrics adds:

• No screen time other than video-chatting for children under 18 months
• They recommend introducing only “high-quality programming” to children 18 to 24 months of age, and advised that parents and caregivers watch the program with them
• Children between the ages of 2 to 5 years should watch only one hour per day of approved programming