Article: Family under the microscope

April 18, 2010 at 9:26 am | Posted in breastfeeding, co-sleeping, Controlled crying, Routine | Leave a comment
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Interesting article today in the Guardian from Oliver James:

To follow a routine or not – that is the question when it comes to your baby’s care. Several studies find that if parents do controlled crying (leaving the child to cry for gradually increasing periods), babies and toddlers will sleep for longer uninterrupted periods than ones whose mothers pick them up and cuddle or feed them. There is similar evidence for feeding: if you gradually increase the gap between night-time feeds, the child will eventually demand them less often, with larger gaps.

This suits parents, especially working ones. However, it’s not necessarily so good for the child. There is persuasive evidence that babies are more secure and less difficult (irritable, fussy, standoffish) if they are responded to quickly, sensitively and lovingly when they indicate they want attention (mostly by crying). Unresponsiveness has been proven to have long-term adverse consequences. To take an extreme example, a key indicator of personality disorder (called dissociation) is predicted 30 years later by unresponsiveness of care, aged 0-2.

Early unresponsiveness from carers makes us emotionally insecure in later relationships. In one study, maternal negativity towards their four-week-old baby predicted insecurity 30-40 years later. This is a bad sign: the insecure are much more prone to mental illness.

On its own, this evidence is strong grounds for concern about the modern vogue for taming the beast in the nursery with routines that suit the parents. The defence is that when a baby is left to cry it learns to “self-soothe” or “self-regulate”. However, this may be “too much, too young”.

Severely neglected orphanage children are prone to indiscriminate friendliness, a people-pleasing false self. One-year-olds who are not picked up and soothed sensitively when crying at night are significantly more likely to be insecure. Mothers who respond rapidly to crying in the night have babies at three months who are less fussy and irritable. Breastfed on demand, babies are more secure. It looks likely that, while it suits parents to get a baby to fit in with them, it may not be good for their state of mind and long-term mental health.

A comprehensive review of the evidence on co-sleeping bears this out. It demonstrates that having babies or toddlers sleeping in a separate room is completely at variance with human history. In 127 cultures surveyed around the contemporary world, 79% of the societies normally have their infants in the same room, 44% in the same bed. Despite social and medical pressures against co-sleeping in developed nations, as much as half of babies do so sometimes in the first months. Some developed nations still do co-sleeping normatively: 59% of Japanese under-fours are in the bed.

The review challenges medical advice on the danger of cot death, showing that co-sleeping may be safer. It promotes more and easier breastfeeding, and although both partners wake more frequently, when carefully observed they get more hours overall than if sleeping alone.

Babies do need routines, but originating in their needs, not the mother’s. If a parent-led routine is the only way a parent is going to stay sane, then that is ultimately best for the child – a depressed parent is even worse. But for those who can tolerate being led by the infant in the early months, that is best.

Co-sleeping review: McKenna, JJ et al, American Journal of Physical Anthropology 134, 133-161. Oliver James’ How Not To F*** Them Up is out in June, selfishcapitalist.com

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I wouldn’t CHOOSE artificial limbs over real ones… and that’s why I breastfeed.

January 12, 2010 at 10:49 pm | Posted in breastfeeding | Leave a comment
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It’s necessary to start this post by stating my position. Despite being a breastfeeding mum, I am not what you’d call a “lactivist”. I am happy to raise my children in the way I want to, and for others to do the same with their children. You’ll never find me on a breastfeeding march or picnic – I’m about people making their own choices – hopefully informed – but their own choices none-the-less.

Frankly, I can’t think why someone else would really care about how I feed my babies, as long as they ARE fed and well looked after, and that’s how I feel about other people’s children. I have supported a number of friends who WANTED to breastfeed, and am always happy to offer my own experiences, useful internet links and contacts etc, but I certainly wouldn’t consider anyone a worse parent for choosing not to or try to persuade anyone. So….

This morning I was catching up with my Twitter feed  and happened to click on a link to Dr Miriam Stoppard’s “Opinion” piece from the Mirror. In it Dr Stoppard set out her counter-argument to an earlier story of a study that had thrown some doubt on the benefits of breastfeeding over formula feeding (sadly, no link or specific information about the article was provided !!!?!).

In the article, Dr Stoppard says:

My fear is that this sort of story can turn women off trying to breast-feed. And while I’ve always been in favour of women having the right to choose, in the UK we have the lowest breast-feeding rates in the whole of Europe and this troubles me.

Reading this page got me wondering WHY so few British women choose to breastfeed. And how come MOST of the mums I know have at least breasted for a short time. Do I live in an unusual area where breastfeeding is more of a norm? Is it something particular to my socio-economic group, my age,  or just my circle of friends?

While I was pondering this I came to think about what it was that lead me to choose to breastfeed my own children, something I was very insistent on despite DS being born early and having time in SCBU and being unable to feed properly for almost a week leading to jaundice. There are obviously many benefits for both mother and baby…. plus it’s free…. it’s convenient…. it just “feels” right…

As all this was going through my head, I looked up to the TV where the BBC news was reporting on a story about a percentage British Soldiers being unfit for their jobs. On the screen was a group of soldiers exercising, including one with an artificial leg. He was doing fine, keeping up with the rest of the group, but despite looking very “hi-tech” it was obvious that the artificial leg just wasn’t as good as the other legs.

I laughed to myself and stopped searching for the “reasons” I breastfeed. I really didn’t need to think about it any more at all. I breastfeed for the same reasons I wouldn’t CHOOSE to cut off my healthy leg and replace it with an artificial one.

UNICEF UK Baby Friendly Initiative statement on new research into Sudden Infant Death Syndrome and bed-sharing

October 17, 2009 at 4:59 pm | Posted in co-sleeping | Leave a comment
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unicefFollowing the publication of new research on risk factors involved in Sudden Infant Death Syndrome (SIDS) 1 and subsequent media coverage, UNICEF UK Baby Friendly Initiative has issued the following statement.

The SWISS study, designed to investigate the factors associated with SIDS in 0-2 year-olds, draws a clear link between increased risk of SIDS and alcohol or drug use when co-sleeping with a baby, particularly on a sofa.

The study, examining 80 SIDS infants and two control groups, one randomly selected, one of babies at high-risk of SIDS, showed that many of the deaths in a co-sleeping situation could be explained by “a significant multivariable interaction between co-sleeping and recent parental use of alcohol or drugs (31 per cent v 3 per cent random controls) and the increased proportion of SIDS infants who had co-slept on a sofa (17 per cent v 1 per cent).” Other
significant factors included pillow use, swaddling, smoking during pregnancy, whether the infant was preterm and whether the infant was in fair or poor health for the last sleep.

The authors conclude that “the major influences on risk were from factors amenable to change within the infant’s sleeping environment….Parents need to be advised never to put themselves in a situation where they might fall asleep with a young infant on a sofa. Parents also need to be reminded that they should never co-sleep with an infant in any environment if they have consumed alcohol or drugs.”

Much media coverage yesterday focused on the study’s statistic that 54 per cent of the infants in the study died whilst co-sleeping, without noting whether it was in a bed or on the sofa. In fact, the percentage of infants that died whilst sharing the parental bed was 38 per cent, which was the same as the percentage of infants that died in the cot.

Furthermore, “the proportion of SIDS infants found co-sleeping in a bed with parents who had drunk two units or less of alcohol and taken no drugs was no different from that of the random control infants (18 per cent v 16 per cent). If parents who regularly smoked were further excluded, then five of the SIDS infants (6 per cent) were found in this less risky co- sleeping environment compared with nine of the random control infants (10 per cent).”

In their conclusion, the authors state “The safest place for an infant to sleep is in a cot beside the parents’ bed. Based on evidence from research into SIDS it is questionable whether advice to avoid bed sharing is generalisable and whether such a simplistic approach would do no harm.”

UNICEF UK has noted previously that bed-sharing has several benefits, such as helping parents to cope with babies who wake frequently to be fed or who are unsettled in the night. Bed-sharing is also associated with an increase in breastfeeding – possibly because many mothers find it hard to get enough rest if they do not breastfeed lying down 2. Breastfeeding is universally recognised as one of the pillars of child health and survival with well established evidence regarding the many health benefits to both babies and mothers. Of particular note is a recent review of the impact of breastfeeding which identified that breastfeeding reduces the risk of Sudden Infant Death Syndrome (SIDS) by 36 per cent in the industrialised world 3. Strenuous efforts are now being made by the Department of Health and others to increase the UK’s low breastfeeding rates in order to improve public health 4,5,6.

Young babies wake and feed frequently both day and night and tired parents are at risk of falling asleep with their baby, especially during the night, whatever their intention. Therefore, parents require full information regarding the various strategies for coping at night, along with the benefits and risks of all approaches in order to allow informed decision making.

In an interview with UNICEF UK, Dr Peter Blair, a co-author of the SWISS study, said “We need to remind parents that there are certain situations where you never share a bed and balance that with sharing a bed at other times…It might be that if you demonise the parental bed you’re still going to get tired mothers with young infants where the infant has woken up three or four times in the night and needs feeding and the mother’s walking around thinking
they can’t take them into the bed, so they go onto the sofa and there they fall asleep. That will and does happen. So coming out with a simplistic statement about bedsharing can do more harm than good.”

In recognition of this, the UNICEF UK Baby Friendly Initiative has for some time been working to assist health professionals to discuss bed-sharing with parents so that risks can be identified and minimised, rather than attempting to promote restrictions which cannot be applied in parents’ real worlds.

A sample bed-sharing policy has been developed for hospitals and a leaflet for parents produced with the Foundation for the Study of Infant Deaths (FSID). Both are designed to promote safety whilst protecting breastfeeding, by educating health professionals and parents on the benefits, contra-indications and safety issues surrounding this practice. UNICEF has also been urging NHS trusts to acknowledge the gap in health professional’s
knowledge and provide training on all aspects of bed-sharing, including best practice for hospitals and how to communicate the key messages effectively to parents depending on their needs and circumstances.

Footnotes
1. Blair PS, Sidebotham P, Evason-Coombe C, Edmonds M, Heckstall-Smith EMA, Fleming P (2009). Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. BMJ 2009;339:b3666
2. Blair PS and Ball HL (2004). The prevalence and characteristics associated with parent-infant bed-sharing in England. Arch Dis Child 89:1106-1110
3. Ip S. et al (2007) Breastfeeding and Maternal Health Outcomes in Developed Countries. AHRQ Publication. No.07-E007.
4. HM Government (2008) PSA Delivery Agreement 12: Improve the health and wellbeing of children and young people.
5. Department of Health (2008) Healthy Weight, Healthy Lives A Cross Government Strategy for England. London: The Stationery Office.
6. Department of Health (2008) Health Inequalities: Progress and Next Steps. London: The Stationary Office

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