Speculative tangents are forming right before my very eyes, about what one
particular research paper *could* be saying and what that *might* mean for
practice implications.
Allow me to gently steer every IBCLC to IBLCE CPC 1.2, "Provide care to
meet clients' individual needs that is culturally appropriate and informed
by the best available evidence," and 1.5, "Present information without
personal bias," and suggest that before we comment on the goods-and-bads of
a research-based article, that it be read, in full, first.
The article in question is: Douglas, Pamela. Excessive crying and
gastro-oesophageal reflux in infants: misalignment of biology and culture.
(2005) Medical Hypotheses 64, 887-898.
The author is an evolutionary biologist. Her premise, heavily-cited to
support the conclusions SHE draws, is that humans are mammals that have,
for 99% of the evolutionary time on Earth, been dependent for the first 6
months of life on "maternal co-regulation for optimal physiological
function." She posits that changes in infant-care practices were brought
on by the Industrial Revolution (in which "infant autonomy" is emphasized,
a.k.a. "caching," or [my description here]
having-the-baby-be-set-down-somewhere-and-not-held-upright-in-arms).
Crying is also the no. 1 complaint that modern-day westernized (author's
term) parents ask their pediatricians about. She quotes an eminent
researcher (Ronald Barr) who argues that the baby who cries excessively is
"less able to adapt to a misalignment between western industrialised
culture and two million years of evolutionary context manifest in its
biology." Douglas says "certain infants subjected to the sensory
under-nourishment relative to biological expectation that is characteristic
of western infant-care practices may regularly respond to discrepant events
with distress." My translation: babies cry a lot when they are not held
upright, and kept at mom's arm's length reach day and night to facilitate
frequent breastfeeds. Excess crying can impact effective feeding ...
ineffective feeding can disturb the baby's ability to handle "normal"
refluxate ... excessive refluxate/regurgitation can cause inflammation of
the esophagus and -- ta da -- we get a diagnose of GERD/GORD.
So she is saying that MAYBE the reason we have so much "GERD/GORD" being
diagnosed in infants in modern western cultures, and maybe the reason we
have so many excessively crying babies, is because the baby's biology was
not intended to have the infant be "left alone" for long periods of time,
un-held and un-BF. But the fact that we DO have so many excessively crying
baby's may, in fact, be a contributor to true GERD/GORD diagnosis. Her
conclusion? "If the hypothesis that biolcultural factors impact on the
pathogenesis of GORD is correct, suggesting to parents infant-care
strategies that may more closely align with the evolutionary expectation of
the infant will prove to be important, e.g., appropriate feeding advice;
prompt parental response; increased sensory nourishment (use of carrying
deices such as slings and backpacks, infant massage, outdoor walks); and
co-sleeping. It is important to emphasize again that only parents know
which strategies are manageable in their own unique contexts."
My translation: medicine ain't necessarily the best medicine; parents
deserve to be taught/told infant care practices to soothe their crying
babies and -- in the end -- it is the parents who will know what does/does
not work for their baby.
I urge everyone to find this article and read it in full. It is worth it.
Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA
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