Dear Holly and Pam,


You both seem to agree that hands up " is how they were in the womb and how they should be outside the womb as well." 

I totally agree!  Imitating the womb sensory experience is the basis of the "4th trimester".  Of course we can't perfectly replicate the world Inside the womb, they have constant sound (at 75 db), constant pressure on the head, face covered by warm water...etc, etc.  

Babies should have their hands restricited (as they are in the womb) and be up around their face....trouble is that is much easier to do inside a womb.  That is why most cultures who swaddle their babies do so with the hands down. That is because more important than imitating the  womb experience of having flexed arms is imitating the womb experience of havinf restricted arm movements.  The world is TOO BIG for a new baby...they need protection, securtity...not freedom.  It usually take until ~3-4 months (or longer) for a baby to reliably selfsoothe by finger sucking. That is why we spend so much time letting them suckle at the breast...they need ot suck, but it is really hard getting and keeping the hands at the moiuth...especially when they are upset!


Holly, please be careeful about extrapolating your NICU experience to full terms...When you say "Having their hands up by their face provides them with security, much like containment.  In the NICU, I train parents to  contain their infants in a flexed, fetal position...scooping up their legs and arms.  Babies almost always instantly respond and are able to reorganize with this approach." you are not describing the usual experience of a parent with a fussy 6 week old.

Also, Holly and Catherine, please provide the evidence for your statement for full term babies that "Swaddling arms down can lead to further disorganization in a child who already cannot come back to center on their own and will lead to shut down.  Shut down is not a healthy response for a child's neurological system and should not be encouraged." Swaddling doesn't "shut down" a baby.  The relaxation babies enjoy is the esame relaxation they enjoy after a great nursing...are those babies "shut down" (they certainly seem a little drunk!).

And, Catherine, I agree babies who cry need something.  But, there is much evidence that is directly contradictory to your idea that they cry because of overstimulation.  In fact, most babies go to sleep at a noisy party or crowded basketball game.  It is UNDERSTIMULATION that is a much bigger problem.  Babies miss the rhyuthmic, hypnotic stim they have 24/7 in the womb...the stimulation that seems to turn on their "calming reflex"

Despite the past 50 years of the birth of lactation medicine...attachment parenting...the rates of persistent infant crying and  the severe sequellae associated with that crying have not diminished.  The wonderful holding and rocking and shushing you are mentioning...have NOTadequately helped the hundreds of thousands of families who are trying to be better parents and learn how to calm their infants.   

Finally, Catherine, I am saddened that you choose to be so perjorative about my work ("How shrewd of Dr. Karp to have turned his package into an empire!" and "most of the people promoting specific, rigid, all-inclusive systems are male").  What is rigid about helping parents learn to calm their baby by doing these ancient techniques optimally? Is that any different from what LC's do? Has LLI turned the natural art of breastfeeding into an international empire?

I have dedicate my life to helping families.  My work is endorsed by leaders all across the spectrum from the LLLI and API to the surgeon general and leaders of the AAP.  It is helping countless parents feel more competent...succeed at breastfeeding...and there is every reason to believe it will help decrease rates of SBS, marital stress, PPD, and even SIDS.

Sincerely,

Harvey


>Date:    Fri, 16 Feb 2007 18:41:42 -0800
>From:    Holly Bernal <[log in to unmask]>
>Subject: Re: HBOTB/Dr. Karp's book-a dissenter
>
>Catherine,
>   
>  You have explained very well what I think Pam's views were and I share these views as well.  After 10+ years in infant development, I would never swaddle arms down.  Babies are oral creatures and need their hands accessible.  They can then learn to self-calm by sucking on their hands or just placing their hands up by their face.  This is how they were in the womb and how they should be outside the womb as well.
>   
>  Having their hands up by their face provides them with security, much like containment.  In the NICU, I train parents to  contain their infants in a flexed, fetal position...scooping up their legs and arms.  Babies almost always instantly respond and are able to reorganize with this approach.  Swaddling arms down can lead to further disorganization in a child who already cannot come back to center on their own and will lead to shut down.  Shut down is not a healthy response for a child's neurological system and should not be encouraged.
>   
>  Thank you for sharing so eloquently your opinions!
>   
>  Holly Bernal, RN, MSN, NNP
>   
>   
>  "Catherine Watson Genna, IBCLC" <[log in to unmask]> wrote:
>  I share Pam's concerns about methodizing anything in baby care, and on 
>her particular critiques of swaddling with arms down, and the words 
>"calming reflex".
>
>Babies cry because they need something, or because their nervous systems 
>have become disorganized due to hyperstimulation. Some parents don't 
>understand subtle cues that the baby needs a break, and keep on 
>interacting, until their baby cries and becomes overwrought. I suspect 
>some of this is an inborn problem in sensory processing, and some is due 
>to lack of having this kind of communication respected when they were 
>babies and infants. (Remember that as little as 35 years ago, mothers 
>were taught that their newborns were blind, deaf, and insensate (could 
>not feel pain). One treats a senseless "blob" much differently than one 
>treats a human being.
>
>The more we study babies, the more we see that they are competent and 
>communicate their needs. If this communication is ignored, or the baby's 
>discomfort/hunger/loneliness get to a certain level, or if there is too 
>much environmental and internal sensation to process, the baby 
>disorganizes. Occupational therapists who deal with sensory processing 
>say to stop all stimulation, then provide organizing stimulation, and 
>then increase the original necessary stimulus slowly and gently, 
>watching the child's reaction. What Dr. Karp has done is taken some 
>organizing stimuli and packaged them.
>
>Swaddling - containment - strong support for the baby's joints brought 
>in toward the body's center, with firm pressure on the skin. Parents 
>have done the same thing from time immemorial by snuggling their baby 
>close.
>Again, the arms straight down thing is actually disorganizing, because 
>it does not bring the joints toward the body's center. It pulls the 
>shoulder blades apart, which is less stable, which makes the neck, 
>shoulders and back muscles all work harder, and is less comfortable for 
>the elbows as well.
>
>Sucking - is a strongly organizing stimulus. Why not just offer the 
>breast first? Breastfeeding combines containment and sucking.
>
>Rhythmic vestibular stimulation - the jiggling. Parents hold their baby 
>and walk or sway or bounce in a gentle, steady rhythm to calm them.
>
>White noise - the shh is another thing parents do in almost every 
>culture. It sounds like the blood flow in the placenta, and is again, 
>rhythmic.
>
>I don't think there is anything magical about sidelying, and he's left 
>out darkness and skin to skin contact. When I soothed my own kids, I 
>breastfed them, and did the rest of these if bf was not possible or they 
>declined to feed. When I soothe someone else's baby, I snuggle them 
>against my upper chest, so their face is at my neck, I touch my cheek to 
>their cheek, providing skin contact and darkness (removing visual 
>stimuli), cuddle them close in a nice flexed position (stability and 
>containment), rock or jiggle gently, and talk to them in a quiet, 
>soothing, repetitive voice right in their little ear. Works very 
>frequently to help the baby organize enough that they are able to take 
>their mom's breast.
>
>I think any of us that work with a lot of babies have our own little 
>combo of variations on these themes that we've packaged for ourselves. 
>How shrewd of Dr. Karp to have turned his package into an empire! My 
>concern is that in over-promoting this one package, we are losing the 
>personhood of the baby, and the sensitive communication we want to 
>establish between parents and baby that will help the parents scaffold 
>their baby's developing nervous system better so the baby learns to 
>modulate incoming stimuli, rather than just constantly treating a 
>hyperstimulated infant. Part of this is the either culturally or 
>biologically determined differences in male vs female thought - notice 
>most of the people promoting specific, rigid, all-inclusive systems are 
>male, and females are more likely to provide toolboxes and guidelines 
>for tool choice.
>
>I have shared most of these concerns with Harvey in person and in email, 
>so I'm not talking behind his back. No one made me the expert on 
>everything either, so he doesn't have to agree with me. Nor do any of 
>you. I'm sharing what I've learned in my work, so you can perhaps add 
>something to your toolkit!
>
>Catherine Watson Genna, IBCLC NYC

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