What follows is my letter to the Pampers Parenting Institute to address some
of the information in some of their materials sent free to childbirth
educators, complete with tear-off pages depicting the stages of labor, with
this parenting information on the back of each page. ( Please note that
every point is footnoted in the copy sent to PPI; thanks to those of you who
assisted my search for references.)
Deane,
Thank you for talking with me about my concerns. Parenting and child care
questions used to be a matter of theory or opinion. Now many of these
questions can be answered based on fact, that is to say, empirical data from
the new brain research. I have listed my concerns below and have included
the references for my information.
First is the issue of delaying offering a feed as page 18 of your booklet
sugests. The American Academy of Pediatrics issued their statement on The
Use of Human Milk in December of 1997. (Attached) It states that "crying
is a late indicator of hunger. Newborns should be nursed whenever they show
signs of hunger, such as increased alertness or activity, mouthing, or
rooting." Additionally for nursing babies, offering the breast as soon as
possible is important because if a baby becomes too upset by the delay, s/he
can become so disorganized that s/he will be unable to nurse effectively.
Secondly, offering a pacifier to a nursing baby is not recommended by the
AAP; "pacifiers should be avoided whenever possible." It is further
inappropriate to make a distinction between nutritive and non-nutritive
sucking for a breastfed baby. Flutter nursing, commonly referred to as
non-nutritive because it does not remove milk from the lactiferous sinuses,
is none-the-less essential as it stimulates and maintains prolactin levels
in the mother which are responsible for milk production.
The third issue is mostly related to the concept of "crying it out" . I am
aware that Dr. Brazelton has always proposed this approach. The first issue
is to examine whether or not crying should be accepted as the biologic norm
for human babies, as is implied on page 11.
1. Prolonged crying is neither a universal characteristic of infants, nor
does it serve a survival function. In fact, it interferes with survival in
virtually every way, with the exception of signaling distress.
2. Crying effects the infant across all systems. The experience of crying
interferes with the cardiopulmonary system - excessive crying interferes
with closing the valve that reroutes the blood to the lungs rather than the
umbilicus, visceral-the gut tenses, autonomic-heart pounds, breathing
becomes labored, motoric-muscles tense limbs loose coordination, and
metabolic- Cortisol, the stress hormone is released. Stress has been shown
to destroy the connections in the prefrontal cortex, which regulate the
infant's ability to self calm.
3. Prolonged, deep crying effects the arterial oxygen balance because there
is a momentary but repetitive cessation of breath intake. The body reacts
defensively, producing white blood cells and Cortisol. Even after the
crying stops, stress hormones remain in the blood stream for 20 minutes;
even after crying ceases, the infant remains stressed.
4. Prolonged crying effects weight gain as it burns calories and drains
energy: babies are often too weak or too sleepy to nurse.
5. Crying disrupts sleep patterns bypassing light sleep and going directly
to deep sleep. This is a response to stress due to physiological reaction
to Cortisol, the stress hormone.
6. Prolonged crying effects formation of relationships; prolonged states of
negative affect are known to be toxic for the young child personally and
interpersonally.
7. Exhausted babies spend less time interacting and learning
8. Babies who cry are at greater risk of setting up negative or minimal
feedback cycles.
9. Parents of babies who cry don't feel as effective, have their confidence
undermined and often blame themselves that can impact the quality of the
relationship.
10. Parents of babies who cry often experience resentment, hostility or
anxiety.
11. The effect of prolonged unattended crying on the infant-parent
relationship "can cause parents to withdraw nurturence, which threatened the
infant's well-being … letting the baby cry it out is indefensible." (The
Vital Touch)
Crying is, however, part of signal system.
1. An infant's cry is loud, 20 decibels louder that speech, insuring a
response and eliciting a maternal physiological reaction. Oxytocin is
released, heart rate and blood pressure rise, breast temperature and blood
flow to the breast increase, milk is released.
2. The response to crying impacts frequency. It takes 90 seconds for an
infant's cry to intensify and become difficult to sooth.
3. Babies who are consistently responded to within 90 seconds cry 70% less.
4. The walking rhythm of adult while comforting a baby (60-70 cycles a
minute) matches the walking rhythm during the last trimester, and the heart
rate of a pregnant woman. Rocked or walked at this rate, babies stop crying
on average by 15 seconds.
The best way to help parents to feel effective is not to encourage an
illusion of control, but to help them develop effective techniques that
encourage a well-attuned, interactive and mutually responsive relationship
with their child. To assume that a child is over-stimulated because
nothing else has worked is unfounded. Moreover, laying a child in bed to
cry unattended because nothing else has worked should not be promoted. As
shown, this might well be a further assault on the child's senses and
organization. While over-stimulation my play a role in an infant's
distress, there may be other factors as well. The formation of trust based
on signal responses is vital at this age, and unattended crying should not
be promoted as vigorously your material does.
I would also suggest that the ideas promoted on page 17 that a parent's goal
is to help their baby self-console so that they can be easier to parent is
misguided and dangerous. A parent's goal is to help meet their child's
needs in developmentally appropriate ways so that the child can grow and
thrive. I find it very objectionable to imply that the goal of parenting is
about making the child more convenient for the parents. Dr. David Elkind of
Tufts University and author of The Hurried Child, and Mis-Education states
in the 1997 summer issue of Tuftonia Today,
“One of the most important parenting skills is to, on occasion, put the
child’s needs ahead of our own or at least treat them equally. I think that
kids today feel that isn’t happening because everybody is doing their own
thing. It’s not the quality or quantity of time parents spend with their
children that is important. What children need to know and what truly
builds attachment, is the sense that their parents care enough about them to
make sacrifices on their behalf. This gives kids a solid sense that they
are important in our lives. Up until the mid-century the majority of
teenagers died from diseases, like TB and polio. But today a comparable or
even greater number of adolescents die from stress-related causes, such as
substance-related automobile accidents, suicide, self-starvation, drug
overdoses. I attribute this in part to the fact that a great many young
people today feel that their needs are not being met.”
While Dr. Elkind is clearly referring to adolescents, the relationships that
are begun at birth set the tone for the interpersonal dynamics, attachments
and relationships well into adulthood. It is crucial to encourage parents
to be as responsive as possible to infants needs and signals. Dr. Brazelton
has pioneered the concept that babies can show parents the way. Questioning
the legitimacy of baby's needs undermines this very concept. I would ask
that you re-evaluate your materials to reflect the errors I have suggested
here.
Sincerely,
Joanne McCrory
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