Analytical Armadillo - The Booby Whisperer

I'm Going To Try Breastfeeding....

2012-01-28T19:33:00.002Z

I hear this a lot - and variations of:

"I'm going to give breastfeeding a shot, but if it doesn't work out I'm not going to beat myself up."

"I will give it a try but have bottles and formula just in case."

"We've decided we will give it a try for the 2 weeks partner is on leave, then we've given it a shot and if it's not working swap to bottle when they return to work."

If we believe breastmilk is "best", and formula is "nearly as good" - these statements probably all sound quite reasonable.

But do we use the same language when discussing something we do consider important, or for situations where we expect a positive outcome?

Let's try - learning to drive:

"I'm going to give driving a shot, but if it doesn't work out I'm not going to beat myself up if I have to take the bus"

"I will give driving a try, but have bought a bus pass just in case"

"We've decided we will give driving a try for the 2 weeks partner is on leave, then we've given it a shot and if it's not working swap to the bus when they return to work."

Hmmmm I don't hear that as much...

Let's try some other scenarios.

"I'm going to give the new job a shot, but if it doesn't work out I'm not going to beat myself up if I have to resign."

"We've decided we will give a healthier diet a try for the 2 weeks partner is on leave, then we've given it a shot and if it's not working swap to ready meals. We plan to only half heat these because the official preparation guidelines on the packet are ridiculously time consuming. (removes tongue from cheek)

"We will give conceiving naturally a try, but have booked an appointment for fertility treatment just in case"

The latter may sound ridiculous - yet realistically the number of women who physically can't breastfeed with the right support is probably smaller than the amount of couples who need some sort of fertility support (I appreciate in the UK many don't get the help they need to succeeed!)

Now let's flip mindset from "alternatives nearly as good", to "breastmilk is normal". Formula isn't vaguely comparable (hence why they are genetically modifying cows to produce milk more like breastmilk.). It lacks thousands of constituents and is ultimately the milk of another species modified so humans can even tolerate it. There is a distinct lack of studies demonstrating its safety - with results varying from a small to significant increase in numerous conditions and diseases. Nobody can know ultimately the total long term effect on the body of not receiving growth factors, hormones, antibodies, stem cells, HAMLET, and everything else that is missing - but the information we do have shows that it does impact, even if at this point in time we struggle to accurately measure the totality. No matter how much we would like to present infant feeding as almost comparable "choices", this is the reality.

Suddenly the above statements don't make as much sense.

Of course breastfeeding doesn't work for some mothers, whether that's down to ineffective support or otherwise - just like some will need support to conceive. Nobody is suggesting anyone should "beat themselves up" - I understand that poor support can result in a traumatic time for mums and that a prior experience can leave someone nervous.

I'm not even talking about trying to convince mothers who don't want to do it to do so - purely those who have decided they want to breastfeed.

But a mental shift has to take place, moving from "I will try to breastfeed", to "I plan to breastfeed". To assume one will be able to until something suggests otherwise, rather than "Most women can't do it, so I will give it a pop but won't hold my breath".

Furthermore why buy an alternative "just in case" - the shops are still open after a baby is born, and parents can feel more tempted to use something sat there, so it doesn't go to waste...

Instead there are lots more productive things parents could do to be as informed as possible. Some spend hours choosing car seats, cots, and discussing the best equipment for their baby, whilst often barely giving a cursory nod to feeding - the very cornerstone of lifelong health.

What comes first - the health system providing the care new mothers require, or women who are determined they want to breastfeed, complaining and stamping their feet if nobody is helping resolve their problems?

The irony is that those who are working tirelessly to provoke change, supporting mothers where the NHS fails - often in a voluntary role without even expenses paid; are not supported by the women that were let down, but attacked as the "Breastapo". What a fantastic market that you only get customers if they stop breastfeeding, and then although you as a company may be key in the reason why these mothers failed - they then defend your product. Genius.

Before I get called "Judgy" or "Militant", let me add that with my first child I was one of those mothers who said they would "give it a try" and who bought formula "just in case". I was naive enough to think a lot of women simply couldn't breastfeed, and that formula was nowadays nearly as good - had I had a different support system I could easily have been "booby trapped."

But think about it logically and as Gabrielle Palmer highlights in the Politics of Breastfeeding - why in such rich medically advanced countries, do we have so few women who can seemingly breastfeed?

Are we broken?

Perhaps mentally and sociologically - but as mammals, we work as well as ever. Believe that, and you're half way there....

Message For Expectant/New Parents.

2012-01-18T19:57:00.002Z

Impending parenthood provokes a different response in each of us, and often a combination of emotions: anxiety, sheer panic, confidence, uncertainty, excitement, happiness to name just a few. Our expectations of what's to come, and what is "best", are naturally based on what we experience around us. Those who already have babies such as family and friends, mixed with our own life experiences, memories of siblings or early life. For many, smaller families may mean fewer memories of siblings as young babies, and it can be rather like wandering into the dark unknown. Even those with lots of young baby practice, may not have lots of newborn 24/7 experience.

Instead as well as looking to those close to us, we often turn to books, magazines, websites and health professionals - who all seemingly have different opinions, but who nonetheless may plant new little seeds of expectation.

Before baby arrives it's common to believe your baby will be the happiest baby around; you will change their nappy when it's soiled, feed them when hungry, provide a nice bed for sleep times and so your baby wont need to cry, his needs will be met. You and perhaps a partner snuggled on the sofa, baby sleeping quietly in the basket next to you. Sure you know babies need feeding at night, but you will have him there right next to you so you can tend to him quickly, fill his little tum before slumber re-ensues.

And for some this may be true.

The reality? Many are not like this, especially in the early weeks - and even then it may require veering from "biological norms" (eg feeding method, sleep training, pacifiers etc) to achieve these expectations based on "society's current perception of the norm".

The one thing I hear over and over from new parents is they had no idea just how hard it would be, why didn't anyone spell out just how challenging being a new parent can be - so for all those parents this blog entry is for you.

Being a parent of a newborn baby can be really, really, insanity inducingly HARD.

No really, harder than that.

From the moment that precious new bundle is placed in your arms, life will never be the same again. It now, at least for a while, revolves around this dinky new being, who co-incidentally didn't read any books, nor pay heed at classes - so doesn't understand any related expectations.

You feed them, change their nappy, wind them, check it's not too hot, too cold - yet still they may cry! The comfy bed you lovingly prepared might as well be covered in 9" nails, as they flail and wail every time you try and gently lower them in. Instead of snuggled on the sofa, you are taking it in turns to pace and jiggle the baby, before one of you tries to eat one handed so the other can have a powernap before shift change.

And the nights, who knew they could be so long? Even when you have everything "perfect" still baby squirms, grunts and wants to feed again; how can this be when it was only two hours since we just did all this?

"What do you want from me?" one mum confessed she had asked her baby at 3am after a rather rough night - desperate to sleep, yet desperately trying to stay awake whilst feeding. Whilst everyone had warned her not to bedshare, nobody had mentioned falling asleep upright or on a sofa was more risky, nor that baby naturally may want to feed quite frequently and having to sit up and do this every time was shattering, which made staying awake sitting up nearly impossible. Nobody had even asked if mum knew she could breastfeed laying down. I don't know what else she could want? What do I do?

One mum recently described the sleep deprivation as akin to mind altering drugs, that she dreamt (metaphorically) of a night of unbroken sleep, that she had never realised it would be so hard.

The only point I want to stress more than just how hard having a newborn can be (did I say that already?) is that it is nothing you as parents are doing wrong, let me repeat that a little louder: it is nothing you as parents are doing wrong.

It can be easy to feel that you are the only parent who has an unsettled baby. That given the books didn't describe this, it can't be common - because if you meet every need baby is settled, right? But that's simply not true. Some babies take a little longer than others to transition to life "Earth side" - even. If you've had a long birth, a long pushing stage, a speedy or difficult delivery - so did they. Some may be a little uncomfortable or windy, and don't forget nobody gave them the books. This piece talks about what a normal newborn expects, then compare that to what most parents in current society typically have in mind.. Whilst I don't feel long spells of crying should be just accepted as "colic", and it's always worth seeking help to explore why baby is crying if you're concerned - the point is that it isn't because you've held them too much/not put them in a routine early enough, not ignored their cries etc

The question also has to be - are your expectations realistic? If not adapting your expectations, can be a whole lot easier than trying to change those of a newborn - and given you have the cognitive ability to adapt, would also seem to be the fairer option. Expectations can play a part in how you perceive your baby's behaviour.

Example
Parents A & B expect their baby to wake and feed frequently day and night, understand their baby had no concept of time in the womb, and is used to receiving nourishment from an umbilical cord, rather than at spaced intervals via a breast or bottle. They know breastmilk changes composition so that at night it includes more "sleepy hormones" and helps to create circadian rhythms (sleep patterns).

"RESULTS: The tryptophan in the breast milk presented a circadian rhythm with acrophase at around 03:00. This affected the 6-sulfatoxymelatonin circadian rhythm with acrophase at 06:00 in the breast-fed infants, and also promoted nocturnal sleep. Assumed sleep, actual sleep, and sleep efficiency were significantly increased in the breast fed infants with respect the formula fed infants."

http://www.ncbi.nlm.nih.gov/pubmed/16380706

They heard that after a feed baby has a high level of something called CCK, and they know this tells him he’s full; but also that the level drops again after another 10 or 20 minutes post feed, so he thinks he’s hungry again - and that he may go through this loop several times, usually in the evening, commonly known as “cluster feeding,” before dropping into a solid, longer sleep stretch.

They've been told how to check output and signs baby is transferring milk well - so they can identify normal from a "needs more help" situation - and they've been shown how to recognise baby's earliest cues of hunger, so there's time to work on getting baby to the breast and comfortable before she becomes really hungry and frantic!

In the evening dad/partner (if applicable) hops in the bath for some skin to skin time with baby, and mum builds a nest of pillows, snacks, books, drinks, music/TV remote as desired, ready to settle down for a longer feeding session.

A & B have also been told it's normal for a newborn to want lots of contact and cuddles from parents, when transitioning from a place with constant movement, sounds and security - familiar voices, smells, touch helps ease this. They've read about the theory of the fourth trimester, and it makes sense to them.

To make this work for all of them, they have a wrap which holds baby to them hands free, which they've found also helps if baby is a little windy or unsettled - on really tough days they head off out for a walk with it. They've discovered it's fab for holding the baby when they want to eat, even if at times this means eating whilst wiggling to settle baby, or taking turns wearing baby in the wrap whilst the other eats.

Baby sleeps next to mum, bedsharing safely or perhaps a cot attached to the bed. This means when baby wakes nobody has to sit up, get up or try and keep themselves awake - but can either just feed, or slide baby over (still without getting up) then feed laying down. They've realised the beauty of this is that there is no "lowering down" - which triggers a baby's startle reflex and wakes them up, and that with practice sometimes this can be done with all barely rousing.

Although baby wakes every few hours as expected, mum doesn't feel completely exhausted as when she does sleep she hits more restful sleep levels due to having her baby right next to her. If people offer to help the parents gladly accept offers of practical help, perhaps some meals cooked for them or an ironing pile tackled!

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In contrast parents X&Y picked up a very different set of books when shopping. They expect that baby will slot around them, that they need to do so early to learn to settle themselves and become independent - quickly developing a reliable pattern.

They feed the baby and then place her in the crib, ready to sit and enjoy a meal together. No sooner is the food on the plate than baby wakes and also wants feeding, two hours earlier than expected. After a nappy change they gently place baby in her Moses basket - but she squirms and wakes, like a Jack in the Box every time she's placed back down. When baby wants to cluster feed from 7-10pm, the parents are tired and confused, why is she wanting to feed so frequently? On the one hand they reason, she can't be hungry as she only fed 45 minutes ago, so at first they try dancing, jiggling and rocking to help baby sleep. But when baby continues to cry for a feed, the doubts can start; she must be hungry? What if mum isn't producing enough milk, that must be the case because the book says she should only feed every 3-4 hours? Is it wind? Colic? How do we work out what's wrong? What if she isn't taking enough? You can't see with a breast to check...

During the night, baby sleeps in a separate crib - when she wakes frequently someone has to sit up, retrieve baby, feed them (staying awake) before taking them back to their bed. As mum tentatively gets back into bed, baby cries again - trapped burp this time. After a few minutes wandering round the bedroom baby settles but as mum places her down she startles and cries again. More pacing ensues and dad takes over for a turn. He manages to get baby into the basket, by swaddling to mask her reflexes and gets back into bed, but by now everyone is wide awake. Just as the parents start to fall asleep - you guessed it baby wakes again. After another 20 minutes trying to get baby into the basket, she's used enough energy that she's ready for feeding again thank you.

The next evening events repeat, and then a few more after that - the parents become more dismayed that baby wakes every time food is served, and they feel resentful they've not managed to have a meal alone together since she arrived. They expected something very different.

They decide if they can get baby to wait four hours for her feed, this will stop the habit of frequent feeding, and encourage the routine of long sleeps with infrequent waking they read about - and so introduce a pacifier which at least gives them chance to eat that meal. Over the next few days baby becomes more unsettled, wants to feed more frequently - and mum becomes more convinced there is an issue with her milk supply. The forums mum goes on related to the books she bought, only compound her feelings - parents are congratulated with a "Great Parenting!!" when someone declares their baby has slept a 9-12 hour plus stretch; which of course infers you're clearly not a great parent if you're baby isn't doing the same.

Partner looks at the exhausted mum and says something has to give, they cannot continue as they are - they need sleep and "me time".

When help is offered, the parents encourage family to nurse the baby whilst they complete household tasks, trying to keep the house tidy for visitors as though a baby hasn't landed and thrown chaos where there was previously order.
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OK so these are extremes, reality is more often various hues of grey - but you can see how mentally parents X & Y have a much harder time than the first set of parents when baby arrived. It can be at times hard to pick "instinct" apart from "social expectations" - ie is the instinct founded on something we already fundamentally believe to be true and thus expect or is there really an issue. It's always worth remembering that a baby simply does not have sufficient neurological pathways developed to manipulate, control, plan or "scheme" - meeting the needs of an infant leads to long term security compared to the potentially negative implications of trying to train behaviour to suit. Babies don't even develop mature sleep rhythms until the they're several months old, they're not developing habits at the newborn stage, they're purely focussed on survival!

Even with the most realistic expectation, some babies will still be much more intense than others - parents can still be exhausted and overwhelmed. Some babies may just need time, others may have an underlying issue they need understanding to help resolve - either way, I hope knowing it is normal and you're not alone or at fault may help, even just a little bit.

Should all newborns be checked for tongue tie?

2012-01-14T18:15:00.001Z

Part 1

Recently there has been lots of talk about tongue and lip ties - and rightly so given the first particularly can be a significant cause of breastfeeding problems, I've been known to blog about it myself a time or three. But recently tongue tie talk has taken a turn that has left me feeling a little uncomfortable - a call for every baby to be checked at birth for tongue tie, and divided if identified..

Logically this appears to make sense - snip them all and things will be well with the world, but I fear in practice the reality is not so. For me there are really important issues that we could focus on first, should we want to promote a change in the current standard of lactation care offered. This means starting at the beginning not halfway up the ladder.

Firstly - we are still currently in a position that many many mums with nipple pain/cracking/bleeding/feeding problems are not even getting this flagged as a problem - no really. They are told positioning and attachment look great, perhaps their nipples are just more sensitive, baby has a "hoover suck", baby is too big/small/hungry/lazy, it takes time for them to learn how to feed well, not all women can breastfeed and don't feel bad if you're one of those that can't.

Far before we move on to tongue ties, I believe we need to be in a position that whomever is caring for mum can identify there is a need for proactive support, if this isn't something that will improve over time. Furthermore they then need to be able to identify the signs a baby needs some extra help, that they're not transferring milk well - without this fundamental basic knowledge, the rest can only come crashing down.

Secondly the reality of our current care system means that many midwives are already so stretched that there are ongoing campaigns and petitions about the continuity of care women receive, quality of antenatal information, how many midwives are looking after each labouring mum. Midwives themselves talk about how little time they have to spend with each new mum, 6 hours in hospital pre discharge for some straight forward births and community visits are shorter. On top we now want them to be trained to effectively check every new baby for tongue tie? If so then there surely needs to be a way to clearly demonstrate this improves outcome, and I'm not convinced it's that clear cut.

Checking for tongue tie requires someone to place their fingers into a newborns mouth, when would this be done? Before baby meets mum? During the routine checks that so often themselves interfere with breastfeeding initiation because baby is removed from mum - something we know impacts? What about the risks of introducing foreign bacteria to a baby's mouth straight after birth?

Babies who have tongue tie are often orally sensitive, they may gag easily and babies often clearly demonstrate that lifting the tongue to check for a restricted frenulum isn't pleasant. My 5yr old describes it as "burny", which I would suspect it would if you are stretching a piece of skin to check its maximum extension. But we do this to all newborn babies just in case?

The biggest flaw as I see it is that whilst some ties are tight and at or near the tip of the tongue, thus easily identifiable - ties further back become much more difficult. As it stands they can be missed or disregarded by everyone from Consultants, to Surgeons, Midwives and Health Visitors - with some only acknowledging ties that sit right on the tip of the tongue - how would identifying more help if nobody will divide them? This is an issue some Lactation Consultants (IBCLC) in practice within the NHS already face. (Blog coming soon on this topic!) and one identifying every tongue tie whether causing a problem or not, wont resolve.

Many people have a frenulum(s) that does not impede tongue function - a tongue (or lip) is only "tied" if that frenulum is too short and tight to allow proper function. Simply seeing a piece of skin between the tongue and the floor of the mouth, or the lip and the gum means nothing - therefore one has to be able to ascertain how the tongue is functioning and how (if at all) that impacts on feeding.

Not all frenulums need dividing,

The NICE guidelines clearly state that a frenulum needs to be causing a problem ie there has to be a reason for division. How do current care providers decide if a frenulum is causing significant problems to feeding or is division worthy, if they are unable to identify good feeding versus not to start with?

Are all babies to be checked regardless of how mum wants to feed and if so what criteria will be used to establish which need dividing? Lactation Consultants don't just look for a tongue tie - they check the tongue function, whether baby's suck is organised, what else apart from the frenulum may be impacting? What impact has labour and delivery had? Is baby struggling one side more than the other and if so what is causing this? What does baby do at the breast during the whole feed? How does this tie in with an oral assessment of baby's sucking skills? The skill is piecing together all the information, to understand the big picture.

NICE guidelines only cover breastfed infants, many areas will only divide frenulums for breastfeeding infants as a means to preserving breastfeeding, so where will the provision (and the funding for it) come from for the thousands of divides that appear if all infants are to be divided?

Not all parents want their baby assessing for tongue tie as standard, nor it dividing if there are signs of restriction but no problems - so midwives would also need to be fully educated to provide enough information to facilitate an informed choice. We're not even there yet with breast v substitutes, let alone how a restricted frenulum can impact on feeding.

Wouldn't it make more sense to ensure those at the first point of contact could recognise a problem, including key indicators of tongue tie that can be apparent without fingers ever going in a mouth, and if so refer to someone with relevant expertise in that area?

Whilst anyone and everyone has an opinion on breastfeeding, like podiatry, osteopathy or a speech and language therapist - lactation is a specialist field and indeed a pretty sound science. But we still don't recognise lactation as a specialist field beyond lip service, it's open for anyone and everyone to give advice.

Why can't parents expect qualified help? As someone a few years ago said (and I'm sorry I can't recall who) You wouldn't expect to go to the hospital with a broken ankle and instead of seeing a qualified doctor, be referred to someone who had broken theirs a few years ago. Feeding is the cornerstone of longterm health! Peer Supporters have a significant and valuable role to play - but this isn't in the role of someone providing all the lactation education and support both pre and post natally because they are significantly cheaper to employ than someone appropriately trained and experienced.

In a city close to me recent economic changes have meant the NHS no longer provides three full time Lactation Consultants, instead it employs one part time with a Peer Support network. One LC for a whole city with many more unsure where future cuts will leave them.

A mum on Facebook today said:

"We are losing our NHS lactation consultants from 3 counties in South Wales this year and they won't be replaced. Other than Health Visitors, a couple of Breastfeeding Counsellors and the Peer Supporters, that is it for breastfeeding support"

Yet all women are advised during pregnancy to consider breastfeeding, many say the pressure to at least give it a try is great - yet where is the support for mums to succeed? Without the voluntary organisations, the private sector and passionate parents - what would we be left with in terms of the NHS? Think of all the breastfeeding information you read and share online - who produces all that?

Magic Bullet
The trouble with perceiving anything breastfeeding related as a magic bullet to all problems, is that for many it simply doesn't work like that. Years ago thrush (Candida) was the magic bullet, and everyone and anyone with nipple pain (which extended to deep breast pain too) was diagnosed and medicated for thrush. Even now we see women who don't have any risk factors for thrush, no visual presentation - who are medicated due to pain with similar presentation..

The fact there can be numerous causes of pain both during and after a feed, and that if the nipple is white post feed tells us baby has cut the blood supply from that area and that is likely to cause pain (think Reynaud's which has the same symptoms as thrush - the pain comes due to lack of blood flow to the area).

The risk with medicating all dyads for thrush regardless (beyond exposure to unnecessary medication) is the real cause of pain remains unidentified - when the thrush treatment doesn't work, the medication doses get larger and more prolonged, with large doses of oral Fluconazole (which in my opinion also potentially carries risks) so who has it helped?

Tongue tie just like thrush treatment for some women is the magic bullet - if that is the only cause of their problems, dividing it often resolves.

But I really don't think it's that simplistic. Firstly we see mums who have an "incomplete divide" ie the front of the tie has been snipped, but the surgeon hasn't gone far enough back to free up the tongue (many having no understanding of what function the tongue needs to feed effectively). These mums will often note no improvement post division, and at times things can even get worse as the baby can no longer use the compensatory skill they have been using. Tongue ties all have the ability to regrow - yet this isn't regularly checked for on the NHS, some surgeons will readdress if it happens and mum goes back, (if she has been told this can happen) others don't acknowledge they can reoccur and there's a good chance mum can come away thinking division didn't work.

But what's just as important is that there can be other things rather than, or as well as the frenulum causing problems - but if the person identifying the tie to start with is purely looking for a frenulum, this is very likely to be missed. In this case division may yield some improvement, with other issues remaining - or may note no improvement at all.

I've seen several babies in the last couple of weeks that had frenulums, but that was NOT the cause of their disorganised suck (it is the resulting disorganisation that causes symptoms) therefore it looked like a tongue tie, presented like a tongue tie but dividing would NOT have resolved the issues. Once the other issues were addressed everything was resolved - yet if this was a routine check the frenulum would have been divided, the actual problem ignored and who would this have helped?

So what's the answer?
Is what I was asked when discussing this recently - I thought I would save "My Ideal Breastfeeding World" for part 2 of this blog entry.

Reply to Brendan O'Neill's message to "Militant Lactivists" @ The Telegraph

2012-01-12T12:41:00.000Z

In response to Brendan's "Message to 'militant lactivists", I thought it only courteous to respond. Given everyone vaguely pro breastfeeding seems to be considered militant, I figured I would qualify as an "addressee" of said message,

Dear Mr O'Neill

Thank you for your message posted today in The Daily Telegraph, I've taken time from my "intense campaigning" to jot you a reply - and perhaps receive clarification on a few points?

In the first paragraph you note breastfed infants are considered more cranky, and that bottle fed infants are more content (possibly as a result of overfeeding) before disputing the conclusion "breast is best". For the record it isn't, it's purely the normal milk for human infants.

Does this mean you feel potentially overfeeding babies to make them unusually settled is "best" or healthy? Particularly given the current obesity problem, and the cost of the NHS treating this and related conditions (estimated by David Cameron at £4 billion a year, with this expected to reach £6.3 billion by 2015 ) it wouldn't appear at first glance to be a healthy option? I'm sure you're already aware, this isn't the only discussion to be had surrounding infant feeding and obesity?

It states the reason you feel this has been the conclusion is because:

"it is virtually against the law - certainly the unwritten laws of polite society - to say anything critical about breastfeeding or positive about bottle-feeding."

And I have to wonder if we're living in the same society. I blogged about how non breastfeeding friendly I think society actually is just a couple of days ago - but perhaps I'm missing something significant?

With mothers exclusively breastfeeding (ie making up the militant fraction) being minute, 3/4% at 6 months (Infant Feeding Survey 2005) - who exactly is running this "intense campaign" to which you refer? Where are they getting their funding, which papers are involved and where are the stories? Or does the research consistently reflecting the fact breastmilk is our human norm qualify as "militant scientists"? I'm perplexed.

Despite I'm sure in your opinion qualifying as one such "militant lactivists", I absolutely think women have the right to choose how they feed their infant and I think they deserve the support to ensure they meet their personal goals, whatever they may be. But don't you feel women deserve factual evidence based research upon which to make that choice if they want it?

You say "allowing women to decide for themselves, free from the pressure of health-worker hectoring and Brussels-enforced censorship" -

before going on to say:

"However, in our breastmilk-worshipping, advert-banning, formula-demonising society"

So you figure anyone educated to provide information should be removed from the equation, but the formula companies, the one making multi millions, the ones who have a vested interested in women using their product, who spend so much money compared to the government for each baby born, reinforcing their milk is "nearly as good" - (despite lacking a few hundred/thousand constituents depending on how you break it down - hence why they're genetically modifying cows) should be allowed to advertise?

And you consider this allowing women to "decide for themselves"?

Perhaps we should get the NHS to scrap any sort of health guidance and just get those manufacturing to advertise instead? Ditch the ridiculous research that consistently "makes us feel bad".

You state:

"The NHS relentlessly advises new mums that they must breastfeed exclusively for the first six months if they want their baby to grow up healthy and happy, inducing waves of guilt in those who, for various reasons, can’t breastfeed or who just don’t want to."

Perhaps this is because after summing up the evidence, the NHS acknowledges there are risks to giving milk of a different species? Perhaps this is because of the millions it costs them to treat conditions directly related to not breastfeeding (infant feeding survey 2005)? Yet this "guilt trips" mothers? You don't feel women should get the facts so they can make the "choice" you purport to support? Perhaps we shouldn't tell parents the risks of not using a car seat either, after all what if someone who can't afford one or who chooses not to use one feels guilty?

The fact is many many mums who want to breastfeed, who have decided simply don't get effective help to do so - they get passive support as described in the blog entry above, and are left feeling they have no choice but to formula fed or endure pain, a hungry baby or whatever else they are struggling to overcome.

Why don't they get the help? We could start by looking at the marketing techniques of the companies that make the product that "saved them", the literature they produce for the health professionals supporting these mothers, the methods by which they insidiously undermine a woman's ability to breastfeed.

Don't you find it amazing how so many women in so called rich, medically advanced countries physically can't breastfeed? Perhaps we're broken!

I'm sure as someone dedicated to "raising the horizons of humanity by waging a culture war of words against misanthropy, priggishness, prejudice, luddism, illiberalism and irrationalism in all their ancient and modern forms." the irony surely can't be lost, if it is, grab yourself a copy of "The Politics of Breastfeeding, When breasts are bad for business".

I've blogged my take on yesterdays news here - can't say I reached the same conclusions you did though.

Thanks

AA

UPDATE - Like others I have been baffled as to why Brendan has seemingly such anger and issues towards breastfeeding, advertising of substitutes and so on - but I think it's all becoming clear...

Discussion on Facebook reveals this isn't the first rant that has hit the news - check out this Guardian rant a few years ago. Even more interesting is one of the comments under said rant:

"Brendan, why don't you tell us a bit more about the relationship between your online magazine, Spiked Online, and the "Infant and Dietetic Foods Association"?

On page 10 of your "Brand Manager's Pack" (http://www.spiked-online.com/pdf/BrandManagersPack.pdf) it says that you've "worked with" the INFORM campaign, which is apparently "an Infant and Dietetic Foods Association (IDFA) initiative on behalf of the UK infant formula manufacturers SMA Nutrition, Nutricia (Cow & Gate, Milupa) and Farley/Heinz." (http://www.idfa.org.uk/resources/public/InformManifesto.pdf)

Also quite striking is the fact that all 8 articles on breastfeeding on the Spiked website (http://www.spiked-online.com/index.php?%2Fsite%2Fissues%2FC112%2F) seems to take exactly follow the industry line in attacking what you call "militant lactivism".

Sorry to bang on, but in your "Brand Manager's Pack" it also says that one of the services you offer to businesses is that you can help them with "brand alignment", or they can "commission a Spiked series". I'm curious - how much does it cost to "commission a Spiked series", and what would I get for my money?

In the name of robust, open debate, free speech etc., do you not agree that journalists with financial links to a particular industry ought to declare any such affiliations up front?"

Well well well.....

Epidemiology. 17(1):112-114, January 2006 Armstrong, J et al, “Breastfeeding and lowering the risk of childhood obesity.” Lancet 2002, 349: 2003-4 Toschke, A.M. et al, “Overweight and obesity in 6 to 14-year-old Czech children in 1991: rotective effect of breast-feeding”, J Pediatr Gastroenterol Nutr. 2002 Dec; 141(6):764-9 von Kries, R et al, “Breastfeeding and obesity: cross sectional study.” BMJ 1999; 319:147-150 (July 17)

Non Breastfed Babies Are Happier - The News Today

2012-01-11T22:15:00.000Z

Breastfed babies show more challenging temperaments, study finds (Guardian)

BREASTFED BABIES CRY MORE AND SMILE LESS - Breast may be 'best' according to health experts - but breastfeeding also makes babies more irritable and prone to crying according to new research. (Marie Claire)

Is breast really best? Study finds babies fed on formula milk cry less and are easier to get to sleep (Daily Mail)

"It is often said that breast is best. But bottle-fed babies are the best behaved.
A study of British infants found those who were breast-fed cried more, smiled and laughed less and were harder to soothe and get off to sleep than their formula-fed counterparts.
The Cambridge researchers however, say that the irritability linked to breastfeeding is only natural, and not a sign of stress or even necessarily hunger.
Instead, it is the baby’s way of bonding and seeking attention and security." (Daily Mail)

Believe it or not, the study is actually really interesting - the media coverage as usual, is not.

Best behaved? Studies aside, it's quite sad really how society perceives well behaved babies as those who are the easiest and cause the parents the least amount of effort. This quote implies breastfed babies are seeking more attention and security than those "well behaved" non breastfed babies. How many people skim such an article and just take away this key message? This really is a great example of points raised in my blog yesterday, and the one before!

But lets get started!

Firstly it's a small study group of 316 infants, further divided into breastfed, mixed fed, formula fed - meaning there isn't a huge study group of each, still I think it's worth a read (1).

The study asked mothers of three-month-old babies to assess their "behaviour" (you can read more about exactly how here), which is what is really the interesting bit in studies such as these. It's subjective - how a parent "rates" their baby is open to many influencing factors.

As the NHS points out the study doesn't take into account:

factors that influenced the choice of feeding method
whether the mother worked
other children in the home
mother’s educational achievement and their perception of infant temperament

But to be fair, the authors do acknowledge this in the paper:

"Findings from such observational studies do not provide evidence for causality."

They also acknowledge that studies in this area are contradictory, But what the heck, let's run with it and suppose its correct!

Something the NHS doesn't mention, and which I think is worth noting - is a study from The Journal of Child Psychology and Psychiatry, April 2011 which found:

"Mothers who feed their babies breast milk exclusively, as opposed to formula, are more likely to bond emotionally with their child during the first few months after delivery. "The breastfeeding mothers surveyed for the study showed greater responses to their infant's cry in brain regions related to caregiving behavior and empathy than mothers who relied upon formula as the baby's main food source."

As it's these same mothers who are then asked to rate their baby's crying - one would, based on the above expect non breastfeeding mothers to note a lower score perhaps?

If you're asked to rate something on a scale - we have to have a frame of reference for this measurement, something with which to compare. If you were an alien and had never seen a baby before, had no preconceived ideas about how much babies were meant to cry and were alone somewhere with no one to ask, how could you begin to rate whether crying was 2 or 7?

A scale such as this relies up an automatic, subconscious frame of reference - which may become conscious ie how much does my baby cry compared to X, Y and Z's. For many breastfeeding mothers, given breastfeeders are the minority - this comparison takes place with non breastfed infants; which, if this study is correct is likely to be significant..

Now we know breastfeeding is the biological norm, the milk humans are meant to consume - therefore it's pretty safe to say they cry a "normal" amount of time. The assumption it's "well behaved" not to, according to this study is flawed. It states:

"Humans often perceive infant crying as stress, but for infant animals irritability is a normal component of signalling to parents. The expression of offspring demand is part of a dynamic signalling system between parents and offspring, and has received much attention from zoologists studying a variety of bird and mammal species."

So crying isn't just about stress, but about signalling - particularly with regard to hunger. Hmmm so if those not breastfed veer from this normal signalling pattern, is that a good thing?

One argument that has been put forward is that non breastfed babies cry less because they need feeding less frequently (given foreign milk protein is harder to digest and therefore takes longer).

Others like co-author of the study Dr Ken Ong feel:

“Bottle-fed babies may appear more content, but research suggests that these infants may be over-nourished and gain weight too quickly. Our findings are essentially similar to other stages of life; people often find that eating is comforting.”

Perhaps this is true...

However - what's really quite interesting is some little known research by Philip Zeskind, an associate professor of psychology:

"Bottle-fed babies in some ways resemble an out-of-tune automobile, while breast-fed babies appear to be more alert, perhaps because their bodies simply run better, a Virginia Tech study shows.

Breast-fed babies develop a more energy-efficient and rhythmically functioning autonomic nervous system, which controls infant arousal, than bottle-fed babies, says Philip Zeskind, associate professor of psychology, who studied the sleep-wake patterns and heart rates of breast-fed and bottle-fed newborn infants.

"Although breast-fed babies are perceived to be more irritable than bottle-fed newborns,"Zeskind says, "our results suggest that the behaviors of breast-fed infants are physiologically more desirable. Feeding infants formula may make them sleep more and may disrupt the smooth running of their arousal systems."

Zeskind looked at babies in all stages of behaviour: deep sleep, dream sleep, drowsy, alert, fussing, and crying. Bottle-fed babies were found more often in the deep-sleep state, and breast-fed babies were more alert. Breast-fed babies also had lower heart rates, indicating better energy efficiency. "This argues against the idea that breast-fed babies are just more aroused and hungry,"Zeskind says. "If they were, they'd have a higher heart rate."

Computer analyses also show that the heart-rate patterns of breast-fed babies are more rhythmically complex, another indication of a more energy-efficient system. Basically, bottle-fed babies are like an automobile engine out of tune, Zeskind says. A less smooth-running arousal system has to work harder and use more fuel.

Which neatly all ties back in with the SIDS research and disruption of the arousal system..

But heck, what does it matter if not breastfeeding can have a notable impact on infant mortality, even in a rich country like America - so long as the baby is "well behaved" right?

Those breastfed and those not may indeed cry different amounts, may be perceived as more irritable or fussy - but this is the human norm. Ultimately beyond parental convenience, there really doesn't seem to be much evidence to support that it's healthy for baby to veer from normal signalling patterns - nor much known about the longer term, potentially lifelong impact.

The study concludes: Increased awareness of the behavioural dynamics of breastfeeding, a better expectation of normal infant temperament and support to cope with difficult infant temperament could potentially help to promote successful breastfeeding.

PS, Funding:

"The Cambridge Baby Growth Study was supported by the European Union, the World Cancer Research Foundation International, the Medical Research Council, the Mothercare Charitable Foundation and the NIHR Cambridge Biomedical Research Centre. BL was a recipient for a grant from the ``Societe Francaise de Nutrition''. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: The authors have declared that no competing interests exist."

1. Breastfeeding and Infant Temperament at Age Three Months, de Lauzon-Guillain B , Wijndaele K , Clark M , Acerini CL , Hughes IA , et al. 2012 Breastfeeding and Infant Temperament at Age Three Months. PLoS ONE 7(1): e29326. doi:10.1371/journal.pone.0029326

The Breastfeeding Nazi - For Real?

2012-01-10T13:27:00.003Z

If there's one phrase that switches me off a conversation or article instantaneously, it's the utterance of the words "Breastfeeding/Tit Nazi".

And it's getting tiresome.

Really it's just plain offensive, as are variations like "Breastapo". Godwin's Law if you're not familiar with it is worth a read.

Mafia is no better:

An organised international body of criminals, operating originally in Sicily and now esp. in Italy and the US. Any similar group using extortion and other criminal methods.

Nope, not many breastfeeding mums tick those boxes either.

What also confuses me is where these "breastfeeding militants" are hiding? They must be super covert.

A flick through the press offerings include this, this and this and there have been more I haven't bookmarked.

So where exactly are all the articles that supposedly call formula "poison", written by these "judgy mummies"? How often do they feature in the press?

Sure we might get the odd piece from the perspective of a breastfeeding mother, but they only make the cut if they're respectful and understanding towards non breast feeders, ie when did you see an article referring to the formula feeding fascists or beady eyed bottle users?

And rightly so.

But this rule doesn't work both ways.

Just last year, Singer Lily Allen (one of the few I thought was really cool up until this point) tweeted:

"I'm not going to breastfeed."

Replies that followed included:

"Let's hope the breastfeeding Nazi aren't following!"

Before Lilly replied:

"I have every intention of breastfeeding, just fancied antagonising the milk mafia"

The tag line for this story read: "Lily Allen's wicked sense of humour caused a mini Twitter uproar yesterday"

Yeah....Wicked.....Sigh

How hilarious this is even vaguely socially acceptable.

Think that's bad enough? These comments are echoed by a DOCTOR, a registered Healthcare Practitioner.

Check his tweets:

When someone replied to his Tweet with the following:

The link to this post you are reading now - about how calling people Militant isn't perhaps the nicest idea... Doctor Christian replied:

And there's me thinking I have an evidence based blog, and that was precisely why a couple of Doctors followed it - interestingly none of whom I've ever heard name call.

More perplexing is that what more evidence would Doctor Christian like that people call us "militants" - than his own blog tweet? I'm not sure there are any studies exploring the percentage of people who name call breastfeeders....

But - just in case you're wondering if perhaps he's having an off day and you should give him the benefit of the doubt. It seems having a lil rant about breastfeeders is something Doctor Christian has done before - last June, again on Twitter to be precise:

Doesn't it strike anyone else as rather unprofessional?
(more of Doctor Christian's tweets at the end)

Imagine if the comments read exactly the same but, the words "breastfeeding" or "milk" were replaced with race, religion or sexuality - it would be completely unacceptable. But whilst it's not politically correct to name call most - breastfeeders are fair game; it's clearly considered funny!

Why not stop for a moment and consider just how breastfeeding unfriendly our culture is.

We have debates and see polls online and on TV shows discussing whether it's OK for mothers to feed their baby milk of their own species, in the way it was intended to be delivered, in public - with some stating that it's akin to taking a dump.

Where are the debates and polls discussing whether it's OK to bottle feed in public? When did Nascar driver Kasey Kahne tweet that he was grossed out by seeing someone bottle feed in public?

When are photos of bottle feeding considered obscene? Heck Facebook recently deleted photos of a toddler pretending to breastfeed her doll as it felt even they were unacceptable.

When a breastfeeding doll was released, how discussion raged across the web as to whether this was "appropriate"? How many dolls you can buy come with bottles and/or pacifiers? Children have play kitchens, washing machines, prams, dolls - all to emulate adult life, this is how children learn we are told, through play. Except of course when it comes to infant feeding - then the plastic bottle is the norm.

Where are the special "bottle feeding rooms", that non breastfeeding mothers are expected to use rather than the main facilities?

Where are the "bottle feeding covers", to ensure modesty when using a replica breast and nipple?

When did it hit the news a mother was asked to stop bottle feeding or leave somewhere for bottle feeding in public? Would this judge have had a meltdown in court if it had been a bottle not breast?

When did someone suggest bottle feeding was sexual or they should stop having a teat once they have teeth, that to continue beyond that with a bottle was purely for your enjoyment?

As one mum on Facebook said:

"I have been called an exhibitionist, disgusting, perverted, accused of harming my child, told to go hide in a bathroom/closet, & alienated from family situations because of breastfeeding."

How many bottle feeders have received pressure to just pack up and "give a breast" when things have been tough? You were breastfed and you are fine! Give a breast it will help him sleep better...

An NCT survey of 1200 women found 65 percent didn't even intend to try breastfeeding because they felt too self-conscious about people staring at them.

There is a huge pressure to be "discreet", which given nature stuck breasts right on the front of us, and babies don't realise social graces - can be difficult!

I've blogged here about the passive support women receive, where they are simply told to stick at it, before this shifts to "you've tried long enough now supplement" - without any help featuring in the equation at all!

Our society so firmly holds not breastfeeding as the norm, that 99% of studies write from the perspective of formula as the basis for comparison. Breastfeeding holds benefit X or reduces risks of Y. It's upside down.

Statistics tell us far more people are bottle feeding than breastfeeding after the first few weeks - by 6 month those still breastfeeding is minute, so who exactly makes up this so called army of breast feeders who are making lives so difficult for non breastfeeding mothers?

Out of those that managed to breastfed as long as they wanted, how many had it tough yet are not allowed to verbalise their pleasure at continuing - otherwise they are accused of making those who didn't feel bad, or they're smug?

Yet the Daily Telegraph ran an article last year headed:

"Breastfeeding: Protect us from the Breastapo"

Crikey - breast pumps at the ready ladies!

It seems now that anyone vaguely pro breastfeeding or who feeds in public, or who decides not to use a bottle <sharp intake of breath>, earns this militant badge - it isn't just given to those who are judgemental or who do not understand the politics of breastfeeding, and how everything is actually stacked against mothers succeeding.

I'm pretty tired of the press only ever covering one side of the story - mothers feel judged however they feed, but terms like these only serve to ever widen the gaps. Breastfeeding mothers are the minority, and a good deal of those have been through a whole heap of crap and understand more than well how someone can stop.

Labelling the majority because of the actions of a few fuels prejudice, and frankly it's only serving to make all mums feel uncomfortable.

Further discussion with Doctor Christian on Twitter:

I'm confused at how me objecting to him using statements such as "breastapo" and "militants" is proving his point beautifully, I wasn't rude or aggressive at any point. But I can't see the point in asking - logic and reason doesn't appear to the main feature of this Doctor's replies!

@efaitch also commented:

"How did I prove his point beautifully? I was also polite too. I also tweeted that I'm not a lactivist (either), I'm a mother who's providing the best that I can for my children. I don't think that I could trust a doctor who as he himself is in a "minority" (homosexual) can put others into a minority and label them as forcing others to breastfeed - I really wish that someone could've forced me to breastfeed my daughter... if only there was such support!
It's really riled me that he has no consideration for people who are trying to do their best for their children. I was devastated that I couldn't access the support that I needed to breastfeed my DD. Only sheer bloody mindedness helped me successfully feed my son. I felt guilty that *I* had failed. Nobody AT ALL made me feel guilty. So, as a formula feeding mother *and* a breastfeeding mother, I'm able to see things from both/all angles. But, because I was able to succeed 2nd time round, I'm also classed as a militant..."

What I'm really thinking: the breast-feeding mother

2012-01-09T09:55:00.000Z

In response to "What I'm really thinking: the bottle-feeding mother" published Guardian Friday 6 January 2012

I see the bottle feeding mothers watching me as I fumble around under my breastfeeding apron, trying to latch on a wiggly baby that I can't see. Those looks speak a thousand words, most of which boil down to, "don't flash an inch of flesh in public, we're feeding our babies without exposing ourselves, why aren't you?"

I feel as if they're judging me, they can have dad, gran, friends feed their baby, whilst I'm tied to mine almost 24/7. Do they feel superior to me? Certainly I feel that I have to defend my decision to continue through sore nipples and growth spurts, justify why I don't just give a bottle, so they'll accept me.

They sit at the postnatal groups, beady eyes peering at me, bottle lids clicking as my son nurses hungrily. But I can't help noticing how their looks change - A bit of envy maybe - when I start to breastfeed. My guess is they're thinking, "that looks a lot more efficient than bottle feeding". You're right, I want to tell them.

I can almost hear the deafening mental processing in those staid church halls: "She won't have to make up a bottle each feed, sterilise them, tote them around. And imagine just being able to roll over at night and have an instant feed, nobody has to get up to make it, and a built in pacifier."

But I don't want to fall into the trap of judging them too harshly, either. I could easily have ended up bottle feeding, if I didn't get the support that helped me succeed with breastfeeding, most have no idea what they're missing. Now I've cracked breastfeeding, I see the advantages. I'd even choose it again next time. It's really not so bad, I want to tell them, after the early weeks are mastered ..
END

The point of this is to demonstrate how ridiculous the original article was. As one reader said on Facebook, it would have been more accurately titled - What I think you're thinking. The reality is that most breast feeders are just trying to get on and feed their baby "discreetly", not judging others, and most bottle feeders are doing the same - it seems everyone feels judged regardless of how they feed their baby. Articles like this, just further hot up the "mummy wars", and we all know how profitable that is.

If I were more of a cynic, I might even wonder if this is a genuine "mummy article" - opinion pieces are free of the "breast is best message" that has to accompany standard articles, and AF companies are not allowed to advertise... The insidious comments re breastfeeding (from someone who didn't do it) and "try it you might like it" theme could be eyebrow raising for some..Just a thought

The Mild Tongue Tie

2012-01-05T20:25:00.000Z

"Baby has a mild tongue tie but it's too small to cause any feeding problems."

I meet so many parents who have been told this by almost every health professional going - from Doctors to Feeding Advisors, it seems to be popular at the moment. Parents I meet because they've called me out due to feeding problems; problems that are of course not being caused by that "mild tongue tie". Except they are...

Babies who have reflux, colic or wind because they are unable to maintain a deep latch at the breast/bottle, painful, constant or sporadic feeding, spluttering, gulping and coming off when the milk ejection reflex (let down) is triggered or the bottle tipped (often still on the slowest flow regardless of baby's age) - because they can't organise and co-ordinate their sucking and breathing fast enough (oh so often diagnosed as "fast let down" - it's not, the mum has a perfectly normal speed let down) some that refuse the breast entirely, others barely letting it go!

Some are told as their baby can protrude their tongue, the tie is mild; others after someone has had a cursory look in baby's mouth - perhaps the only thing worse is the "there's no tie" (when there is) or "baby has a short tongue", but all can deter mums from getting timely, appropriate help.

So can a tongue tie be mild?
Absolutely - a "tongue tie" or Ankyloglossia to give it it's official term, is when the frenulum (the bit of skin that anchors the tongue to the floor of the mouth) is too short or tight to allow the tongue to function properly. Some can be on the shorter end of typical, or further towards the front of the tongue than we expect, but the tongue still has enough movement to feed properly - this is what I would term a "mild tongue tie".

What the BIG problem is however, is that by simply having a quick peek in a baby's mouth - whilst you can often confirm if a tongue tie is significant, it's much harder to confirm insignificance. In order to do so you have to piece together the signs and symptoms, watch the baby at the breast/bottle, assess the baby's suck and what the tongue is actually doing whilst baby is feeding, and if there are significant indicators, a specialist who is competent lifting the tongue to complete the picture.

Why?
Because tongue tie isn't about how the tie itself looks, but about how it allows the tongue to function - looks can be deceptive. A tie can be like a super thin wire, or slightly wider and diaphanous - still appearing "tiny", yet if it is tightly holding the tongue, it matters not if it's super thin or a more chunky number. Furthermore a tie can look insignificant from the front, but when assessed properly, one can find the frenulum runs back down the tongue, getting thicker and causing significant restriction further back.

To feed effectively the tongue needs to not only be able to protrude, but also needs to be free to move laterally in a co-ordinated fashion, plus it needs to elevate and undulate ie a wave like motion. How can you confirm a tongue can do all those things with a glance?

Anther myth is people generally consider ties right on the tip of the tongue to be the "most severe", those nearer the back "insignificant". Whilst cosmetically this may be so, a tie anywhere down the tongue can impede function in exactly the same way - just because it doesn't pull the tongue into an impressive heart shape matters not. When you think the tongue has to undulate when feeding - a short thin tight tie at the back prevents the posterior tongue lifting, which is pretty essential to feed in an organised co-ordinated fashion without spluttering and gulping. Regardless of where the tie is, a baby will still compensate with an alternative tongue action, which may (or may not) lead to nipple trauma for mum and ineffective milk transfer for baby. They will still fail to make a seal at the breast, pulling, slipping or gradually working their way back to a shallow latch - does that sound less significant to you?

Do all ties need dividing?
Nope, I was called in this week to assess a newborn baby with a posterior tie, yet the tongue had excellent function and I was confident the problems they were experiencing were not due to the restriction. 48 hours later baby was feeding fantastically, is settled and happy between feeds with a 5-6 hr stretch overnight and mum is pain free - that's a mild tongue tie!

Formula Saved My Baby's Life!

2012-01-01T16:06:00.000Z

I read this a lot online - sometimes from mums whose milk didn't "come in" or who were medically unable to breastfeed, and more often from mums whose baby was unable to transfer milk effectively, dehydrated and thus the "life saving formula" was introduced.

But I have to wonder how accurate this statement is.

Did the artificial substitute save the life of the baby in that he/she did not die, did it provide adequate nutrition so that the baby could grow? Absolutely - so is Carnation Milk a lifesaver too? (ie the replacement widely used pre formula?) or dilute cow's & goat's milk, or "dry feeding" which was used prior to animal milks. Isn't the reality simply that eating and drinking, thus not starving/dehydrating is the act that is lifesaving?

The second thing I wonder is, is it purely about surviving versus not surviving? Isn't the big picture about health too? ie how healthy that surviving person is long term?

We know that feeding humans milk of their own species is the biological norm, and we know that veering from that norm increases the risk of illness, disease and yes even death - not just in infancy, or childhood but ever reaching into adulthood.

Therefore to my mind, breastmilk is lifesaving - obtaining donor milk is "lifesaving", formula, rather like Carnation Milk, even in this narrow context, doesn't deserve the badge.

Furthermore it's also kinda ironic that the thing that "saves the life", is the very thing that for many women undermine it in the first place. Lack of effective support, this post discusses how there's no excuse for the dehydrated breastfed baby.being just one way (and the Politics of Breastfeeding covers this in more than enough detail)

Just a thought.

Nipple Shields - Don't Throw The Baby Out With The Bath Water

2011-12-28T18:23:00.000Z

Modern Silicone Shield

Nipple shields, the word practically draws a gasp in some circles and to be fair perhaps with good reason. For years nipple shields were used by many as the "solve all" to breastfeeding problems, rather like sticking a giant plaster over whatever was causing the problem - they either didn't help and feeding was just as painful, or did but mum's supply suffered, and if she got through all that it was often a long and arduous process getting baby to feed without them; techniques recommended ranged from "making baby go cold turkey" to "cut them down gradually" (really not recommended nowadays due to shields being made of silicone which can be very sharp when cut).

Dr Jack Newman himself states there is never a need for nipple shields - and perhaps in a perfect breastfeeding world where everyone can get the help they need instantly, he may be somewhere near the mark. But at least where I am in the UK, we're simply not there at the moment.

But let's start at the beginning.

Nipple shields have been around since the 16th century, and have been made of lead, silver, wax, wood, pewter, tin, bone, ivory and glass.

Portia Shield

Glass Nipple Shield

More recently plastic, rubber or latex became popular and nowadays the typical shield is a thin piece of silicone worn over mum's nipple and areola - although there are still a few odd contraptions around, like the Portia nipple shield (on the right) endorsed by Claire Byram Cook (or so the packet says). The mum pops the "teat" over the plastic holder, and then puts the plastic holder over her nipple; I'll leave you to make your own minds up about that one, but I'm sure many will note the similarity between this and the image on the left...

Numerous studies demonstrate that shields can affect milk transfer and thus mum's milk supply, however these studies are examining older fashioned thicker shields, that would reduce stimulation to mum's nipples too.

Latex Shield

A 1980's study found latex shields reduced milk intake by a 22%, but had no significant effect on sucking patterns. But shields are now made of thinner silicone, so how applicable is this?

Not very in my opinion.

A 2006 study published in the Journal of Obstetric, Gynecologic, & Neonatal Nursing, which examined use of an ultra thin shield found:

"Physiological results demonstrated no significant difference in maternal hormonal levels and infant breast milk intake for breastfeeding sessions with and without nipple shields."

I'm sure many are wondering where I'm going with this - surely we don't want everyone reaching for the shields do we? Of course not - but we've gone so far the other way that they're seen as a huge cause of breastfeeding problems and something to be avoided at all costs. They are no longer seen as a useful tool in the bag of someone suitably qualified, but a big no no.

A few months ago I suggested a mum considered the temporary use of shields, with the result being the local NHS Infant Feeding Advisor (midwife) was so upset, you would have thought I had suggested hanging the baby upside down from the washing line whilst mum latched him doing limbo.

I met the mum four days post-partum after what she described as an "horrific" labour and delivery, 48 hours resulting in an emergency section. There was a long delay between birth and her holding her baby, who had promptly refused to latch - again she filled up as she described the past few days in hospital. The baby had "screamed" every time she held him, trying to latch, pulling away writhing and twisting, leaving mum in tears. Biological nurturing (leaning back) which they had suggested in hospital, she had found difficult due to her very large pendulous breasts meaning baby ended up somewhere under her armpit and even with pillows etc mum had felt extremely uncomfortable and the baby had just "pecked and bobbed".

Midwives had offered to take the baby, and as he settled with them (away from his "food source"), mum felt it was her causing the baby to become distressed. She had managed to get him latched for four feeds the previous day, all of which had followed a 30-50 minute battle, a number of other feeds had resulted in them "giving up" because baby simply wouldn't latch and became either too upset or sleepy to feed. Mum had been expressing since day one and cup feeding in hospital had been messy, with mum confessing dad had tipped a little in because they were so concerned he wasn't taking any milk (please note this is not recommended and can pose a choking hazard). Even after the feeds that they managed baby was unsettled and rooting for more.

Lead Shields

Mum didn't hold her baby unless she had no option but to attempt a feed, because otherwise the whole rooting, writing, crying scenario would unfold again. Mum was utterly miserable - just wanting to feed her baby without him becoming so distressed and frustrated first; she confessed if things couldn't be sorted today she didn't know if she could continue breastfeeding; as it was she was beginning to wonder what she had let herself in for having a baby! She looked shattered, emotionally drained and desperate.

Before long it became clear why this dyad were having problems - baby had a tongue tie which was severely restricting tongue function (probably not helped any by the failure to progress and resulting section), and mum had flattish nipples that inverted with pressure; the combination proving frustrating all round. Without adequate tongue function baby has cues missing from the feeding sequence he uses to latch, add to that retracting nipples and he can't even get by using a less effective technique.

When a feed was attempted and baby struggled and expressed his frustration, mum quickly became tense and distressed - "you see" she declared, ""we just can't do it". Despite every trick to improve protrusion, breast sandwiches, deep latch techniques and nipple flips in almost every imaginable position, baby barely latched, he nibbled on the nipple maybe twice but nothing more. Mum gave a little expressed milk via finger feeding (which both parties loved and the cup hit the bin!) to take the edge off and keep him interested - but just as she had described the cycle of them both ending up upset continued.

At this point mum sobbed, and everything came out from her "failure to birth properly", to her "failure to even hold her baby without him becoming beside himself", to her "failure to feed him".

Mum gave baby some expressed milk so he would settle, I made us a cuppa and we had a long chat, which resulted in me asking if she wanted to consider using a shield until the tongue tie could be further assessed, and so they could both do a little healing from the birth - some breathing time. After a quick chat about pros and cons, how it may not help or may cause pain, dad popped out to the chemist.

Silver Shield

Mum popped the shield on, hesitantly put her son to the breast and within an instant he was latched and taking full advantage of her now abundant supply! Mum cried again, this time with tears of joy - "I'm feeding him, I'm actually properly feeding him!!" she declared triumphantly. She preened and stroked him as he nursed, telling him how clever he was, compressing her breast until before long he popped off satisfied and content.

How do we begin to measure the psychological boost that feeding her baby without distress gave that mum? The renewed hope that she could breastfeed, that she no longer had to dread picking her baby up and that he only ever cried with her? Was the latch perfect with the shield? Nope, but did it actually at that point matter? Baby got enough to feel satisfied, mum was happy and this was a short term intervention.

With a now beaming mum I called the Infant Feeding Advisor to ask the best route of referral for NHS division. I was advised to speak to the midwife who as if on cue, knocked on the door.

That's not a tongue tie the midwife declared (after nothing more than a cursory look in baby's mouth) I will refer you but they won't do anything with that. And what are those shields? You should be cup feeding, our Infant Feeding Advisor would not be happy with you using those....When she spotted the syringe used for finger feeding, I thought she might actually pop there and then in the kitchen!

At this point mum looked about to cry again and dad quickly intervened to say they had had a lot of trouble cup feeding and this had worked really well. I will get someone round to show you how to cup feed properly was the midwives reply, he will never breastfeed if you keep using those shields, new guidelines are they're not recommended at all. Finger feeding shouldn't be used either once the baby needs more than 1 or 2 mls...

After the midwife had gone it was dad who reminded mum of her brilliant feed and that she should follow her instincts, mum decided to stick with the shields and see what panned out.

I received a phone call from her several hours later, telling me the area Infant Feeding Advisor (IFA) had arrived with her less than an hour after the midwife had gone (called in by the midwife) the IFA confirmed it was a tongue tie and referred the baby for division, but also agreed shields were against NHS guidelines and she did not support their use, nor the finger feeding which should not be used as the baby needed to "stretch their tongue attempting to cup feed" and it was not an evidence based method of supplementation (clearly Salisbury NHS disagree and guidelines do actually state cup OR finger feeding is fine). By this point mum wasn't up for engaging in further discussion and politely told the IFA she intended to continue as was until division.

Long story short the parents waited several weeks for division, during that time they did not receive any information as to when, where or even if the division would take place. She tried on numerous occasions without the shields, but the result was always the same frustrated crying and so she continued using the shields and feeding her baby! After 48 hours solid of trying to obtain a date/time for division from the NHS, the parents decided to go private and contacted the IFA on the morning of their appointment to advise her of their plans - within 5 minutes they were advised to drive to a particular hospital where the tongue would be divided....

After the procedure, mum was again advised to expect difficulty stopping shield use, and so did not attempt it for 3 days whilst the tongue healed. On day three half way through a feed mum removed the shield and never used it again.

Evidence?

Clinical Use of Silicone Nipple Shields, J Hum Lact. 1996 Dec;12(4):279-85:

"Use of nipple shields is controversial. However, when weaning is imminent, they may enable breast-refusing infants to transfer back to the breast."

Women's experiences using a nipple shield, J Hum Lact. 2004 Aug;20(3):327-34.

"An informal, retrospective telephone survey of 202 breastfeeding women was conducted over an 8-month period of time, assessing patients' perceptions regarding use of a silicone nipple shield. Sixty-seven percent of the women continued to breastfeed after transitioning off the nipple shield."

Now bear in mind we have no idea how many of these 202 mums may have given up breastfeeding entirely without the shield...

Long-term nipple shield use-a positive perspective, J Hum Lact. 1996 Dec;12(4):301-4.

"This report describes ten cases in which silicone nipple shields were used for two weeks or longer. In nine of the cases, shields were used to help babies attach to the breast. These babies had struggled to attach to the areola because of suck problems or the mother's lack of protractility of breast tissue. In the tenth case, the shield was used because of extreme nipple soreness. All babies were off the shield by 3.5 months of age; nine were feeding directly from the breast. All weights were appropriate or above for the age of the infant at three weeks, two months and four months."

Discussion:
Much of the focus surrounding nipple shields is about function - does it impact on milk transfer, mum's hormone levels, milk supply. What about the psychological impact, did it empower this mum? Absolutely, and I have no doubt in my mind at all that it preserved breastfeeding where it would otherwise have ceased. Even if eventually we had managed to get baby latched, what happens at the next feed or at 2am?

I think before anyone even thinks shields, the key is establishing WHY a baby is struggling to feed well - without this it is just a sticking plaster. They can be hard to stop using if the root cause isn't also addressed, I think they should only be discussed by a lactation consultant or very experienced, competent breastfeeding counsellor and not as the solve all they used to be. They're not the answer for all mums, and they're definitely not the answer to all or even most problems - but used wisely, I for one think they're a godsend.

Nine Good Reasons NOT To Use Baby Rice

2011-12-04T11:20:00.001Z

1. It's bland and tasteless, yet sweet - which may influence later food choices: Try it - whilst the texture may be a new experience for baby, there's certainly no flavour enjoyment. People mix things with it like apple or pear - why? Why not just give the fruit?

Dr Greene in his paper "Why White Rice Cereal for Babies Must Go" states:

"Some taste preferences are hardwired. And different babies experience taste differently, in part because of hereditable differences in taste bud density. But careful studies of human twins and of young animals suggest early exposures and social interactions outweigh genetics when it comes to food preferences.(11)"

"Indeed, up to 85 percent of the variability in eating patterns is due to environmental, not genetic factors.(12,13,14,15,16)

We know in animals that the first bite of solid food can be particularly influential.(14) For human babies the moment of the first bite is laden with positive associations. The child has often been staring at the parents’ food choices, eager to learn what eating is all about. The child is the center of attention at an emotionally charged moment, often with a camera capturing the event. The processed white rice flour is often mixed with breast milk or formula, giving it an even stronger positive association.

Conversion of the white rice flour to glucose begins while the cereal is still in the baby’s mouth, lighting up the hard-wired preference for sweets (and the cereal is nearly 100% glucose by the time it is absorbed in the intestines). Given this “perfect storm” of extrinsic and intrinsic factors, both initially and throughout the formative months, it is easy to see how a preference for processed refined grain products could become firmly established, and later in life, challenging to change."

2. It's outdated: back when guidelines suggested 3-4 month weaning (ie before the gut was closed) introducing what is considered to be a low allergen food that is easy to digest (due to the processing) was considered safest, otherwise food proteins can potentially provoke an allergic reaction. If weaning commences when baby is ready ie they are reaching for food and putting it in their mouth, or at around 6 months as guidelines now suggest; the gut is closed and thus this is not an issue. Furthermore, in small babies mixing with foods was to try and coax the baby to accept a flavour they may typically reject - a baby ready for solids is ready to enjoy full flavours too. Those breastfed have already experienced a range of tastes via breastmilk, so why would they need a tasteless food?

3. It's highly refined: and not in the elegant and cultured in appearance sense - but over processed like white bread which is stripped of nutrients by the processing It is often then fortified with synthetic vitamins - some just with Thiamin (B1) whilst others are "enriched with 13 vitamins and minerals, like iron and zinc". However these are less bioavailable to baby than those naturally occurring in foods.

4. It can cause deficiencies: consider that when a baby starts solids, the food is shown to displace total milk intake over a 24 hour period. In a breastfed baby this means they are swapping calorific nutrient rich foods for a poor substitute. Studies have also shown infants who received iron fortified foods (as some baby rice is) before 7 months, had significantly lower haemoglobin levels at one year than those who had not. Excess iron also potentially causes harm to the body.

5. It's high in sugar: Dr. Alan Greene, a paediatrician at Stanford University who started the campaign "white out" says:

"I have been studying nutrition very carefully for more than a decade now and one of the things that I have become convinced of is that white rice cereal can predispose to childhood obesity," said Greene. "In fact I think it is the tap root of the child obesity epidemic."

Besides its touted digestion benefits, Greene said white rice cereal is also high in calories and made of processed white flour.

"The problem is that it is basically like feeding kids a spoonful of sugar," said Greene.

"The difference between white rice and brown rice is huge," said Greene. "White rice is basically 94 percent starch."

6. It could be linked to diabetes: A 2010 study published in Arch Intern Med found Those who ate white rice 5 or more times a week had a 17% increased risk of type 2 diabetes compared with those who ate it less than once a month. Those who chose brown rice or another whole grain instead of white rice had up to a 36% reduced risk.

Another study entitled "Carbohydrate Nutrition, Insulin Resistance, and the Prevalence of the Metabolic Syndrome in the Framingham Offspring Cohort", found:

"Whole-grain intake, largely attributed to the cereal fiber, is inversely associated with HOMA-IR and a lower prevalence of the metabolic syndrome. Dietary glycemic index is positively associated with HOMA-IR and prevalence of the metabolic syndrome."

7. It can contain Arsenic (yes really): From the NHS

"Rice fields are regularly flooded and arsenic is naturally present in the soil. Subsequently the substance is present at a relatively high level in rice. High levels of arsenic are reportedly linked to an increased risk of certain cancers. Researchers in this study tested levels in 17 samples of three unnamed brands of baby rice in British supermarkets and found that 35% of them contained high levels. The Food Standards Agency is reported as saying that there is no danger to infants, but that food regulations should be updated. There are currently EU and US legislations governing inorganic arsenic content allowable in water, but not in foods."

Brown rice is likely to contain more than white, so is not really a viable alternative. There are currently no EU-wide regulations for arsenic levels in food after the European Food Safety Authority ruled that previous safety limits were inadequate.

8. It can contain other toxic metals: A study featured in the journal of Food Chemistry, found feeding infants twice a day on the shop-bought baby foods such as rice porridge can increase their exposure to arsenic by up to fifty times when compared to breast feeding alone.

Exposure to other toxic metals such as cadmium, which is known to cause neurological and kidney damage, increased by up to 150 times in some of the foods tested by Swedish scientists, while lead increased by up to eight times.

Researchers said:

"Alarmingly, these complementary foods may also introduce high amounts of toxic elements such as arsenic, cadmium, lead and uranium, mainly from their raw materials."

9. It's pointless: Ultimately the question has to be - why use it? Rather than why not. There is no research or logic suggesting a baby needs baby rice, and given potential risks what are the benefits?

Breastfeeding Problems? Remember One Question...

2011-11-30T09:55:00.001Z

The mantra of three year olds everywhere, "but wwwwwwhhhhhhhhyyyyyyyyy?", "why is the sky blue", "why do I have to put shoes one", "why can't I eat my sandwich doing a headstand next to the dog?". Their pursuit of "why" is relentless as anyone who has been in that position will tell you - even when you think you have the best answer ever, they toss back a "why?" to that too!

A very common theme amongst the mothers I see are cracked/damaged/bleeding nipples (as those who read my last blog entry will remember.) Yet bizarrely a huge percentage have also been told "latch is fine/good/great" - which sort of begs the question, why then is the trauma occurring?

If you bought a pair of shoes and got huge blisters, and the shop assistant said well the shoes fit absolutely fine - would you not ask why then you had blisters on your feet?

Breastfeeding is no different.

The other day it went like this (I paraphrase as I can't remember the exact wording):

Midwife: Your positioning and attachment is great, latch looks fine.
Mum: My nipples are very sore and bleeding
Midwfe: Ouch they look sore, put on plenty of lanolin
<Our Visit>
Mum (to midwife) The IBCLC I've seen has suggested my baby has lots of indicators of tongue tie
Midwife: No your baby isn't tongue tied (no examination/assessment) it's just down to positioning and attachment.

Woah, so we've gone from it looks great - to that's the root of the problem in the blink of an eye.

I wonder what the midwife would say if the conversation went like this:

Midwife: Your positioning and attachment is great, latch looks fine.
Mum: My nipples are very sore and bleeding
Midwfe: Ouch they look sore, put on plenty of lanolin
Mum:Why are my nipples bleeding if positioning and latch are good?

This can be applied to any area - why is my baby not gaining weight, why does he feel to be slipping off, why is she clamping/grinding etc, why does he never seem settled? Then listen to see if you get an answer that satisfies you; it's normal or that's just what some mums experience does not qualify as an explanation, regardless of how nice the person is delivering it.

If you don't get an answer that makes sense and resolves the problem - be inspired by the toddler phase of "but why?". Ask to be referred to someone who can help, or do your own digging to locate support, problems are never "just because", that answer is just as unsatisfactory when supporting a mum as it is to a three year old..

How I Think The Milwaukee Sleep Ads Should Look....

2011-11-25T10:54:00.001Z

I'm sure most have now seen the Milwaukee Sleep Ads:

Here's how I think this one should look:

This is what the research shows, why demonise all bed sharing?

and

"You can say that half the deaths occurred while babies slept with their parents. You could also say that half the deaths occurred while babies were alone in their cots, he says, but: "I don't see anybody saying, 'Don't put your baby in a cot.'"

Professor Flemming, Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England BMJ. 2009; 339: b3666.

The Duracell Bunny Baby

2011-11-23T18:00:00.000Z

The Internet at times seems to have two distinct camps - the "expect them to sleep 12 hours" side, and the "it's normal for babies to only nap for half an hour, never want to be put down/sleep on a chest and wake every hour at night" side.

I (as usual) don't fit in either.

I often read from other mothers that very broken sleep must be normal, because their baby does it - some babies, even teeny weeny ones just don't need sleep! If mums have had several children and some slept great, others not - this reinforces the belief it is personality; and in the past I would have agreed. We call these babies "spirited" or "high needs", Sears writes a whole chunk about them here; and I think his descriptions are fantastic; but I think we can break it down even further and am not convinced personality is the whole explanation. Yes babies are meant to be held close on a chest - does this mean that it's therefore normal they never want to lay down? Babies are meant to sleep next to mum, but did cave woman sleep standing up?

Partly I think this has arisen as direct opposition to the "expecting 12 hours sleep camp", IE embracing baby's cues and being responsive. But for me responsive parenting can also include exploring if there is a reason baby may be struggling to relax, if the parents feel that's something they need to explore. That is not the same as suggesting not addressing the reason will lead to "bad sleep habits" or a baby that never sleeps better, babies change a lot as their brains and bodies grow. Some will naturally iron things out as they mature going into the second half of the first year, some may be nearer 3 or 4 and some may continue to struggle to get to sleep/rise early, although the signs may become more subtle as sleep requirements reduce.

I'm not talking about training them to sleep, leaving them to cry or enforcing strict routines - but really watching baby's body language and cues to see if this is normal personality stuff, or, if he is desperately trying to convey something with constant waking and/or an intense need to suck.

Many parents I have discussed this with are those who have posted seeking advice - and they've mentioned replies are often to co-sleep, sling wear etc; but as they pointed out, what if they're already doing all that and still feel they have an issue? Some say mum shouldn't ever expect a good chunk of sleep, that this is parenting and again I agree that there will be times baby is fussy and unsettled at night, certainly it's normal for babies to nightfeed - but does that mean therefore that it's typical for a baby to never be settled and sleep for longer than an hour or so?

With a first baby this may be easier, mum can nap when baby naps, head off to bed with baby at 6pm should she fancy - but throw 2,3,4,5 or more other children in to the mix, and/or work outside the home - and things can be very different, some mums are so exhausted they can barely function.

Whilst reassuring mums things are normal can be helpful, and there is a wide range of normal, there is also a range of what parents can cope with - some may stop co-sleeping/breastfeeding/responsive parenting in a bid to save their own sanity or because their gut instinct is something isn't right, yet they have no idea what. Whether these "work" in terms of changing behaviour or not is irrelevant, the impact to baby can be significant.

I'm of the belief there can be several reasons for consistently very disturbed sleep patterns or indeed a spirited/high needs infant, none of which involve bad habits, breastfeeding to sleep or baby needing to sleep in a cot to (say it with me) create positive sleep associations. My feeling is that frequent wakers seek comfort, not that they wake due to a habit or reliance on said comfort to remain asleep; but what I want to focus on today, because it's a matter close to my own heart is the Duracell Bunny Babies (DBB).

How do you know if you have one of these?

Generally if the comment: "just go with the flow, babies will always sleep when they're tired" makes you laugh out loud, it's a pretty good indication; well they might, but no longer than 35/40 minutes in one nap (consistently), even if exhausted. In exchange they might take lots and lots of little naps, day and night - or may stay awake for most of the day from a very young age and then wake frequently at night too.

The reality is that some babies do not sleep well despite being tired. Nope, Nada no way - DBB are called such because they rarely seem to run out of energy!

DBB's according to Sears are:

"HYPERACTIVE"
"This feature of high need babies, and its cousin hypertonic, are directly related to the quality of intensity. Hypertonic refers to muscles that are frequently tensed and ready to go, tight and waiting to explode into action. The muscles and mind of high need children are seldom relaxed or still. "Even as a newborn, I could feel the wiry in him," one mother related."

Whilst many would recognise this in a toddler, being "tense and tight" are not characteristics we typically link with the label hyperactivity. I like "hyper switched on/hyper alert", as I feel it's more descriptive. Their muscles are often frequently tensed and tight - their muscles and minds do seldom relax, but is this always easy to recognise this in a baby? I've put together some of the indicators I think define a DBB.:

Signs of a DBB:

Baby appears very physically strong - many comment they head their head very early, sometimes from birth. When they arch and push with their legs they feel strong and many are very early movers. This is not related to size - baby may appear unusually strong for age/size.
Baby is very alert from a very young age - being "very alert" is very difficult to describe, but many mums of DBB comment how alert their baby is (and often others have too) they are often described as "very switched on".
They don't show tired cues - whereas when a typical baby starts to become tired, they slow down start to relax and show tired cues; the DBB is opposite. They flip from awake to asleep without the relaxing/showing cues/unwinding. One minute they can be playing happily, the next rubbing their eyes (an overtired cue) and if you have a tool like feeding to sleep/pram at this point, will typically suddenly zonk for a power-nap. Many DBB in my experience use either feeding/motion to sleep - not through habit but because it assists relaxation, they tend to be like marmite when it comes to prams/carseats/motion, and either love or hate it.
Hyper when overtired - some have a slightly longer window of doing the stage above than others, some flip straight to the almost hyperactive behaviour a very overtired baby displays. They may struggle to keep still, fidget, fuss and cry a "tired cry". Some resume play seemingly full of energy again although they may be short tempered or as one mum described "manic" flipping from laughing to crying in quick succession. The parent ultimately feels the baby is tired yet wont sleep!
Struggle to stay asleep - all babies have periods of unsettled sleep, for DBB's it's consistent and persistent month after month and comes with other signs here (as mentioned above babies can have unusually disturbed sleep for other reasons). Baby may show signs of exhaustion with purple/blue bags appearing under eyes (whilst this may be a sign of food intolerance, lack of sleep will give you them too!) yet still no longer naps or stretches appear. In fact often the more tired a DBB becomes, it seems the less they sleep!
Co-sleeping makes no difference - baby still consistently wakes 1-2 hourly, it's likely to be more bearable but DBB's may want to be awake and playing in the middle of the night, regardless of where they are. Others have an intense sucking need and are described as "Velcro babies who would stay permanently attached given a choice."
Constantly moving - sit and watch a DBB and you will note they never keep still, even when tired they do not relax. A leg may be bouncing, an arm wiggling - but they're in some way always constantly on the move when not asleep.
Mum feels baby is tired - some mums will acknowledge their baby isn't sleeping the huge stretches many mainstream books state they will, but that they are happy, settled and content with the sleep they are receiving. Others though have a gut feeling their baby is just not getting enough sleep and desperately want to help them sleep better.
Baby is very sensitive to mum's emotions - something I've noticed is that if you take an already tense baby, and you add a tense/frustrated mum, a lot of DBB's will become even more tense/unsettled and will struggle even more to settle; for some even just laying there willing baby to sleep seems to be enough to unsettle them! If you're beginning to feel this way & are holding baby "change of arms" can help IE passing to partner can work, if no spare arms available laying down next to them on your bed or suchlike can be an alternative. If you're "sleep willing", try and do some relaxation/breathing exercises yourself (great to teach DBB if they're still struggling in toddler hood too) to clear your mind and truly relax yourself, and you can sometimes be amazed how quickly this will help baby to settle too. If all else fails taking a shower with baby is something many mums comment can be a good stress buster if home alone.
May cry before sleep or upon waking - especially if tired, some DBB can seem prone to almost needing to cry to settle and again when waking ie they wake fussy and grumpy not happy and well rested. Parents sometimes say he cries whether I'm holding him or not so I may as well put him down, but crying in arms is very different to crying alone.

Identifying why your baby is struggling to relax is perhaps the hardest piece of the puzzle because it can be several causes or just one, so finding someone to help work through things can be difficult; reasons can range from an undiagnosed tongue tie, food sensitivities, cranial or structural discomfort from birth and so on. Something I believe can help these babies in the meantime is.....wait for it......*whispers* a rough sleep routine *sharp intake of breath".

Before you hit close hear me out!

Just because baby doesn't show sleep cues, doesn't mean they don't have a window of time in which it is easier for them to settle to sleep. Some studies have suggested when a baby becomes overtired their bodies produce adrenalin and other "stay awake" chemicals, which is why they can appear to become suddenly energetic.

My own Duracell bunny had a predictable wake up time - OK so it was 5am, but it was predictable. By playing with the gap from wake up to sleep, rather than watching her cues - I found trying to assist sleep at a particular time had more success than others; with the highest success rate before she showed any sleepy cues at all (the window was so small from this to overtired, she didn't get the "wind down" time she needed). I started with the morning nap and then worked my way through the day, once I had a rough idea of times I then adjusted accordingly this based on how well she had napped earlier.

Of course the easiest way to do this with a younger baby is sling wearing - most sleep in a sling so they are "in position" for when they start to become tired. Contact and movement can help many DBB's relax (some resist contact and the sling and arch away) and with many carriers a small adjustment can be made to manoeuvre material, and help cut out visual stimulation for baby (which some DBB seem to really need). Some slightly older babies seem to prefer a back ride to a front carry; resting their head sideways on the wearers's back to nod off.

If this isn't possible/doesn't work/baby is older and wants to be down playing - you can try putting baby in the sling at what you've worked out as the "optimum times". Despite what any book tells you this will be variable for each baby. As an example when my daughter was taking three naps, she needed to be relaxed and ready to sleep two hours after she woke for the first sleep, despite books etc saying she should have a longer gap for her age.

Clock watching is a total pain - if you have a baby that is happy without, I wouldn't recommend it to anyone! But if you're struggling it's something you can try and which may help a little..

The last thing I would add is that the DBB can easily seem to get stuck in a cycle when overtired, the less sleep they get, the more frequently they wake.

Something that can sometimes help is "sleep cramming", which is doing anything and everything that works to maximise sleep for a day or two IE laying down with them when they nap, feeding them back off if they stir (and you're breastfeeding) long walks in the sling/pram. Sometimes helping them catch up during the day can pay dividends at night/early morning wake up time - but with some it can be easier said than done. White noise, reducing stimulation eg colours, sounds etc can also help "switch off", whilst I would never endorse baby napping in a dark quiet space as important (it's oftenblooming inconvenient)- for some DBB in my experience it does make a big difference; in my daughter even encouraging her to turn and face the wall instead of gazing around her room had a dramatic effect.

Above all remember your baby is not waking to manipulate you or because of anything you have (or haven't) done. They're not trying to be spirited, or "high needs", or challenging, or whichever term you prefer to use, in fact they're just as bewildered as you (if not more so). Instead of being left to cry or trained, these babies in fact need more understanding and sensitivity than your average bear; whilst I've met many mothers who have regretted not responding more, I'm yet to meet one who wishes they had responded less - regardless of what the mainstream books say.

24 Hour Speed Raffle For Children In Need!!

2011-11-17T17:54:00.001Z

RESULTS!

CONGRATULATIONS:

254, 216, 4, 338, 59, 139, 258, 209

I will email you in turn re prizes!

CLOSED

1 Ticket = 50p, 5 Ticket = £2

Upon receiving your donation we will reply with your ticket numbers.

Winners will be drawn using a random online number selector tomorrow evening, and results added to this blog post.

That's only 24 hours to buy a ticket!

Prizes: Each of the SEVEN winners will select a prize in turn until they're gone! However one prize is a mystery prize....May be great, may be not great - that's the gamble!

Prize 1 = Pudsey Bear

Prize 2 = Pudsey's Beary Best Friend - Blush Bear

Both from Build-A-Bear Workshop®

Following the success of last year’s campaign that sold over 11,500 bears, Pudsey and Blush Bear are back and now available at Build-A-Bear Workshop® stores nationwide.

Pudsey and Blush fans are able to make their beary own BBC Children in Need mascot at any of 55 Build-A-Bear Workshop® stores across the UK with £5 from the sale of each Pudsey and Blush Bear going directly back to the national charity Appeal. Blush Bear who is Pudsey’s ‘BBF’, likes playing the drums and dancing and is on hand to help Pudsey with his busy fundraising schedule, lending him a well needed paw when he needs it. Blush loves to have fun and comes with magnetic paws to help her cover her rosy cheeks.

In 2010, Build-A-Bear Workshop donated a bear-illiant £135,000 to BBC Children in Need through the sale of Pudsey and Blush Bear and this year they’re hoping to do even better with the addition of new clothing for the furry pair. Every penny raised helps to make a positive difference to the lives of disadvantaged children and young people right here in the UK.

Prize 3 = A triple chain of aventurine, sodalite and citrine gemstone chips, with a lobster clasp.

From Cluster Jewellery

Cluster jewellery produce handmade crystal & gemstone jewellery:

"Jewellery-making started off as a hobby of mine about 8 years ago and quickly turned into a mini-obsession! I really enjoy making pieces and go out of my way to source the best quality components: I only use silver- or gold-plated findings, some sterling silver as well; no nickeland nothing cheap and nasty. I use genuine Swarovski crystals, real gemstone chips, freshwater pearls and beads and some lampwork and glass beads."

Prize 4 = A custom twiddle buster nursing necklace

From Monkey Mama Necklaces

Originally designed for nursing and babywearing mamas, Monkey Mama Necklaces are perfect for any mama who wants jewellery that offers style, safety and durability. The lightweight nature makes the necklaces easy and comfortable to wear. Each necklace is created with handmade resin beads, with the lush colours of a candy store and the visual softness of seaglass

Monkey Mama Necklaces are created using super tough cotton cording and incorporate strong knotting techniques for extra security. The feature resin beads are completely non toxic and highly durable. The beads that make up Monkey Mama necklaces are handmade in a small Indonesian craft business. They are fairly traded on every step of their journey to you. Prize is a custom made twiddler in the colours of your choice!

Prize 5 & 6 = 2 x Brugo Mug

From Brugo Mug!

As I've given one of these away before, you can read the full lowdown on the mug here. Brugo have in fact contributed numerous mugs to our mum and baby gift bags, so big thanks to them!

In short the mug incorporates "Thermodynamic Technology", which in English means
not only does it keep drinks warm for several hours, it also cools some to the perfect temperature for you to drink....clever huh!

The lid has three options; lock, sip and tip and cool. When you first make your drink if you want to drink some straight away, you can twist the lid to the tip and cool setting. Tip the cup away from you for a few seconds and some of the liquid moves into the patented temperature control chamber.

You then swill with a "brandy" motion and that sip is instantly adjusted to the perfect temperature, while the remaining liquid in the main chamber stays hotter.

Prize 7......Mystery Prize......More details soon!

Why breastfeeding is NOT like taking a dump!

2011-11-16T10:13:00.001Z

Earlier this morning whilst scanning the news, I spotted this article. It outlines how a Michigan judge chose to publicly humiliate a mother; not for neglect, drug abuse or some other heinous crime judges like this must come across - but because she went to the back of the court room and began discreetly breastfeeding her fussing, unwell young baby.

When the mother defended her position by pointing out breastfeeding in public was her legal right, the judge claimed state laws did not apply in his court:

“Ma’am, it’s my courtroom, I decide what’s appropriate in here. Come on up, okay? You have to understand that a judge — the laws don’t apply in a courtroom. The judge’s law applies, do you understand that?

If this is indeed true, surely all attending should be given full details of what the the judge's ~~whims~~ laws are, otherwise how can anyone ensure they remain "judge's law" abiding?

Clearly anyone carrying a baby should be specifically told the "breastfeeding is forbidden" rule - otherwise how are the mums supposed to know? Given every health authority in the world (including the US) recognises the alternatives carry risks and so advise mums to breastfeed for a minimum of six months - why would anyone suspect a different US government building would defy state laws in order to prevent it?

The first comments that followed the piece were just as incredulous:

"Yes, breastfeeding is a natural bodily function vital for survival.

So is taking a dump.

But we don’t rail on about people’s right to do it in public.

I’m sorry, as a woman and a feminist and a college-educated female feminist, I still think breast-feeding should be a private act and I fail to see why it’s such a horrible anti-feminist, anti-woman and anti-baby stance."

Had this been the first time I had ever had the misfortune to read such an ignorant rant, I would probably have just closed the page. But comparing breastfeeding to toilet habits seems to be a pretty standard argument against public breastfeeding (particularly if you've ever picked up the Daily Mail) frankly it's crap, if you excuse the pun.

"As a woman and a feminist and a college-educated female feminist"

OK we get you're female and a feminist (twice) but it seems college clearly didn't adequately cover "bodily functions", so let's go right back to basics.

Feces

Feces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation. The word faeces is the plural of the Latin word fæx meaning "dregs".

The distinctive odor of feces is due to bacterial action. The perceived bad odor of feces has been hypothesized to be a deterrent for humans, as consumption or touching it may result in sickness or infection.[4]

Human breast milk

Breast milk is the milk produced by the breasts of a human female for her infant offspring. Milk is the primary source of nutrition for newborns before they are able to eat and digest other foods; older infants and toddlers may continue to be breastfed, either exclusively or in combination with other foods.

After 3 to 4 days, breasts will begin producing milk that is thin, watery, and sweet. This quenches the baby's thirst and provides the proteins, sugar, and minerals that the baby needs. Over time, the milk changes and becomes thick and creamy. This satisfies the baby's hunger.[16]

The first contains potentially harmful pathogens that can cause sickness or infection, hands need thoroughly washing afterwards and thus a bathroom is a sensible idea; not to mention, where would you put a random dump in a court room?

The second is an antibacterial, antimicrobial substance that has been shown to actively kill infections - hands do not need washing post breastfeed; milk goes into baby.

I'm hoping I don't need to point out the differences between an anus and a breast!

Breastfeeding is no less hygienic than anyone else sat eating (and a great deal more so than some people's "washing machine style" of food processing that I frequently have to witness). If the mum was sat squirting it around the room rather than into her baby's mouth, I could perhaps see the issue!

Next, does any one else see the irony in someone purporting to be a feminist, yet who also supports the suppression of women using their breasts for their intended purpose?

Isn't that rather like someone calling themselves an "advocate for same sex marriage", right before adding "as long as they are only a couple in private and don't rail on about wanting rights to be affectionate in public" ? Then claiming they fail to see why that is an anti-homosexual stance....

Feminism

Feminism is a collection of movements aimed at defining, establishing, and defending equal political, economic, and social rights and equal opportunities for women

Yet men can even go topless in public right?

Breast Bottle

What makes it a private act, why is a real breast so much more inappropriate than a plastic replica of a breast and nipple, or just a nipple in the form of a pacifier? Would it have caused such a brouhaha had the mum pulled out either of those instead of the genuine article?

What should this mother have done? She presumably had to attend the court, she had to take her unwell nursling - had she denied his cues to feed, he would likely have cried, loudly; is that appropriate for a court room? Would that not have disturbed proceedings far more? No doubt then the "dump brigade" would have been tutting and muttering about how inappropriate the noise was. Perhaps babies just shouldn't be allowed in public full stop?

Society needs to realise that milk of our own species is the normal way to feed a baby, and if it's a location a baby is permitted, a mother has a basic human right to be able to feed her baby as he requires without doing so in a toilet or a stinky nappy changing room. Why should a hungry baby incapable of waiting, have less right to eat than an "educated female feminist"?

Related Posts:
Breastfeeding mums should use a bottle in public!

Breastfeeding in public is offensive - see for yourself!

Let's do breastfeeding covers

Tips for breastfeeding in public if you feel self-conscious

Emma's Pregnancy Diary - Armadillo Style

2011-11-15T17:49:00.001Z

When the lovely Emma (who helps as an admin on Facebook) rang me to share some news, I thought it would make perfect blog fodder to share with you all. Ever modest Emma wasn't sure people would want to read her story, but after a little ~~harrasement~~ asking nicely, she kindly agreed <grin>.

Whilst we see lots of journals shared by first time mums, I thought hearing from a mum of two planning her third addition might be of interest to those who already have children and perhaps are thinking about more! :D

Over to Emma:

I'M PREGNANT....Well, it’s a good start. That was the plan. We’ve been “trying” for quite a few months, but as my periods haven’t started since the birth of son #2 and I’d had no signs of ovulation so I didn’t think that we were going to get anywhere fast.

The Armadillo is chuckling heartily at this point, because I recently rang her recently to discuss my nursing son’s fussy behaviour and tiredness. When she asked if pregnancy was a possibility, I assured her it wasn’t – because of course, I was sure it wasn’t.

Quite how I came to find out I was pregnant is another story in itself - so here’s what happened.

Given that I knew quite clearly I could conceive on my first ovulation, I was looking out for signs of egg laying (fluids, cervix position and Mittelschmerz, I wasn’t bothering with temperatures). I pride myself on being pretty switched on with this stuff; Which as they say, comes before a fall!

So I didn’t notice any signs of ovulation, and was assuming that they were still suppressed by son #2’s breastfeeding. I’d been chatting to my breastfeeding counsellor about ways to trigger ovulation, and we were aiming for a 5 hour gap within each 24 hour period as for some women this is enough to get things going.

However, given, I thought, that I may just miss that I’d ovulated, and given that I might just conceive on that first cycle, I thought I’d be very smart and be one step ahead of myself. So I ordered 20 cheapy ebay tests for about £2 so that I could take one test every 2 weeks, thus knowing for sure when I wasn’t pregnant, so I would then know how far on I was when I did get pregnant.

They duly arrived and I quickly did one, just to get a job out of the way, and nearly passed out with shock when the pink line appeared. It’s a good thing that I bought 20, as I used the next 10 straight away (well, you never know). It’s a good thing that hubby works from home so I was able to go straight up and tell him. That put a grin on his face.

So the next question is – how pregnant am I?

I’ve been really, really tired for about three weeks now and just not managing to keep up with my normal “stuff”. So, I’m guessing 7-8 weeks would be about right. I’ve obviously conceived on my first ovulation post delivery, which is great, which would make it about 13 months without periods. Good old breastfeeding.

Now to see if I’m right…

24th October

I’ve booked in with the midwife this Friday. I’ve actually moved surgeries to do so! I am a peer supporter and one group that I sometimes cover has a midwife drop-in at the same time. The midwife is really pro home birth, and a few months ago was running a big fun day at the local Children’s Centre to raise money for homebirth pools. I was very happy to be able to help, running a stand for our local NCT group. A friend made an amazing cake with a waterbirthing mum and baby on top! That went into the raffle and was very much admired including by one small boy (not mine!!) who decided to try to have a taste. It was a good day. I liked the midwife so much that I decided to find out which surgery she was at, so this afternoon saw me filling in new patient forms for me, Son #1 and Son #2 (hubby is sticking with his GP, thank you very much).

The receptionist asked me how pregnant I was and I was very embarrassed to say that I had no idea, but I guessed 7-8 weeks. Hopefully my midwife will be able to give me a better idea!

UPDATE TWO

28th October
Midwife booking appointment - she was as lovely as expected and delighted to take me on as a homebirth booking. We had a good chat about my last two births and how things didn’t go as planned, and why I was so determined to home birth this time. She explained about the Trust’s obligations to provide a home birthing midwife and how to be firm on the day should it be necessary.

We discussed some of my really big concerns, such as the PPH (post partum haemorrhage) that I’d had last time and how she would handle it and was extremely reassuring. In both my last deliveries I’ve aimed for an unmanaged third stage. With Son #1 they got very jittery and scared me after an hour had passed, and persuaded me into the injection. With Son #2 they were very encouraging and supportive, and all was fine, but then I did start to lose blood which was rather worrying for everyone and I ended up very weak after birth and anaemic for some months afterwards. It was all fine, but I think a bit less messing around with me and a bit more letting me get on with it would have ensured the contractions would have racked back up more quickly and limited the blood loss.

So after all of this, out came the pregnancy wheel and she asked me when my last period was. I don’t think that “2009” was helpful! So she then asked me if I’d any idea of my dates and I had to make a full confession: not only did I not know how pregnant I was, I’d not actually thought I was pregnant when I took the test!

Once we’d established that I for one couldn't help with dates, I popped up onto the couch and she had a rummage around.

Shock number two – she estimates 12-14 weeks. Aarrgghh!

31st October
Emergency scan at a private scanning clinic as the NHS can’t offer me a scan for another 2 weeks. We want the nuchal scan (Down’s Syndrome test) and if I’m really that far on then that might be too late for the nuchal. Despite been here twice before with Sons #1 and #2 it didn’t make it any easier. In a sense we didn’t really know why we were doing it because if it came up as high risk, what then? It’s not a diagnostic scan, just a screening giving a risk, not an answer. We really don’t want to have an amniocentesis with the risk of miscarriage. I think we’re both burying our heads in the sand a bit and hoping for the best.

On the other hand it all seems a bit silly, because there are so very many ways in which a baby may have problems, so why a low risk result would be reassuring I don’t know! Still, it was wonderful to see that the pink pregnancy test line had magically morphed into a cute little baby shape, complete with heartbeat and nasal bone (which apparently is a good thing on the Down’s test). Baby measures at 14 weeks! It seems to get longer every time! I have a blood test taken to get the most accurate screening results which we’ll get in a few days.

We drive home armed with lots of fuzzy piccies of a rather skeletal looking baby and memories of the sound of the heart beat, hugely happy and excited and just ever so slightly embarrassed. Or I am, at least. Hubby really can’t believe that I’m over 3 months pregnant and didn’t know. So much for me being “in tune” with my body. Much ribbing was undertaken.

3rd November
Flu jab. I’d been told in no uncertain terms that contracting flu could be quite dangerous for a pregnant lady so after some research I decided to go for it. I’ve never had one before so was hoping I wouldn’t have a reaction to it. Everyone seemed to be really pushing it at the surgery and saying that it was totally safe, etc etc, until I actually got to the nurse who did the jab who then proceeded to tell me that it was untested in pregnant women (because it’s unethical – but apparently quite ethical to just dole them out), we don’t know if it’s safe for the baby, blah blah. I made some comment about how it’s been around for a while now and we’d have heard about any significant problems to which she replied, “well we’d hope so” which didn’t fill me with confidence! I asked if my having the vaccination would pass any immunity onto Son #2 through my milk, which she didn’t know but she did then pull out all her documents to see if it was safe for lactating women (which it is, apparently. Either that, or untested!). Nice that she didn’t bat an eyelid that I am breastfeeding a toddler (who was with me causing havoc and destruction as is his norm).

4th November
UK Association for Milk Banking Trustees meeting today. We’re planning some awareness campaigns including one in May so I fessed up to the fact that I was likely to be busy on or around the 1st May. A fellow trustee with 3 children made it clear that I was totally nuts by joining the club J. Ah well, at least we know it’s not twins.

And we got the results from the nuchal scan! Excellent result – risk of 1:21,000 compared to my age-related risk of 1:175. It is a relief and yet I can’t help but wonder why. There are so many disabilities out there, so why did we put so much score on just one? And then there was the awful question of what would we do if the risk factor came back as a high risk? This is a screening test, not a diagnostic test. Would we then risk the diagnostic test with a miscarriage rate of between 1:100 and 1:200? And let’s say we did that, and it came back as positive for Downs. Then what would we do?

These questions, in one form or another, are questions that most pregnant mums or couples will need to work through, even if it’s only to decide that they’ll have no screening at all. For us, we chose to bury our head in the sand and wait for the screening results, feeling that there was no point in trying to resolve the “next step” questions unless necessary.

I feel very lucky in many ways that we have reached this point in this pregnancy without having the weeks of anticipation. I think one of the hardest things is finding people to discuss it with because of the high levels of emotions involved with all “options”. We can now close this door and move on – at least until the 20 week scan. But many people can’t, and that’s tough to think about.

I wish that a more open discussion about the euphemistic “options” was possible. I don’t think that anyone can imagine themselves being the parent of a child with a serious disability, but the idea of aborting one’s child is also abhorrent. For some it would never be an option and for others it would be the only choice. Emotions, quite rightly, run so strongly on both sides that to even think about mentioning it risks deep distress – and yet not talking about it leaves mums approaching screening in a state of confusion and worry. This is why I have written this post. I don’t have any answers but I know I’m not alone in wishing that there were some.

The Dangers Of Demonising Bed Sharing

2011-11-11T10:01:00.001Z

To bedshare or not to bedshare - this is the question that is often hotly debated on parenting forums. Guidelines (including those just released by the AAP) often state "in a different bed in the same room", ie no sharing; which would appear to support the notion it's generally a risky business, ties in neatly with many mainstream books and thus socially "sits comfortably".

However what is the evidence behind these guidelines? Explore it (including new research out this month) and we find a very different and more detailed picture about infant sleep; hence debate ensues.

The trouble is that just like the starting solids guideline - official recommendations have to be a short snappy piece of information that everyone can understand. A guideline cannot be detailed, discuss different risk factors and provide information so parents can review and act accordingly.

Therefore don't bedshare is considered a "key" message. A fact FSID don't dispute.

Joyce Epstein, director of FSID, says:

"If you can get people's attention for more than three seconds you would like to give the whole story every time, but at what point do you lose everybody?"

From their perspective, the simple direct message – put your baby to sleep in a cot near the bed, not in the bed, is the key.

But I'm not sure the message is actually all that safe - and here's why....

This is what the AAP guidelines actually state if you go beyond the bullet points:

"Bed Sharing

There are some reports of infants being suffocated by overlying by an adult, particularly when the adult is in an unnaturally depressed state of consciousness, such as from alcohol or mind-altering drugs. Co-sleeping on sofas has emerged as a major risk factor in 1 study. Others have shown bed sharing with multiple family members in an adult bed to be particularly hazardous for the infant. Although overlying may be the mechanism in some of these cases, soft sleep surfaces, entrapment, and the likelihood of rolling to the prone position in such circumstances also may have a role. The risk of SIDS associated with co-sleeping is significantly greater among smokers. Some behavioral studies have demonstrated that infants have more arousals and less slow-wave sleep during bed sharing, but no epidemiologic evidence exists that bed sharing is protective against SIDS. (remember the bold bit I will come back to that in a moment)"

But is there any evidence at all to suggest an infant is more likely to turn prone when co-sleeping than when in a cot? Why don't the AAP tell us what the actual risks of co-sleeping are in a prepared environment ie not on a soft sleep surface (ie waterbed/pillows and heavy bedding near baby) no risks of entrapment/entanglement, no drugs/alcohol, no unplanned cosleeping ie mum falling asleep sitting up, baby next to mum alone and not in the middle of a family bed AND exclusively breastfeeding - where are these figures?

Now scroll down the AAP guidelines to "Proposed Mechanisms of SIDS":

"It is generally accepted that SIDS may be a reflection of a variety of causes of death. A leading hypothesis for a large proportion of SIDS cases is that SIDS may reflect a delayed development of arousal or cardiorespiratory control."

and

"The hypothesis is that certain infants, for reasons yet to be determined, may have a maldevelopment or delay in maturation of this region, which would affect its function and connectivity to regions regulating arousal. When the physiologic stability of such infants becomes compromised during sleep, they may not arouse sufficiently to avoid the fatal noxious insult or condition."

Right - but as nobody has done an epidemiological study to prove bedsharing is protective (remind me again where the studies are proving cot sleeping is protective? Wasn't SIDS called cot death for long enough?), we don't acknowledge any link here? Has there been a a study proving safe bedsharing isn't protective?

Just this month a study published in Biological Psychiatry found:

"Heart rate variability in 2-day-old sleeping babies for one hour each during skin-to-skin contact with mother and alone in a cot next to mother's bed. Neonatal autonomic activity was 176% higher and quiet sleep 86% lower during maternal separation compared to skin-to-skin contact."

In basic terms this means separating mother and baby caused significantly more "anxious arousal" and less "quiet sleep".

Dr Bergman, co-author states:

"What is desirable for newborns is to have 'sleep cycling,' which means an even distribution between active sleep and quiet sleep, in periods of about one hour,"

"In our study, sleep cycling in separated babies was mostly absent, and in six of 16 babies that did show some quiet sleep when separated, it was shorter and shallower."

The scientists also noted concern that the disrupted sleep patterns and stress to the heart could make it difficult for them to form relationships.

This research addresses a strange contradiction: In animal research, separation from mother is a common way of creating stress in order to study its damaging effects on the developing newborn brain. At the same time, separation of human newborns is common practice, particularly when specialized medical care is required (e.g. incubator care).

Dr Bergman added:

"When babies are smothered and suffer cot deaths, it is not because their mother is present. It is because of other things: toxic fumes, cigarettes, alcohol, big pillows and dangerous toys."

Dr. John Krystal, Editor of Biological Psychiatry, commented on the study's findings:

"This paper highlights the profound impact of maternal separation on the infant. We knew that this was stressful, but the current study suggests that this is major physiologic stressor for the infant."

This larger study echoes what Dr Sears found when he conducted a very small experiment of his own:

"Our study revealed that Lauren breathed better when sleeping next to Martha than when sleeping alone. Her breathing and her heart rate were more regular during shared sleep, and there were fewer "dips," low points in respiration and blood oxygen from stop-breathing episodes. On the night Lauren slept with Martha, there were no dips in her blood oxygen. On the night Lauren slept alone, there were 132 dips. The results were similar in a second infant, whose parents generously allowed us into their bedroom."

Dr Mckenna has written extensively on the subject as to why he feels infants are more at risk sleeping alone - yet mainstream media and literature barely gives a nod to these significant findings.

He states:

"Mechanical breathing teddy bears placed next to apnoea-prone human newborns, which replicate what the mother’s body provides, have the effect of reducing infant apnoeas sometimes by as much as 40–60%, in addition to physically drawing infants to sleep next to them.39

Many studies similarly show that infant mammals, including human infants, appear to be pre-sensitised to receive sensory signals linking them to a co-sleeping partner.40–43 All have been shown to change infant physiology, including heart rate and breathing patterns including increased arousals yet the cessation of excessive night-time crying.

Until recently, all human infants experienced access to at least one cosleeping adult body, usually the mother 45,46 so it is not surprising that maternal contact stimulates a variety of signiﬁcant ‘hidden regulatory processes’ that are clinically advantageous to infants."

Dr Mckenna has also noted the mother's sleep patterns differ when separated from her infant:

"We found that bed-sharing infants face their mothers for most of the night, and that mother and infant are highly responsive to each other's movements, wake more frequently, and spend more time in lighter stages of sleep than they do while sleeping alone. Co-sleeping makes it easier for a mother to detect and respond to an infant in crisis."

Interestingly mum also hits more restful sleep phases for longer.

So here we have internationally recognised doctors (not just a random unqualified baby tamer who has written a book) stating actually co-sleeping may be protective against SIDS. That cot sleep may in fact be more risky?

This all seems rather a far cry from "don't bedshare" doesn't it?

However, people are comfortable demonising bed sharing....

On 14th July 2009 here is what hit the news:

"Co-sleeping dangers. 54% of cot deaths due to co-sleeping! More than half of cot deaths happen when a baby is sleeping with a parent, a study has revealed."

At a glance that leaves many parents content they use a cot and off they go..

But even if we take this statement at face value and look no further - it's surely immediately obvious that if 54% of infants were co-sleeping, 46% were in a cot? Hardly a compelling demonstration of cot safety?

The professor involved with this study was not happy at the headlines however. He hit back in a Guardian article days later. They reported:

"Yes – the study found that 54% of cot deaths occurred while the baby was co-sleeping with a parent. But although the risk was strong if they had crashed out on the sofa, it was only significant among those in a bed if the parent had drunk more than two units of alcohol or had been taking drugs."

Professor Fleming himself commented:

"You can say that half the deaths occurred while babies slept with their parents. You could also say that half the deaths occurred while babies were alone in their cots, he says, but: "I don't see anybody saying, 'Don't put your baby in a cot.'"

Quite!

When babies are shown to have suffocated due to a fabric comforter - the guidelines are updated to say don't use comforters. Ditto cot bumpers and duvets/pillows under one year old. Yet when a baby has been shown to become entangled and suffocated on inappropriate bedding when bedsharing, the guideline isn't "address the problem", but "don't bedshare!"

There is also an underlying assumption cots are safe. This article highlight two strangulation deaths of infants with the electrical cords from baby monitors. This the risk of blind cord strangulation when unsupervised (including in cots) I have read stories of babies pulling heavy or dangerous items in on top of themselves, or worse this poor boy who died after becoming entrapped when climbing out. Yet nobody ever suggests not using a cot, instead parents are advised to ensure appropriate measures are taken to make the area safer.

Furthermore going back to the study, if only 54% were co-sleeping to start with, once you remove known risk factors and compare the revised figure with those sleeping in a cot, the picture is very different.

What's really interesting is that same study found ONE QUARTER of infants were swaddled. A whole 25% - yet where was the news article highlighting this? Why are popular parenting books who are so anti cosleeping, still promoting swaddling without any mention of this? (nor is this the only study that has demonstrated a link as the second half of this article highlights)

Even if we move the debate away from the simple argument of which location is safer in terms of statistical outcome. We also need to consider the knock on effect, and therefore possible risks associated with where parents place their baby to sleep.

We know that when we tell parents co-sleeping is unsafe, many decide their baby will sleep in a cot. The very real danger with this is that a parent falls asleep sitting up in bed, or on a sofa. Something the above study found was a massive risk factor with regard to SIDS. Every parent of course believes they would never fall asleep when feeding - yet nature delivers a huge hit of sleepy hormones when mum breastfeeds (strange if mum isn't supposed to be sleeping on the job ;)) and despite best intentions many many mums report accidentally falling asleep - including myself (who didn't co-sleep due to ignorance and official guidelines with my first).

One mum commented she had to play with her iphone to ensure she stayed awake, others try moving from bed to an upright chair to prevent temptation.

The knock on effect of this may be minimal if you have a baby who only rouses infrequently. Throw a frequent waker into the mix however and there is a good chance the mum will a) become overly tired which in itself is listed as a SIDS risk, b) give up breastfeeding believing she needs more sleep to function than the current (PITA) night ritual provides.

Yet not breastfeeding is not only linked with SIDS but other significant health outcomes too. In fact the one significant risk factor the vast majority of studies fail to adjust for is feeding method ie breastfed, breastmilk or formula. Those that have demonstrate a compelling link - therefore any that do not, are potentially fundamentally flawed from the start? The definitions of co-sleeping and bedsharing are often blurry, known risk factors not adjusted for and so are parents really getting the big picture?

Professor Fleming shares the same concerns with regard to the "no bedshare" message::

"The study showed that sleeping with the baby on a sofa really is a risk. Yet seven of the parents whose baby died say they had gone to the sofa to feed, aware that bedsharing is said to be dangerous, and had fallen asleep.

Any advice to discourage bedsharing may carry with it the danger of tired parents feeding their baby on a sofa, which carries a much greater risk than co-sleeping in the parents' bed,"

To sum up a quote from Dr Mckenna:

"The possible hazards of co-sleeping must be assessed. Is the environment otherwise safe, with appropriate bedding materials? Do the parents smoke? Do they use drugs or alcohol? (These appear to be the main factors in those rare cases in which a mother inadvertently smothers her child.) Since co-sleeping was the ancestral condition, the future for our infants may well entail a borrowing back from ancient ways."

UNICEF Bedsharing Guidelines

"Me Time" - When did it become critical?

2011-11-02T20:32:00.002Z

"Me Time" - we hear a lot about it. It's the essential time every mum must have, without which one cannot possibly mother adequately the rest of the time. The Baby Whisperer (original) clearly recognised this and handily built her routine EASY (Eat, Activity, Sleep, Your Time) - to of course help keep parents sane.

I recently heard of a mum of a four week old baby, who had decided to place her daughter in nursery part time as she needed "me time". This was a much awaited and longed for child, yet only four weeks in mum was so overwhelmed she planned separation.

Marketing bods of course also recognise mothers are busy and desire "me time", and so design a whole host of tools to assist - from dummies that attach to the mattress so a baby can put them back easily without requiring a parent, to ready made bottles and then bottle holders to feed the baby, because clearly feeding is a chore that can be delegated to an inert third party.

But recently I began thinking about a book I read a while back, "Call The Midwife" - a recount of 1950's East End London from the perspective of a midwife. These women had up to 14 children, they had communal washing/drying areas, their husbands were typically working or at the pub (no sharing of house work) and I wondered when did they get "me time"?

Washing, mending, baking, - all without the many gadgets we have today; would they not marvel at how easy we have it in comparison? (and yes many mums work, but few do in the very early weeks) I wonder just how much "me time" these mothers had and how they managed without being committed to therapy?

Whilst I'm not suggesting we revert to 1950's style parenting, or implying any mum who has an interest outside the home is anything other than normal, but is it realistic to expect lots of "me time" with a young baby?

I began wondering does it in part come down to expectations? The reality is that first babies ARE an all consuming life changing experience - new parents often tell me how overwhelmed they feel and I remember being there!

Perhaps today's typically smaller families mean there's a lot less first hand experience when young of what younger siblings were like? Perhaps the more nuclear set up means many have no direct experience of life with a baby pre their own?

For whatever reason many parents pre baby believe he/she will just slot neatly into their existing lives, but this doesn't generally mean popping baby in a sling and taking them along. Instead it means their behaviours will be convenient to the parent - they will nap alone for X hours to give "me time", they will self soothe and cut night feeds ASAP so the parent's sleep is not disturbed. But 99% of babies didn't read the manuals their parents did; so they often need "training" or "manipulating" to conform; those that recommend this often failing to address longer term potential impact of their methods.

Breastfeeding and responsive parenting may be biological norms, but I think there is a huge chasm between this and social norms and thus expectations.

In order to come close to social norms, a whole host of books and gadgets may also be required - with parents feeling they are doing something wrong if they can't get their baby to fit! They can be told they are making a rod for their own back or must get tough - despite the fact this really is quite illogical! Which other mammal is born and fed by a holder (sometimes milk of another species), comforted by a plastic replica or cloth reminder of their mother, expected to put themselves asleep, and stay asleep for a specific amount of time somewhere away from their mother?

Yet in comparison to many mammals, humans are extremely immature; the newborn's brain is only about 25 percent of its adult weight at birth, while most other mammals are born having 60 to 90 percent of theirs. Think how soon after birth some walk!

James McKenna, Ph.D., professor of anthropology at Notre Dame University explains that when primitive women evolved to stand up on two legs, the shape of the female pelvis became narrower and resulted in human babies being born three to four months earlier, before their heads grew too large to pass safely through the birth canal.

This has led to many believing there is a "fourth trimester" once baby arrives - the baby's only real needs warmth, comfort and nutrition.

In some ways "baby rearing" is actually far more simple in less developed areas; mothers simply pop baby in a sling, feed them when hungry and they sleep when tired. No routines, schedules, expectations or rod making...It seems the more sophisticated our lifestyles become, the more we need time "off" to cope.

Oil Pulling For Children?? You Raging Hippy You!

2011-10-28T17:44:00.001+01:00

So when I first mentioned oil pulling on Facebook, the replies were interesting. My previously cavity free just turned 8 year old has developed three in the last six months, and as someone always plagued by needing loads of dental work (despite all the oral hygiene measures as advised by the dentist) I was interested in exploring natural approaches that may prevent further decay in my daughter. Some were horrified, including one mum who replied; "I would never ask a child to do that!" Some were interested and wanted to know more, and of course given how cool Armadillo readers generally are, some were already doing it.

What is oil pulling?
To be honest you can dress it up in various ways, but the bottom line is it's a traditional Indian folk remedy that requires sesame, olive or coconut oil (all virgin cold pressed) to be swilled around your mouth for 5-20 minutes (depending upon which website you read) pulling it through your teeth before spitting and brushing; swallowing is not recommended Optimum appears to be first thing in a morning, but some do twice a day - generally the guidance seems to be 4hrs after eating (not sure I ever go that long!) and 1hr after drinking...

Er why?
Well proponents of oil pulling claim it pulls toxins from the body, which can help a whole host of health conditions. From eczema to acne and joint issues, diabetes, migraine, hypertension, ischemic heart
disease, liver & respiratory conditions; Google and you will find someone claiming oil pulling cured them. I don't honestly see how toxins could be pulled through the mucous membrane as some websites suggest, which I will discuss more in a moment; but as it is also reputed as excellent for oral health, getting rid of toothache and reducing gum disease, I decided to read more. What's interesting about oil pulling is that there's no big pharma heading up this campaign, posting fake reviews etc; clearly people who advocate pulling believe it helped them.

There are those however who take the claims of oil pulling to another level, particularly Dr Karach MD - feel free to do your own digging!

How?
Ok as I said above, I'm not convinced toxins can be pulled through the mucosal surfaces of the mouth; however things can certainly pass into the bloodstream sublingually - think of the tiny pills or spray that people put under their tongue during an angina attack. In fact this route is faster and the substance is only exposed to saliva before entering the bloodstream; anything swallowed has to pass through the digestive tract where enzymes get to work.

A little digging turned up a paper entitled "Oil pulling – Unraveling the path to mystic cure", Alaka Hebbar* Vaishali Keluskar** Arvind Shetti*** *Post Graduate Student, **M.D.S, Professor and Head, ***M.D.S, Professor, Department of oral Medicine & Radiology, KLES V.K Institute Of Dental Sciences, Nehru
Nagar, Belgaum, Karnataka, India. Published in the Journal of International Oral Health 2010 states:

"Sesame seed oil has a high concentration of polyunsaturated fatty acids and is a good source of vitamins. The antioxidants present in it are namely sesamin, sesamolin and sesaminol. These lignans have certain actions on the living tissues like- Detoxification of toxins, antioxidant effect, potentiates the action of vitamin E, prevents lipid peroxidation and antibiotic effect in that it helps in the destruction of microorganisms. Sesamin has found to inhibit the absorption of cholesterol as well as its production in the liver, reduces lipogenesis and exhibits an antihypertensive action."

You can find it here and is well worth a read if this subject interests you. This suggests amongst other things that the oil hit alone is responsible for some results.

In terms of dental health the claims are it breaks down plaque and neutralises harmful bacteria - resulting it whiter, cleaner, healthier teeth and gums and fresh breath. The paper above also explores this:

"The mechanism by which the oil pulling therapy causes plaque reduction is not known. The viscosity of the oil probably inhibits bacterial adhesion and plaque co-aggregation. Other possible mechanism might be saponification or the „soap-formation‟ process that occurs as a result of alkali hydrolysis of fat. Sesame oil is a vegetable fat and when it is acted upon by the salivary alkali like bicarbonates, the soap forming process is initiated. Soaps are good cleansing agents because they are effective emulsifying agents. Emulsification is the process by which insoluble fat like sesame oil is broken down into minute droplets and dispersed in water. Emulsification greatly enhances the surface area of the oil there by increasing its cleansing action."

Evidence?

Interestingly there is, particularly pertaining to dental health:

"AIMS: The aim of this study was to evaluate the effect of oil pulling with sesame oil on the count of Streptococcus mutans in plaque and saliva of children, using the Dentocult SM Strip mutans test, and to compare its efficacy with that of chlorhexidine mouthwash.

RESULTS: There was a reduction in the S. mutans count in the plaque and saliva samples of both the study and the control groups. The reduction in the S. mutans count in the plaque of the study group was statistically significant after 1 and 2 weeks (P=0.01 and P=0.008, respectively); the control group showed significant reduction at all the four time points (P=0.01, P=0.04, P=0.005, and P=0.005, respectively, at 24 h, 48 h, 1 week, and 2 weeks). In the saliva samples, significant reduction in S. mutans count was seen in the control group at 48 h, 1 week, and 2 weeks (P=0.02, P=0.02, P=0.008, respectively)

CONCLUSION: Oil pulling can be used as an effective preventive adjunct in maintaining and improving oral health." (1)

and in another study:

"The effect of oil-pulling on the reduction of total count of bacteria was determined. There was a remarkable reduction in the total count of bacteria. The process of oil-pulling reduced the susceptibility of a host to dental caries." (2)

and another:

"The oil pulling therapy showed a reduction in the plaque index, modified gingival scores, and total colony count of aerobic microorganisms in the plaque of adolescents with plaque-induced gingivitis." (3)

and

"Oil pulling is having dental benefits. Hence this holds a chance to be added to other oral hygiene measures" (4)

I think the paper discussed above; "Unravelling the path to mystic cure", sums things up well in its conclusion:

"Inspite of all the advances in the field of health science, traditional healing methods still have a major role to play. These methods are born out of native wisdom of very high intellectualism. They are untouched and unspoiled. If they are analysed on scientific backgrounds they stand the test of time. Hence oil pulling is one such method which improves the oral health and benefits various systems as well."

So do you oil pull? Has it helped? Are you planning on trying? If so please keep us updated!

1. Effect of oil pulling on Streptococcus mutans count in plaque and saliva using Dentocult SM Strip mutans test: a randomized, controlled, triple-blind study. Journal of the Indian Society of Pedodontics and Preventive Dentistry (2008)
Volume: 26, Issue: 1, Pages: 12-17

2. Effect of oil-pulling on dental caries causing bacteria, African Journal of Microbiology Research Vol.(2) pp.063-066, March, 2008

3. Asokan S, Emmadi P, Chamundeswari R. Effect of oil pulling on plaque induced gingivitis: A randomized, controlled, triple-blind study. Indian J Dent Res 2009;20:47-51

4. Effect of Oil Pulling on Plaque and Gingivitis, J Oral Health Comm Dent 2007 ;1(1):12-1

Home Educated Children Lack Socialisation...

2011-10-17T22:45:00.000+01:00

This is by far the most common concern I hear raised about home education. That children will miss out on socialising; forming a peer group, team sports and so on.

This assumption appears to make sense; school = large group of children, home = parents plus 1+ child. As most people send their children to school, this is the norm, the basis for comparison.

The reality could not be further from the truth.

Before my eldest started full time school at 6, we did part time flexi schooling. This meant she attended the Montessori for 2-4 days per week and was home schooled the other days, an arrangement that suited us really well.

During this time I dipped my toe into the home schooling pond for our "days off" and was quite surprised to find just how many people in the area were home schooling! There are several area networks within easy reach and the range of activities running on a regular basis is vast; ice skating, gymnastics, french club, construction clubs and open groups that include creative writing and themes such as countries and so on.

Our favourite was an open group run in a local gymnasium - some bits of climbing equipment and a huge open space for the children to run and play. Team games, creative stuff, instruments - the children always had something going on.

On top of this were numerous days out to museums and learning events - often heavily discounted or free as the joy of home ed is you can access everything whilst everyone else is at school.

Aside from all these arranged social gatherings, what it's worth remembering is that social encounters are numerous even just going about normal daily business.

As one mum during a discussion on Facebook highlighted:

"Don't underestimate how everyday life produces opportunities to learn. Trips to the supermarket? Maths, budgeting, socialisation, reading, writing (a list). Its all there!"

another added

"Being with a parent while socialising with peers has many benefits too.
In a school environment it's like the blind leading the blind.We get told they "need" to go to nursery / school to "learn how to socialise" but in actual fact WHO are they learning from? If all kids are going to "learn" then who is teaching them? The adults."

When you think about it, whilst classrooms are a good way to provide an education to "the masses", nobody has ever proven, nor attempted to that schools are the best way for children to learn; or that grouping 20-30 all same aged children together improves the outcome in any area including socially (see research below).

When home educating, younger children learn from watching and role modelling themselves on the older end. For those a little older, helping and mixing with younger ones not only builds confidence, but also develops social skills further as they are used to interacting with a wide age range including adults. Just like those educated in a mainstream school, the older home educated children arrange sleepovers and have play dates, attend after school clubs or groups - they do not live in a cave ;-)

Something rarely mentioned in the "pro social skills at school" argument is the downsides of a large group of same aged children with one or two teachers (who tend to direct with discipline rather than role modelling)

Again the discussion on Facebook mentions a few:

Bullying
Playground politics
Peer pressure
Need to conform

Indeed in non mainstream settings there is much less of a boy/girl divide, play is often mixed. Similarly there is less pairing off with a best friend noted, whilst of course closer friendships develop, play tends to be inclusive and spanning a wider age range.

One mum raised a concern that again I think is common:

"In a school environment your child learns a lot by being around other children and they make friends. Obviously they can make friends elsewhere if they are home schooled but the interaction is different because in school they aren't with you"

But when you really think about it, what exactly does a child learn away from you that they won't learn with you? To stand up for themselves? Do we assume that if a disagreement gets too much and the child seeks support from his parent he will end up a pushover or unable to solve a disagreement without his mum?

Children in mainstream seek a teacher, and they step in and deal with matters appropriately (or not depending upon how good the teacher is, previous "reputation" of the child, what they witnessed and so on).

When home educated children play out of earshot of their parents (which they do, they aren't chained at the ankle) if there's a disagreement they too seek help - it may be that an older child playing negotiates a solution, it could be a carer/parent. But if it's the latter they talk to the child about what has gone on and help him come up with solutions to resolve what has happened - setting him up with the skills to progress and do this himself as he matures.

I've never witnessed any physical fighting, name calling or bullying at a home education session and I can't personally see any reason it would be beneficial for a child to endure any of the above?

It was really interesting today to hear from a mum who was home educated herself too:

"I think the socialisation concern is the most common misconception I have always encountered, I am 32 and people always seem amazed I can string a sentence together when they find out I didnt go to school. The only socialisation I recall from my brief time in school is being mildly bullied and feeling generally bewildered at what was going on socially. There are 4 of us so I did have siblings with me all day then went to play out when school ended with kids on my street who did go to school. Also had lots of pen friends ( probably dont exist now lol) who were home ed. Home ed is what you make it and my mums approach was very laid back so I pretty much taught myself from reading and doing little projects. Btw I have excellent communication skills and 2 degrees so I thoroughly advocate home schooling to anyone and feel I gained more than I could have ever missed out on."

The Research....

"Despite the concerns of the general public, the typical home educated child participates in a wide range of activities outside the home (Mattox, 1999). In 1992, Prof. Larry Shyers assessed whether or not home educated children suffered from retarded social development and found that public school children had significantly more problem behaviours than did home educated children. Possibly this is because the primary models of behaviour for the home educated are their parents, rather than their peers. Shyers also concluded that there was no significant difference between home educated and schooled children in terms of either self-concept development or assertiveness. According to Prof. Thomas Smedley's research, home educated students are more mature and better socialised than those in either public or private schools (Smedley, 1992). Dr Raymond Moore's research indicated that home educated children were happier, better adjusted, more thoughtful, competent, and sociable (Moore, 1986). A Cornell University study showed that schooled children become peer dependent while those who learn with their parents had more self-confidence, optimism and courage to explore".

http://www.muslimhomeschool.net/hsa/homeschoolworks.html

In terms of whether schools offer optimum learning.....

Home-schooled students may have the academic edge over their public schooled peers, according to a new study from the Canadian Journal of Behavioral Science.

"The study, which examined the test scores of 74 students ages 5-10, found that kids educated in structured home school environments actually outperformed their public school counterparts in math and reading.

Researchers found that public school kids tested either at or above their grade level, while home-schoolers tested about a half-grade higher in math and 2.2 grades higher in reading.
“Structured home-schooling may offer opportunities for academic performance beyond those typically experienced in public schools,” author Sandra Martin-Chang, a professor at Concordia University, said in a statement about the results. The test score differences remained even after researchers controlled for income levels, the mother’s education, employment and marital status."

and

"According to the U.S. Department of Education, "Virtually all the available data show that the group of home schooled children who are tested is above average." Such impressive results have been observable for at least 15 years with home-educated children in the U.S. surpassing the national averages on both the major college-entrance tests. Time Magazine reported that "the average home schooler's SAT score is 1100 - 80 points higher than the average score for the general population." Dr. Lawrence Rudner's research covered 20,760 home-schooled students and found that in every subject and at every grade level, they scored significantly higher than their public and private school counterparts. Similarly, a Moore Foundation study of parents who had been arrested for truancy found that their children ranked 30 percent higher on standard tests than the average schooled child."

"Interestingly, Rudner found that having at least one parent who is a certified teacher has no significant effect on the achievement levels of home-schooled students. Test scores of children whose parents had ever held a teaching degree were only three percentile points higher than those whose parents had not. Children who were taught at home by mothers who had never finished high school, still scored well above public and private school students. Students who had been home educated for their entire academic lives scored higher with SAT scores improving from the 59th percentile for those home educated for one year to the 92nd percentile for those home educated for seven years. (Ray, 1997). According to Rudner's research, home schooling families typically have an above average income, are two parent families and have above the average number of children."

When you think about it logically, this kinda makes sense. A classroom situation has to try and ensure all have grasped the lesson. This means those who have grasped quickly can be waiting for those who haven't to catch up, similarly someone that needs more support in a specific area may need more than that dedicated lesson. When learning is individual, things grasped quickly can be expanded upon rapidly and more time and focus can be given to areas that don't come as easily.

Furthermore:

"Homeschooled children can accomplish in a few hours what takes a typical classroom a week or more to cover. In a recent interview, John Taylor Gatto, New York City Teacher of the Year and a 26-year teaching veteran, said that in many classrooms less than one hour out of each school day is spent on "on task" learning."

http://school.familyeducation.com/home-schooling/parenting/29861.html#ixzz1b4UGpC00

Jane from Playful Minds agrees, when asked how long she thought it would take to cover in a day what is typically covered in a school day, she replied:

"Going by my extensive experience of being in 100's of schools as a freelancer.....I would estimate 2 hours tops!"

Add no homework to that and you can see why home education is becoming a viable choice for a growing number of families.

Further Reading:

Struggling with breastfeeding? Have a hug from us

2011-10-10T21:48:00.001+01:00

Today I wanted to send some inspirational words to a family I'm supporting who are having a tough time with breastfeeding. Baby had an undiagnosed tongue tie and so the "technical" side is taking a little time to resolve. Emotionally and mentally though mum was finding things hard going, wondering if she should continue when it's so difficult and really needing to hear things will improve.

The replies I received on Facebook were so kind (did I mention just how cool some readers on my FB group are?), I thought it would be nice to pop them in a blog post. Then should any other mum need a mental hug, it's here for all.

Krystie: Just take it one feed at a time. also the saying that helped me when i had really bad after pains with every feed for 3 days, "This too shall pass"

Sarah: If they are tiny all they want and need is cuddles, clean bum and boob, boob boob. our culture has made us think that is wrong and it is not. and do some research on cosleeping and baby wearing. get people to look after you, the mother needs to be mothered also.

Sarah S: ♥ that it will be ok!

Emma: The rewards are given by the baby themselves once they are able. Although I had a fairly smooth bf journey i did go through an awful biting phase that really made me question whether to continue and at 15 months we are still going strong with smiles, strokes and cuddles thrown in :) You are doing a great job xxxx

Arabella NN: No inspirational words, sorry, but do let her know that many will be thinking of her and her baby, willing her on and admiring her determination and love for her child.

Lynn: For me I needed to know when it would get better. We had latch and supply issues and it was a nightmare. I had a friend say to me "Hang on, around 12 weeks it gets soooooooo good.' And it did. And I did. ♥

Rachael: Go back to bed, and stay there, cuddled up with baby. Feed, sleep, change bum, get someone to feed you, feed, sleep, feed, sleep. Breast feeding is really difficult, I gave up after 12 weeks due to lack of support/information and have regretted it ever since. Its a learning curve for you and your baby, practice makes perfect. Your a breast feeding star, keep going, it DOES get easier x

Megan: ‎"This too shall pass" became my mantra too. I struggled with some things in the beginning but by the time son was older and it was easy, I can't even count the number of times I said "I'm so glad I'm still breastfeeding". For a variety of reasons. My local LLL leader also told me that there are lots of moms all over that would be trying to feed their babies at the same time I was - I felt a lot of solidarity with women I didn't even know, especially in the middle of the night. :)

Tanya: The best thing anyone said to me was, "in the whole of their life, this is such a short time. It won't last forever and you'll even miss the toughest of days when it's gone" and I have to say after 27 months of feeding it's true :)

Luisa: Once all this is over you'll be so fricking glad that every feed is a piece of cake and you'll never have to worry about whether to take hot bottles cold bottle or how long you'll be should you take 3-or 4 and can you keep that many hot or warm..

Tracey: I agree with the one-feed-at-a-time mantra, it got me through a whole heap of pain from untold damage caused by a missed tongue-tie, and several blocked ducts. Oh and also I say get a sling. Once I had one I was like "OMG! Why didn't I do this earlier!!!"
Also let her know we're here for her, night or day ♥

Anna: She's doing great and what is best for her baby. I heard a lot of.... Its not you doing anything wrong its just you and baby need to learn the right technique so as with anything new it takes a while to perfect x

Hannah: It will get better and you will look back on this time as a short period in your breastfeeding journey. And tomorrow is another day - never make any decisions in the middle of the night. Hugs to her

Cassaundra: You ARE capable of doing this. women's bodies have been doing this for millions of years. an YES, you are in a society that isolates women and makes it as hard as it can possibly be. YES, the difficulty you are having IS real. but YOU are stronger and better than all that society can throw at you. you CAN do it! That is the "one" message i would send.and blessings and hugs :)

Katy: It wont last forever and it will be so worth it the long run

Sarah Sc: The tough days at the beginning are eventually eclipsed by the lovely feedings where your baby helps you recharge your emotional batteries. Where baby strokes your cheek or holds your breast tenderly. I haven't forgotten the early days of tears, confusion and pain but those days have somehow made our successes greater, our bond stronger and my breastfeeding resolve reinforced.

Kate: Things do get easier......I clearly remember my lo was 8 weeks old when I finally thought....I can do this........8 weeks is a long time to think everyday I can't do this, every feed, but it gets easier & is the best thing in the world & you are doing amazingly well!!!!!
Also get yourself to some support groups. You will be so proud of yourself, don't give yourself a hard time at all........this phase will pass!!! Promise!
Don't give yourself any goals, just go with it as much as you can!
X

Melissa: Whenever I think about breastfeeding, I think about the fact that I am not doing so for MY benefit. I am doing it to give my baby the best start in life that I can. Every little problem will just make me stronger, strengthen my resolve and make me more confident in myself because I was able to work through my problem and the tribulations.

Isolde: Only ever feed lying down until it all feels better. and watch out the expression on munchkin's boob-drunk face afterwards - that look of pure peace, contentment and slight inebriation is worthy it 100 times over.
‎(obviously I'm working on the premise that everything is better when lying down!)

Jen: That it will be so so so so worth these initial struggles...

Georgina: Hold on in there, it is so easy to say that but a lot harder to do, i know because i have been there, but its the best feeling when its working out and you will be so so proud of yourself, big hugs to you, it will be OK and you can do it x x x

Samantha: My message would be that there is ALWAYS a way to get over whatever hurdle you've hit and that there is nothing like looking back and congratulating yourself for getting through it. I had mastitis, thrush, cracked nipples, a baby that wouldn't gain weight (not all at the same time!) and every time I persevered, I was so proud of myself for getting through just one feed at a time. "This too shall pass" - great mantra!

Amber: Stick at it, every tough feed takes you a step nearer the easy ones, when you can just go out and feel secure that you can feed your baby anywhere, anytime. And think how much chocolate you can buy for the cost of one tin of formula. Then multiply it by the hundred or so tins you wont need :)

Hayley: I also went through a nightmare breastfeeding at the beginning, didn't know if i could continue but was emotional at the thought of stopping. nipples bled, got flu like mastitis, worried my son was dehydrated. Things that helped me were finding programmes that took my mind off the pain and saving them on sky+ to watch at feeding times, keep trying different latch/holding methods, someone else making nice comfort food meals for me. And eventually (feels like a few weeks in my memory but eternity at the time) it got better. I'm still feeding at nearly12 months and it was worth all the tears. x

Rachel C: My advice would be never be afraid to ask for support and advice. I have an amazing support from my online mummy friends (words can not describe how grateful I am for their patience and support), my partner and the breastfeeding supporters locally. I just wish I had the same support for my first two children ♥

Sally: I had really tough time and it hurt so much I didn't think I could keep it up... But it all seems so long forgotten, it seemed long ago even a week after getting it sorted. But I still remember how far off it seemed whilst still in the dark grim haze of pain and misery. But hope is just around the corner... I have been amazed by the strength and determination of women whilst have overcome impossibly huge obstacles, much greater than mine. Their example makes me feel confident that I could overcome ANY bf obstacle that presented itself. I reckon now, that appropriate technical support is essential, first and foremost - but the magic that makes it all work and help overcome anything is determination. And get.thee to a good supportive group. My local LLL is where I have met all the inspirational bf mama that have spurred me on.

Clare: You can be really smug when your baby/toddler doesn't ever get ill when all the bottle fed babies are keeping their mums up at night (after they've bragged for months about them sleeping through whilst you were the walking dead) and your contented angel has passed all these early problems! We all feel distressed and overwhelmed, go to bed for the day, stay there with lots of naughty foods (and healthy ones) watch TV, sleep or whatever indulgence will make you feel better.

Shelley: We had a REALLY tough time too :( (all came down to a undiagnosed posterior tongue tie and bad dvice) 12 weeks of massive nipple trauma from a popped friction blister, mastitis, severe thrush which lasted 10 months and pumping for 8 weeks while blister healed and TT divided, things improved dramatically at 12 weeks. A very close friend of mine said " look back to this time last week not this time yesterday". I could always see an improvement even if it was a small one. This kept my spirits high at the darkest of days. I hope you can look a week or more and see that something has improved. My thoughts are with you and your family. You are strong to have gotten this far. Well done. Not long now:) xxx

Kaye: Once you get past the difficult first stage you will love every minute. There is nothing that can compare to it. I struggled at first, my nipples split and I cried at every feed. But I am so glad I was too lazy to get up in the night to prepare bottles! You are doing an amazing thing for your little one. As you are probably aware it will do wonders for your health as well as your baby's, it also protects against SIDS. You can get through this. Cuddle up with your baby, sleep when he/she does and have a relaxing bath. I'm sure I can speak for all of us here when I say if you need anything you can get a message to us and we will encourage and support you in any way possible.

Baby Schedule V Routine

2011-10-04T19:46:00.001+01:00

A lot of the books I have read that encourage a schedule, claim it results in a perfectly content baby because all babies thrive from the security of a routine, of knowing what comes next. It therefore follows that living life to a timetable creates stability and predictability that a baby loves.

But I'm not at all convinced that a routine is synonymous with a schedule.

Dictionary definitions:

Sched·ule
Noun: A plan for carrying out a process or procedure, giving lists of intended events and times: "we have drawn up an engineering schedule".

Rou·tine

Noun: A sequence of actions regularly followed; a fixed program: "I settled down into a routine".

So a schedule is a list of events and times, a routine is a sequence of actions - but is there a time implication?

When I wake up in the morning I have a routine - a pattern of events that has naturally evolved. First I make coffee, then breakfast, then whilst the children are getting washed/dressed/teeth brushed I tend to have a quick check of emails and Facebook, then I get ready, finish off any bits eg hair brushing for the squids, we collect lunches, sports kits and out the door.

This does indeed run roughly to a schedule, because we have to be at the school bus for a set time - but even when both were flexi - schooled and we had a couple of days at home, we followed the "routine" but generally an hour later on non school days. The routine was not interlinked with the time.

For many routines are instinctive human behaviour, and we implement them naturally. Following a pattern in the morning, or have an order in which things are done before bed and so on (even if it's as simple as one person lets the dog out whilst another gets the lights).

Non of this means we do the routines to a stopwatch - sure life generally has some constraints that force a schedule, but we have variety too. During the week one may be forced to eat lunch at a set time, does this mean at the weekend an alarm is set to ensure this doesn't vary? We at least sometimes have brunch, if we're out and about we may get lunch at whatever time is convenient, if we've had snacks we don't normally have we might eat later! Some days I may eat numerous snacks, other days I don't feel as hungry...

Ditto getting up - how many who have to leave for work at 5.30am during the week choose to rise later on their days off? That same person may have a pattern of going to bed at a set time during the week so they feel awake enough to wake at 5.30, yet decide to go out the night before their day off because they have no forced schedule? Not having a schedule is often relished, the freedom it brings.

Whilst routines provide us with a sense of comfort, schedules are not an integral part of human nature and in fact they can for many be hard!

Suggesting a baby needs to wake, eat, sleep, snack, snooze at the same time and for the same duration every day - based on the fact humans like routines makes little sense to me; it doesn't reflect "normal life". Whilst most babies adopt a rough napping pattern and some do sleep almost like clockwork, many vary; for example one baby taking two naps per day may sleep longer one day compared to another, perhaps after a busier than usual morning, or an appointment that prompted an earlier start than typical. Some mums have a wide and varied pattern to their routine, with school runs or after school commitments, meaning nap times change on a day to day basis; it's OK to live life around one baby's routine until you have several children!

Even if we take sleep out of the equation, how healthy is it to teach a baby to eat and drink to a clock? Not when hunger and thirst strike but to a clock? How can this in any shape contribute to self regulating appetite and recognising hunger and satiation when older? How often do you go four hours without eating or drinking anything?

Many baby books warn should you not follow a schedule your baby will never sleep resulting in shattered, unable to function parents and babies who cannot stop snacking! (but that's one for another blog entry) Yet omit to focus on the fact that following their plan means you are tied to a schedule 24/7 - the aim your baby will wake at a set time and if not you will wake them. No weekend lay ins following a bad night teething, no visit friends at the weekend and staying slightly later knowing you can all sleep longer in the morning. Mind you, given some routines state you must always put baby to nap in their cot, if following this visiting friends for longer than a couple of hours is ruled out anyway! Even in the very early days when baby is super portable and sleeps anywhere.

And that's the less tiring option?

Spotlight on Fenugreek - Does natural always equal safe?

2011-09-25T11:28:00.002+01:00

There often seems to be an assumption that if something is derived from a plant or herb - it is safe, or at least safer than a pharmaceutical drug because it's natural. Often there is little consideration given to the side effects of a natural supplement, nor potential interaction with other prescribed medications.

Galactogogues - something taken to try and help increase milk supply, seems to be one area where this is so. Many look to herbal options such as fenugreek, blessed thistle and goats rue, before considering a pharma drug such as domperidone (Motilium); with some suggesting it's better for parents to try the natural option before moving onto medicine.

The trend also extends to the "mummy market" - breastfeeding teas and lactation cookies, some claiming to be miracle supply boosters (but more about that in a minute) can be purchased, containing the above ingredients.

But is it really as clear cut as natural is good, pharma is bad?

I thought I would start the "spotlight on" section with probably the most common UK galactagogue.

Fenugreek

Fenugreek has used both as a herb (the leaves) and as a spice (the seed) since ancient times. Some charred seeds have been dated as 4000 BCE and reports state desiccated seeds were also found in the tomb of Tutankhamen.

Fenugreek is a commonly used flavouring agent in curries, chutneys/pickles as well as sprouted and eaten as a salad. It is used as a dye and also medicinally in some areas; drinking a cup of fenugreek tea per day made from the leaves, is said to relieve the discomfort of arthritis and others report its effectiveness when applied to eczema (there are lots of other reported medical uses too from reducing cholesterol levels to relieving gastric discomfort).

Something used in food is therefore bound to be safe as a supplement right?

Perhaps, except that if we consider the tiny amount of fenugreek seeds that are in a chutney, or the small amount that is likely to be consumed in a curry - the benefits and potential side effects of fenugreek may be less pronounced than when it is used as an supplement.

Even drinking fenugreek tea made from leaves or using those in cooking, is significantly less potent that something made from the seed

Safety as a galactagogue?
Kellymom states:

Fenugreek is on the U.S. Food and Drug Administration's GRAS list (Generally Recognized As Safe). As with most medications and herbs, various side effects have been noted; see the side effects and safety information below.

However another site points out:

Fenugreek has not been evaluated by the FDA for safety, effectiveness, or purity. Additionally, there are no regulated manufacturing standards in place for these compounds. There have been instances where herbal/health supplements have been sold which were contaminated with toxic metals or other drugs.

This makes sense - if it's a herb/spice regularly used in cooking, it's comparable to say turmeric in that it's a regularly consumed food and thus likely to be generally regarded as safe. Does that therefore mean supplementing with larger amounts of turmeric would have no side effects?

Dosage
The widely accepted daily dose for milk production is 3.5 - 7.3 grams capsule wise (3 x 3 capsules), or 3 teaspoons of seeds.

Some websites state to buy Fenugreek from a specialised herbalist as the quality is better than chain store brands - but if nothing is tested or regulated, how does one begin to compare?

Smaller doses, such as those provided with the supplement (typically 1 - 2.5 g per day) have not been found to be effective at increasing milk supply.

Risks?

As mentioned above in the kellymom quote - various side effects have been noted.

Drugs.com states:

"Do not take fenugreek without first talking to your doctor if you have a bleeding or blood clotting disorder or diabetes, or if you are taking any medicines to prevent or treat a blood clotting disorder or diabetes. Fenugreek has been reported to affect blood clotting and blood sugar levels.

Also, talk to your doctor before taking fenugreek if you have any other medical conditions, if you take medicines or herbal/health supplements other than those previously listed, or if you suffer from allergies (especially to plants). Fenugreek may not be recommended in some situations.Do not take fenugreek supplements without first talking to your doctor if you are pregnant or planning a pregnancy. It is not known whether fenugreek will harm an unborn baby. The amount of fenugreek customarily used in foods is not reported to be problematic. Do not take fenugreek without first talking to your doctor if you are breast-feeding a baby."

Blood Clotting: According to the Memorial Sloan-Kettering Cancer Center (MSKCC), fenugreek may increase the effectiveness of substances with blood-thinning properties. These substances include warfarin, heparin, ticlopidine and other platelet inhibitors and non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen.

Diabetes & Hypoglycemia: A couple of studies have demonstrated fenugreek can reduce blood glucose levels, increasing the risks of hypoglycemia in those susceptible.

Uterine Contractions: Pregnant mothers who notice a drop in supply may reach for the fenugreek - yet nearly every site discussing supplementing highlights it can cause uterine contractions and should not be used when pregnant (indeed fenugreek has been used traditionally to stimulate labour)

Asthma: Some mothers with asthma have reported fenugreek seeds aggravated their condition. In contrast others recommend as something to reduce asthma symptoms.

Allergy: Numbness, facial swelling, breathing difficulty and fainting are likely a sign of an allergic reaction. Fenugreek is from the same family as peanuts and chickpeas - and therefore is more likely to provoke a reaction if you are allergic to these.

Iron absorption: Several sties exploring fenugreek safety state it can interfere with iron absorption so should be avoided by those who are anaemic; a quick hunt online didn't turn up any evidence

Thyroid issues: Several sites exploring fenugreek safety, state it can alter balances of various forms of thyroid hormones and thus should be avoided in mothers with thyroid issues. Again a hunt suggests others have found fenugreek helped with thyroid issues, it seems it all really depends on what the problem is. The suggestion is fenugreek may curb the conversion of T4, the inactive thyroid hormone, to T3 the active form of thyroid hormone the body uses (1). Some people already have trouble converting T4 to T3 in the body and therefore the addition of fenugreek to these people's diet might make their symptoms of hypothyroid disease much worse (and reduce milk production)

One user on Babycentre said:

"I was just told recently to stop taking fenugreek. I was told by an herbalist that fenugreek can counteract your thyroid condition and even make your symptoms worse. Funny because the day earlier I was in the Dr's office telling him I thought my Thyroid medication needed to be adjusted because I was feeling all the symptoms from before I had it removed. I take Levixyl and since I stopped fenugreek about a week ago, I am feeling better and in a better mood. My supply is up almost an ounce a day which is phenomenal for me."

Potassium: Fenugreek may lower potassium blood levels, it may therefore cause hypokalemia when used in combination with some diuretics, laxatives, mineralocorticoids, or other hypokalemic agents (2)(3)

Some other side effects may occur such as headaches, dizziness, diarrhoea and wind when fenugreek is used at recommended doses.

One mum online felt compelled to let others know in a post entitled The Risks Of Fenugreek, it reads:

"Not only did it not boost the supply, but I found that it was affecting me and our 3 month old baby. I was having stomach cramps so bad I could barely walk ( not period pain, but actual stomach), I was thirsty all the time and having tension headaches. Our baby also suffered terrible stomach cramps and was generally restless.

The fact sites my partner looked at confirmed that fenugreek was indeed the cause of our problems. I have now stopped taking it and things are starting to go back to normal.

As a parent wanting the best for your child, you should have more of the facts and I sincerely hope these give you more. As a parenting wanting the best for my child, I did what I thought was something helpful and instead it was a nightmare."

Dr Thomas Hale - often considered a Guru regarding breastfeeding and medications states:

"The transfer of fenugreek into milk is unknown, but untoward effects have not been reported." Hale classifies it in Lactation Risk Category L3 (moderately safe).

Even further food for thought is that Dr Hale rates Domperidone (Motilium) the pharma drug of choice for milk production as L1 (safest)

But does it work?

One study from February 2011 examined 66 mothers in the early postpartum period found Maximum weight loss was significantly lower in infants whose mothers consumed Fenugreek tea compared to both the placebo and control groups (p < 0.05). Infants in group 1 regained their birth weight earlier than those in control and placebo groups (p < 0.05). The mean measured breast milk volume of the mothers who received galactagogue tea was significantly higher than the placebo and control groups (p < 0.05). (4)

In another small study examining milk production in exclusively breast-pumping women. Ten women kept diaries of their breast milk production for two weeks. The first week established baseline milk production. During the second week three capsules of fenugreek seed were taken three times daily. This observational study used each patient as her own control in comparing breast milk pro-duction with and without the fenugreek. Average daily pump volumes for week 1 and week 2 were compared; the average daily milk volume for week 1 was 207 ml compared to 464 for week 2. This increase was statistically significant (P=0.004). (5)

The upshot

Does this mean we should all throw out the fenugreek and look to other galactagogues? Absolutely not! But we do need to recognise that just because something is natural, this does not make it risk free.

When discussing supplements to help increase milk supply with mothers, we should like all other areas of support provide all the information so the mum can make an informed choice. Simply telling a mum to take fenugreek without making her aware of any potential link with blood sugars or possible interaction with other medication she may be taking/other conditions she may have is I think irresponsible. A diabetic mum absolutely may decide to explore fenugreek as something that can help with blood sugars as well as supply, but she needs to know that it has the potential to impact on her sugars so she can monitor/adjust insulin as required. If a mum is aware of potential side effects, she can identify them if they arise and choose to cease using the supplement - if not as we observe above, it can be upsetting to experience.

With items such as cookies or tea, I've noticed contraindications and/or drug interactions are rarely noted. Nor do some state what dose of each herb or spice is within the product - therefore how can mum ensure she takes the right amount? It's one thing selling a tea or biscuit as tasty, but if you're going to claim it has milk inducing properties then you surely need to tell women how much to consume? ie minimum and maximum amounts for results? As discussed above below the recommended dose has been shown to have little impact on supply, too much could increase the risk of unwanted side effects.

Associated reading: http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31402/347265.html

1. doi:10.1016/j.physletb.2003.10.071
2. Lipids 1991;26:191-197.
3. East Mediterr Health J 2000;6:83-88.
4. J Altern Complement Med. 2011 Feb;17(2):139-42. Epub 2011 Jan 24.
5. EFFECT OF FENUGREEK ON BREAST MILK VOLUME, Stephanie Swafford, MD and Pamela Berens, MD. ANNUAL MEETING ABSTRACTS SEPTEMBER 11-13, 2000

2011-09-23T19:07:00.001+01:00

Armadillo Reviews

2011-09-22T13:38:00.000+01:00

I've decided to add a review section to the blog, where things, places or events that I and readers like (or don't!) can be shared. I'm sure as parents most of us have our "top items" we couldn't live without, and if anything like me with my first - also an awful lot of tat that was barely used.

It's definitely not a list of "essentials" but more of an I or a reader loves/loathes idea; perhaps you have found a chain store to be consistently positive and welcoming towards breastfeeding, or perhaps you bought a bouncy chair that sucks and want to let others know to avoid!

Rather than just the usual baby stuff, I thought it would be nice to extend to toddler/children age too as I know lots of readers have older ones - did you buy something brilliant or visit somewhere as a family you want to share with others?

At the moment I'm pondering children's birthday parties - I want something a bit different to the usual home/crafty affair, but play place parties and suchlike are definitely not for us. The market out there is vast from swimming, bowling or karting parties to street dancing, face painting and even cooking! (I'm going to pretend the dreaded "princess pamper parties" and suchlike don't even exist) With prices ranging widely and then of course there's the whole party bag - to do or not to do, I get the feeling I should have started planning months ago.

AA

Well aren't you the perfect parent!!

2011-09-10T18:05:00.000+01:00

This it seems is the internet's answer to any discussion that cannot be answered with logic - and it's popularity ever increasing. But is there a darker side?

Here's how it goes (these are real comments from various places on the web):

"I don't agree with Cry It Out methods, I've seen evidence suggesting it can be harmful and prefer more gentle techniques".

"Well aren't you just the perfect parent!!!!"

"I think smacking children is just wrong, how can "no hitting", followed by a hit teach anything?

"It's great you are such a perfect parent and don't ever lose your temper and smack"

"I try to be responsive to my child - babywear, breastfeed, co-sleep"

"Groan - another one from the perfect parenting brigade."

In none of the above statements is anyone implying or stating they are the perfect- they are sharing their opinion/experiences on a topic; but it seems the "perfect parent" card is one to be played when there is no logical response, or when emotional response trumps the rational brain.

Just like the marketing behind formula, pushing things we didn't do but know to be better as "perfect", allow other options to sit as "ok". The alternative is surely admitting we didn't make the best choice or worse considering something may (however inadvertently) potentially caused harm - for many the former is far easier.

The emotional response may not even be logic based - it could be it simply evokes a feeling of inadequacy, guilt or perceived failure.

But does this have deeper, darker roots?

In Jan 2011, A Mumsnet survey revealed that most parents feel unduly pressured to comply with the ‘model of perfect parenting’ as a result of reading Mumsnet:

‘Modern parents face an increasing number of stress-inducing activities on Mumsnet,’ explained Mumsnet spokesman Susan Thurrock. ‘These include reading about only using organic ingredients, browsing articles about the correct classical music for your child to fall asleep to, or contributing to forums about how to park far enough away from school to make it look like you’ve walked. While good Mumsnet users will be able to achieve all this and more without breaking sweat, the bad parents will struggle.’

I thought the last bit a rather odd statement, but on the whole I'm not sure it's that it's Mumsnet per se, but more that the internet generally provides parents with information they never had access to before. Pre WWW generation you may buy a book or chat to friends - but mothers didn't often access research studies and discuss outcomes, if the health visitor, midwife or nurse said it - it was assumed true. The thing about being a parent is the more that the more we know, the worse we can feel if we think we missed the mark, OR if there is suggestion we have. Even if we do a hundred other things that are fantastic, the however many things we don't do can weigh heavier - even more so if someone didn't have or felt they had no choice in something they did, perhaps due to a lack of support with alternatives.

"Desperation decisions" as I call them, typically envoke the strongest feelings later compared to "informed decisions" - and when people feel vulnerable it makes for tension and our old friend "guilt".

Child development expert and author of Self-esteem for Girls: 100 Tips for Raising Happy and Confident Children Elizabeth Hartley-Brewer agrees.

‘The wider context is the huge pressure on parents to be perfect,’ she says. ‘Mothers who have been successful in their previous lives want to be successful in child-rearing too. They decide what camp they belong to – be it Gina Ford or the Baby Whisperer, the stay-at-home camp or the working mums – and gather on the dividing lines. If you feel insecure and vulnerable, you present a greater degree of certainty to hide it. You have to be right, and show no cracks. From the outside, it can seem a lot like bullying.’

The media, marketing companies and generally those out to make a buck (or sell one ;)) leap on this, just like the formula companies do - and from "Perfect Parenting" stems "Mummy Wars". Dividing parents makes consumers less powerful and vendors more so - if everyone could discuss, chat and share ideas openly, imagine the potential impact on a brand or product should the masses get a whiff of something amiss, or discussion and support about better alternatives?

PHD in parenting w rites brilliantly on the topic here, well worth a read. It says:

"The perfect parent is a myth. That person does not exist. We all make choices as parents, some free choices and some forced choices. Sometimes we are able to do what is best for our children and sometimes we are not"

Aint that the truth. We have parents anxious they are not making the grade of "perfect", yet just like an airbrushed magazine cover - it's chasing the impossible, a fantasy, it doesn't exist. We have parents calling each other "perfect" as an insult, apparently involved in some mummy war! Does that mean we should all stop trying to do our best, educating ourselves, learning and changing the way we do things if we decide that's a better option, stop actively seeking help if we need it? Absolutely not. But we do need to realise nobody gets it right all the time, and you know, that's what makes us human.

Winner of Merino Kids Giveaway!

2011-09-04T08:56:00.000+01:00

And the winner of our Merino Kids Go Go Bag™ is:

SUSIE Q

CONGRATULATIONS SUSIE!

Please email me your address to claim your prize!

Advice VERSUS Information & Support

2011-09-03T19:01:00.001+01:00

Many times over the years have I had my knickers in a knot over advice versus information and support. It was the great late Pam Lacey, chair of the Association of Breastfeeding Mothers that first really opened my eyes to this concept - and it's one I really wish more breastfeeding supporters would recognise..

So if you're a breastfeeding counsellor, peer supporter or anyone who works with mothers as a lactation worker - please read on!

Advice definition:

"Advice is a form of relating personal opinions, belief systems, personal values and recommendations about certain situations relayed in some context to another person, group or party often offered as a guide to action and/or conduct. ".

and

"Recommendations concerning future action, typically given by someone regarded as knowledgeable or authoritative.

We see advice in many forms: "What I would do if I were you", "you need to", "you must", "you should", right through to a blunt "do X".

The role of a breastfeeding counsellor is not to convey personal opinion or beliefs or to tell mothers what they should do; it is to support the mother and help her explore her options, to help her unpick any confusion she has surrounding a problem and empower her to reach a resolution she is happy with (regardless of whether this sits with your individual beliefs - this isn't your journey).

Good reasons not to give advice:

To give advice assumes superiority, it presumes you know better than the person asking the question, it also makes you responsible for the outcome. If you give someone advice and they follow it - what if it doesn't work or worse still has a negative impact?

Here's an example of one I see regularly.
"My baby's poop is green, do I need to worry? What should I do?".

Example of a typical "advice" giving reply: "This is caused by too much foremilk, you should start single side feeding - one breast per feed".

We know there are actually various reasons for green stools, one of which can be insufficient milk intake. Limiting the baby to one breast could potentially create a more serious problem, particularly if the baby is very young.

And another

"My baby is colicky and refluxy, won't settle, what should I do?"

Example of a typical "advice" giving reply: "You need to cut out all dairy ASAP".

We know there are actually numerous reasons for colic, one of which is dairy sensitivity - but what if that isn't the problem in this case and so doesn't improve or resolve things? What if just being told to cut dairy without discussion, exploration or explanation sounds so drastic to the mum asking that she decides to formula feed instead, worried her milk is causing the problem?

It doesn't empower anyone. Often mums have already had numerous people give advice - how do they pick who to listen to? If a counsellor gives advice and then a paediatrician gives conflicting advice, who would you listen to as a vulnerable new mum? How do they tell good advice from bad?

Giving advice can leave you open to mistakes. A mum starts telling you about a situation, you think you have all the information, so you tell her she should do "X". After hearing your suggestion the mum adds no she doesn't think that would work because of "Y" - a new bit of information the mum hadn't shared before. Oh you say, then in that case I would do "Z". The mums confidence is now faltering in you.....

Longer term advice doesn't help. What does the mum do next time she has a problem? She again needs to contact someone for advice! If the mum had been encouraged to help resolve her own problems with information and support, this empowers her with skills to apply to future issues.

Advice involves making a "judgement" - offering a non judgemental ear can be very satisfying to the "talker", and help people to feel a weight has been lifted. People can be reluctant to share what they feel the "listener" won't agree with if judgements are involved.

Sometimes what people state initially as the problem, actually may not be the real issue - if you give advice rather than encouraging them to unpick their thoughts, this may not come to light.

Alternatives to advice:

Active Listening:
Don't consider problem solving, but listen (really listen) to the big picture. Ask open and closed questions to get all the relevant information so the mum can unload everything in a safe space.

Reflection:
Always clarify clarify and clarify again - "so it sounds like you're saying X, is that right?", sometimes reflection can literally just be echoing back what the person said - when the mum hears it back or summarised, it gives her chance to add things or realise X point isn't as significant as Y and so on. It can help clarify things for mum too!

Give information:
There is often more than one way of resolving a situation; discussing various options with a mum so she can select what she feels works best for her situation. Examples include "some mums find X works for them, whilst others prefer " - recommending that a mum with four other children to take her baby to bed and baby moon for a few days may simply not be feasible (particularly if baby is a few weeks old and partner is back at work)

You can still give firm "facts" without giving advice - eg "we know that to maintain a supply if baby isn't at the breast, mums need to express 8-12 times per day".

Outlining WHY often empowers mum to begin to recognise poor advice eg "your breasts know how much milk to make based upon how frequently and how effectively they're drained - therefore if baby isn't feeding directly at the breast, we know mums need to express 8-12 times per day in order to mimic this and protect supply".

Support mum to think things through:

"So you feel X is the biggest issue, what would be the absolute ideal outcome for you?" or "If X was resolved, do you feel that would resolve everything?". "Do you feel X would be practical for you or is Z something you feel more comfortable with", "could X be impacting on Y do you think?"

Mums who receive advice, often leave an encounter feeling more confused than before they arrived - especially if they have previously received conflicting information. Mums who have received information and support often feel "lighter", as though they have offloaded. Listening can in itself make a person feel valued.

Believe it or not the most valuable tool you have as a breastfeeding supporter is not your mouth, but your ears.

Breasteeding Top Tips - BabyShow Guest Blog

2011-08-30T10:50:00.000+01:00

Tips 1-5

1. Learn as much as you can when you’re pregnant:

Options include breastfeeding preparation classes, DVD, books and blogs. However you prefer to learn it is much easier to grasp the basics of things like milk production and how to avoid common problems before you have your baby. Afterwards it’s normal to feel emotional as your body adjusts to no longer being pregnant, and knowing the basics can help you feel confident. Dads/partners can be brilliant at remembering the hands on practical details and you can also explore ways they can bond and support breastfeeding.

2. Choose your source of information carefully:

Unlike many areas of parenting which are really about differing opinions, breast milk production is a sound scientific model with decades of research behind it. In the UK both breastfeeding counsellors (trained and registered with an official organisation) and lactation consultants carrying the letters IBCLC after their name, have completed training to support breastfeeding,

Read the rest of PART ONE on The BabyShow Blog Here

Tips 6-10

6. Understand normal newborn feeding:

Newborn infants need to feed a minimum of 8-12 times per day. Work this out and it’s every two hours day and night! Often babies begin cluster feeding and taking frequent feeds over a spell of several hours – most often between the hours of around 7-11pm.

This is because after a feed baby has a high level of CCK (a nifty hormone that relaxes baby and helps him sleep), which also tells him he’s full; the level drops and baby feeds again. Baby may go through this loop several times before dropping into a longer sleep, with a full tummy to last.

Gradually your baby begins spacing feeds further apart and if you follow their cues, develops a natural routine.

7. Understand that breastfeeding isn’t just about food and calories:

Breastfeeding is recognised as pain relieving and breastmilk changes throughout the day to include sleep inducing properties at night. It is a live substance like blood, and in fact in the early days contains more antibodies than blood! It contains a protein which has been identified to be lethal to over 40 types of cancer, hormones, stem cells and so much more. It not only protects against infection, but enters the infant’s system to help fight problems and “teacher cells” that help direct the infant’s immune system whilst it is immature. It is your baby’s first “vaccination” and the most nutritionally complete food they will ever consume…

Read the rest of PART TWO on The BabyShow Blog Here

"Don't feel guilty" does the phrase really help?!

2011-08-27T21:48:00.004+01:00

"Don't feel guilty" - a statement often uttered by those trying to reassure/comfort someone feeling bad about something. Like much language it's often tossed about frequently online, particularly parenting forums, "mommy blogs" - anywhere a collection of women (who typically feel guilt far more frequently than men) group around an emotive subject.

But it hit me recently that "don't feel guilty", can actually provoke feelings of guilt. It can in itself imply a person is or should be feeling guilty.

I was chatting to my mum whilst driving, I can't even remember what about and it's not relevant anyway; what I do remember is I was expressing upset/sadness over a situation and my mother's reply - "well don't feel guilty". Up until that point I hadn't felt at all guilty, it was a situation completely beyond my control, but the fact my mum had said what she said, obviously implied she thought I could be feeling guilty. Otherwise why mention it?

Here's how it often goes online:
"I'm feeling really down today as I had to give little x a bottle today, we're just really struggling with the breastfeeding and he hasn't gained enough weight. I'm in agony so will be sad to stop breastfeeding but think it's time to throw in the towel."

The reply often goes along the lines of:
"X don't feel guilty, you have done your best, happy mum = happy baby etc etc etc".

The mum didn't express guilt, she expressed upset, sadness but not guilt. Telling her not to feel guilty isn't going to help or empower her to become less sad/upset is it?

Furthermore even if the mum was feeling guilt - since when did saying "don't feel <insert whatever emotion here<" ever stop anyone feeling it? Oh well yes now you've said that, all is dandy!

Still not convinced?

If you ever find yourself in a position of trying to breastfeed and your midwife/health visitor/breastfeeding counsellor is sat with you - yet it STILL hurts, or baby isn't gaining or settled or whatever; and then they say something along the lines of "well it appears OK", without giving you any practical help you resolve your problem or give you answers as to why you're struggling. Reverse the situation and say "it's OK don't feel guilty you can't help me". What reaction would you expect?

Oh and don't forget to add "please refer me to someone who can" ;)

Why I'm concerned about Tizzie Hall's Breastfeeding Advice - PART TWO

2011-08-17T21:14:00.001+01:00

Continued from PART 1

What we also need to throw into the mix of Tizzie's breastfeeding advice is that she also recommends limiting the duration of feeds too:

Before milk comes in:

"Day 1: Feed every three hours from both breasts - 6 minutes per breast
Day 2: Feed every three hours from both breasts - 9 minutes per breast
Day 3: Feed every three hours from both breasts (if milk not in) 12 minutes per breast
Day 4: Feed every three hours from both breasts (if milk not in) 16 minutes per breast"

We know how important colostrum is for babies, it's often called "liquid gold". Why would anyone want to limit the amount of this their baby receives? Containing more white blood cells (antibodies) than blood, examine its properties further and you soon realise if it was bottled and sold we would be advised to encourage baby to consume as much as possible!

Once milk is in the routine is first breast 25 minutes, then second 15 minutes every 3 hours (alternating which you start with) then a shorter gap of 2 hours between 4-6pm followed by a 3 1/2 hr gap to 9.30pm. By six weeks there is a 4 hour gap between the first and next feed and this extends until the gap is 4 hours throughout the day by 10 weeks (with 3.45 mins before the last feed) although it does switch to 25 minutes each breast at 6-8 weeks and then the timings just vanish from the routine (I'm assuming you can go wild and feed as long as you want at this point!)

Tizzie feels feeds need time limits so nipples can "toughen up" and "helps avoid cracked, sore or bleeding nipples, which can be horribly painful".

"Other babies are very sucky and if given the chance will stay sucking on the breast all day and night. The mother could end up very sore and even cracked and bleeding nipples, especially if she is too exhausted to correctly latch her baby onto the breast."

To a new mum this may seem to make sense - but I feel it's based on myth as this blog post explores.

Furthermore, science has examined this theory:

"To investigate the effects of the frequency and duration of breastfeedings on nipple soreness we studied two groups of mother-infant pairs during the first 10 postpartum days. Mothers in the control group fed on a 3- to 4-hour schedule and those in the experimental group were encouraged to breastfeed as frequently as the infants desired. All mothers recorded the time and duration of each breastfeeding for the first 10 days after delivery and gave their own daily assessments of nipple discomfort. Although mothers in the experimental group nursed significantly more frequently (10 vs. 7.4 feedings/24 hours, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;.0001), they did not experience more nipple soreness. There was no significant correlation between the frequency or duration of feedings and the degree of nipple soreness."

Does the Duration and Frequency of Early Breastfeeding Affect Nipple Pain?

Manoel de Carvalho M.D. Steven Robertson Ph.D. Marshall H. Klaus M.D.

Setting these sort of limitations on a newborn is quite mind boggling - but it doesn't seem to give any consideration to a baby not feeding well. This is the group I'm passionate about as these tend to be the people I see/hear from day in and out.

If a baby is not for whatever reason transferring milk well - it's rather like you or I drinking from a squished straw. Sure you get some liquid, but it makes your face ache and you stop long before you would if you had a normal straw.

These babies may fall asleep quickly at the breast - yet aren't really asleep and wake showing hunger cues as soon as they've moved. They can spend an age at the breast and suck and suck, whilst consuming very little - a lot alternating between sucking, crying and cat napping..

In this situation the mum can develop sore/cracked nipples - but not from the constant feeding, but from constant incorrect feeding. If something is preventing the baby from performing the correct action, they can compensate with suction! Some have a crushing very strong suck (as shown on ultrasound) which will absolutely crack and damage nipples.

Some feed very quickly but are hungry again half an hour to an hour later, or even sooner with feeds rolling from one into the next and the baby unable to settle. I meet parents who say, I don't know what's wrong, it can't be hunger because he's been feeding for two hours! Yet the baby would need to be attached 24/7 to take enough milk with how inefficiently they're feeding. If you feel your baby never appears full or settled - seek help from someone appropriately qualified such as a breastfeeding counsellor or lactation consultant (I.B.C.L.C.). This is not typical, but does not mean the only option is a strict routine.

I found Tizzie's book confusing in how one should deal with this though.

Firstly the baby falling asleep quickly:

Q. My baby keeps falling asleep during a feed - what should I do?
A. This is what I call a sleepy feeder. If she dozes off before taking enough milk to get her to the next feed, you will start to have problems if trying to follow a routine. Try changing her nappy or taking some clothes off as the cool air might rouse her. You could also try putting her down somewhere safe to rest for ten minutes and then try the feed again.

Ok so what next? If baby is not transferring milk well they WILL keep falling asleep - even after a 10 minute rest. Then what happens if it gets near sleep time?

In one section of the book entitled "settling your new baby to sleep", it discusses a newborn not settling doing the "emotional cry" (ie the one Tizzie feels indicates a need).

"This cry I would never ignore. Get the baby up and look for a problem, and if there's no visible problem I would offer some more milk".

I was quite heartened to read this although I did wonder which breast and how many minutes.

However still under "feeding in the first two weeks" it says:

"If you believe he is hungry between feeds and you have no expressed milk, just offer an extra feed for a few days no closer than two and a half hours after the last one."

Which suggests expressed milk is preferable if possible, but also seems to contradict the statement before?

The trouble with tiny babies is when they take insufficient calories the first thing they do is signal to feed; if this is ignored or their intake has dropped for another reason, they do one thing - sleep. The more calories drop, the harder it is to rouse them to feed - especially at night. They stop spontaneously waking, and a mum has to start setting the alarm to "remind" her infant to feed. It's also easy for a mum to think she has a "good" or "content" baby (because how long they will sleep now seems to define that in our society) who can't be hungry otherwise he would wake. When she tries to wake him he struggles to rouse, compounding her belief he simply doesn't need to feed.

Whilst on Tizzie's Facebook group, I've read parents of young infants 7/8/9 weeks announce hurrah, their infant is sleeping 12 hours! The response is often "great parenting", yet Dr Sears suggests otherwise:

"One thing we have learned during our years in pediatrics is that babies do what they do because they're designed that way. In the case of infant sleep, research suggests that active sleep protects babies. Suppose your baby sleeps like an adult, meaning predominantly deep sleep. Sounds wonderful! For you, perhaps, but not for baby. Suppose baby had a need for warmth, food, or even unobstructed air, but because he was sleeping so deeply he couldn't arouse to recognize and act on these needs. Baby's well being could be threatened. It appears that babies come wired with sleep patterns that enable them to awaken in response to circumstances that threaten their well being. We believe, and research supports, that frequent stages of active (REM) sleep serve the best physiologic interest of babies during the early months, when their well being is most threatened."

Dr Sears, 8 Infant Sleep Facts Every Parent Should Know

As clearly the above would for many ring alarm bells about supply, Tizzie recommends expressing alongside for the first 8 weeks.

In addition for the first two weeks until baby has regained their birthweight, mum has to set an alarm at night allowing a sleep of no longer than 5 hours. After this mum can stop waking baby, but until 4 weeks she has to express after 6 hours if baby hasn't woken for a feed - but only needs to remove an oz (I'm not sure what this figure is based on)

"I strongly believe expressing in the early days is a key factor to having a good milk supply while following a routine."

and

"I encourage all my clients to express first thing in the morning and at other times in the day. This is for two reasons. One, this milk can be given in the bottle later in the day and some of it an be frozen and stored for when your baby has a growth spurt"

and

"After a few days your breasts will start to regulate and produce only the amount he is taking. This is fine initially, but when your baby goes through a growth spurt in the early weeks you may not have enough milk to satisfy his needs. This would result in you having to feed him more often and will get your routine off track. It may also result in you feeding your baby too close to sleep time resulting in him using the feed as a going-to-sleep-aid."

Tell me, if it's so normal for a baby to follow the routine, why does one need to express to maintain a good milk supply? Isn't expressing a lot more time consuming than just feeding more frequently when baby wants to up supply - the way he's supposed to? Really is the world going to end if the routine goes out of the window for a few days?

The other issue I notice when young babies feed from very full breasts (which may happen following a 3-4 hour gap) is wind. It seems Tizzie has noticed this too as she suggests mums should wind their baby every three minutes during a breastfeed. By my calculations if a feed is as Tizzie advises 25 mins one breast and 15 the other - that's 13/14 windings per session!

My OH asked an interesting question after reading this entry, he said if you have to feed for 40 mins as per the routine, and you have to wind 13 times, if each winding is only 2 minutes - this is 26 minutes of winding. Is this on top of the 40 mins feeding making each feed 1hr and 6 minutes or is it included? ie 14 minutes actually feeding?

Looking at the routine

But none of it considers how unique each breastfeeding dyad is; that we know some mums have a larger initial store than others (although most can make roughly the same over 24 hours), that babies feed with different levels of effectiveness and that some mums have a bullet proof supply whilst others don't.

The last reason Tizzie gives for suggesting scheduled feeds is quality of milk - we are compared to cows in a dairy and our milk is claimed to be "similar to that of a cow" - which is eyebrow raising on so many levels. Tizzie proposes that dairy farmers say the quality and quantity of milk increases if they stick to two set expressing times per day -" is it such a leap to assume that's so for babies?"

Tizzie that's not a leap, it's a freaking pole vault, of Olympic standard.

A dairy is not the normal environment for a cow you know? When they have calves the farmer doesn't stand in the field with a stop watch, signalling when to start a feed and when to swap udders!

According to a dairy farmer, modern equipment allows the cows to choose their own milking times - and stated the times were set previously because of how long it takes to put a full herd through the milking process. Hand reared calves are fed two - three times per day, and then also are offered hay and grains within a few weeks! Bovine milk is designed to develop bulk not brains, because they're cows not humans. In contrast, gorillas feed on demand as frequently as the guidelines suggest humans do.

Humans don't drink cow's milk because it's vaguely comparable (don't know about you, but I have just the one stomach!) The protein size is cow sized not human, in fact sheep and goat's milk would be more comparable in some ways to human (although still not close) Humans drink cow's milk because cows can produce vast amounts of milk whilst being cost effective to keep and docile enough to allow it. Cow's milk has to be massively modified so a human infant can tolerate it and along with wheat is listed amongst the most common allergens. Each mammals milk is species specific, the antibodies, hormones and everything else is only of use to the same species. This is why there is a movement of mothers sharing human milk.

I appreciate Tizzie's book is opinion not a "science journal", but when your opinion is influencing how people raise babies isn't there some sort of ethical or moral obligation to at least consider how this sits with the evidence? I can understand areas where there is mixed evidence that it can come down to opinion, but some throw away comments are I think misleading:

When talking about prems:

"Often these babies are fed by tube or parents are advised to give their feeds from a bottle until the babies are strong enough to suck from the breast".

In an effort to refute the widely held assumption bottles are easier than the breast, one study sequenced babies to alternative between feedings at the breast and by bottle. During bottle feeding infants showed:

Poorer coordination of sucking, swallowing and breathing
A greater number of oxygen desaturations
A significant fall in skin temperature
Shorter duration of feeding.

Meier P, Bottle and breastfeeding: effects on transcutaneous oxygen pressure and temperature in preterm infants.

Another study found bottle feeding increased the incidence of desaturation episodes compared to cup feeding (1) whilst another found a 10 fold increase in desaturation episodes to <90%, compared to "no change" whilst cup feeding (2)

When talking about multiples:

"Most mothers are capable of producing enough milk for more than one baby. But it's also important to look at both your individual situation and your family's needs. There is no point trying to breastfeed if you are finding yourself too tired to enjoy your babies, or you spend all your time worrying about whether they are getting enough food. If you are concerned about this, talk to your health professional about their weight gain. If they are all gaining enough weight, settling and sleeping well, then you know you are producing enough milk, And remember, some breastmilk is better than none. With this in mind, a lot of my clients have decided to give a mixture of breastmilk and formula."

Hang on, I thought the whole point of the routine was supposedly to "stop mothers feeling too tired to enjoy their babies?" But to suggest there is "no point" if tired or concerned about weight seems really quite bizarre to me. Mums don't need to stress about whether their infants are "getting enough" if they are peeing, pooping and gaining as expected, just like with a singleton; why does "sleep and settling" come into play?

To Tizzie's credit she does suggest mums struggling can contact the breastfeeding organisations, and gives further details of who they are - my only concern is that if mums contact them, they may end up extremely confused as the first thing they will say is "have you considered feeding your baby by cue, not a routine?" The training to man these helplines includes looking at all the reasons a routine isn't the ideal for a breastfed baby.

Lastly here are the recommendations from the World's main sources of health care advice:

UNICEF's Baby Friendly Approach clearly states:

"There should be no restrictions on the frequency or length of breastfeeds."

The NHS breastfeeding website reads:

"Feed your baby as often as they want. This is called baby-led feeding (it's also known as 'on-demand'). Let your baby decide when they’ve had enough. It's not necessary to time the feeds. In the beginning, it can seem that you're doing nothing but feeding, but gradually, you and your baby will get into a pattern of feeding, and the amount of milk you produce will settle.

It's important to breastfeed at night because this is when you produce more hormones (prolactin) to build up your milk supply. At night, your baby will be safest sleeping in a cot in the same room as you."

The Department of Health lists good practice as:

"Encourage breastfeeding on demand."

The American Academy of Paediatrics' breastfeeding policy states:

"To nurse whenever the newborn shows early signs of hunger, such as increased alertness, physical activity, mouthing, or rooting. Crying is a late sign of hunger. Nondemanding babies should be aroused to feed if 4 hours have elapsed since the beginning of the last nursing. Time limits for breastfeeding will be avoided"

The World Health Organisation recommends:

"Breastfeeding on demand – that is as often as the child wants, day and night."

1. Rocha NM et al. Cup or bottle for preterm infants: effects on oxygen saturation, weight gain, and breastfeeding.
2. Marinelli KA et al. A comparison of the safety of cupfeedings and bottlefeedings in premature infants whose mothers intend to breastfeed,

Win with Merino Kids!

2011-08-11T20:51:00.003+01:00

We've talked lots recently about bedding - too much, too little, what type!

One thing I think most agree on is that natural fabrics are typically the best way to go at night. We first discovered this when my youngest was born at 34 weeks and in a heated cot.

After the first few days he became better at regulating his own body temperature without the heater, when suddenly one evening out of the blue it started becoming unstable again prompting concern - so much so they had to flick the heater back up to earlier levels. Whilst I sat the next day waiting for the doctor, one of the lovely SCBU nurses came on shift - the old school type. I explained what had been happening and she immediately checked his bedding; under the top fleece layer was not a wool/cotton blanket (the white layer you can see in the photo), but a second fleece. She explained that standard bedding was one cotton or wool blanket on top of baby and another wool OR a fleece blanket on top of that (wool were in shorter supply!) When he had been sick the night before, I remembered the nurse swapping the soiled wool blanket for a fleece. We swapped it for wool and within an hour they could flick the heater on his cot down again.

I then remembered visiting a mum recently who passed me her baby in the most amazingly soft sleeping bag, so much so I commented and discovered it was Merino wool. Again I thought little more of this until recent discussion regarding the use of synthetic fabrics next to baby at sleeptime.

Fleeces and sleeping bags are now very popular, but if they're synthetic can this impact on how warm/hot baby is at night?

I contacted Amie at Merino Kids - a company specialising in Merino Wool items for babies and children. We chatted about my SCBU experience and Amie explained why sleeping with synthetics can cause problems - baby gets hot, they sweat, the moisture can't escape and thus they end up cold (or in a cold sweat)

OK so it's actually a bit more complex than this and it turns out there are a whole host of reasons to pick Merino, but this page covers it fully:

I was also quite excited to learn Merino make their own sleeping sack range! "Standard weight" which covers 18-30 degrees and "Duvet weight" for temperatures 16-20 degrees. No other sheets or blankets required!

What's more I discovered that agresearch, New Zealand’s largest Crown Research Institute – an independent government-owned research and development organisation has explored this very area! Nifty!

"Product Comparison of Merino Wool and Polyester Baby Sleeping Sacks: Dr S R Collie, Dr A Tasker and M F Hnat."

You can read the full report here

Some quotes from the report:

"The Merino Kids sleep sack has moisture vapor absorption (MVA) that is approximately 80-times greater than the Halo"

"This intrinsic ‘breathability’ of the merino fiber, and hence the Merino Kids sleep sack, would better allow moist air to move away from the body’s micro-environment, preventing dampness and potentially chilling, while keeping the warm air around the body from escaping via convection."

"In the product comparison reported here, clear differences in thermophysiological comfortrelated performance have been identified between the merino wool Merino Kids and polyester Halo sleep sacks."

and

"The Merino Kids sleep sack had much higher moisture vapor absorption, approximately equal moisture vapor transmission and much lower air permeability, all of which indicate a much more sophisticated level of ‘breathability’ of the merino system, with it likely to be better at transferring moisture away from the baby while reducing convective heat loss and mitigating the chilling effect of drafts."

"These test results, coupled with the outcomes of previous research into sleeping comfort and the well-known low flammability and volatile absorption properties of wool indicate that merino is an ideal material from which to construct sleep sack bedding systems for infants."

It seems to me there is little point having natural flat sheets and top sheets, plus perhaps a blanket - if the item right next to baby is causing the problems discussed.

Instead why not use one natural item?

Merino kids have very kindly offered a gorgeous international award winning Go Go Bag™ for one lucky winner!!

Choose either Newborn to 2 years or 2-4 years - further details below:

To enter share any article from this blog somewhere online and then post a message letting me know where. Please only share somewhere you are a regular (ie please do not spam somewhere you don't normally visit) Each share will get you one entry - the more shares the more entries.

Winner will be drawn Wednesday 31st August and announced on this page and on Facebook. If the winner does not contact me within 16 days from date of draw, I will re-draw.

Why I'm concerned about Tizzie Hall's Breastfeeding Advice - PART 1

2011-08-09T19:38:00.005+01:00

I'm going to make this two part entry my last for a while on the subject of Tizzie Hall. I mentioned in my last blog post that I wanted to cover one particular section of her breastfeeding advice - an area which concerned me. However this post ended up so long I have split it in half so you can stand a chance of getting to the end ;)

Part 1 which is below, explores restricting breastfeeding frequency, some of Tizzie's ideas and why I think mums planning on following Tizzie's advice should be cautious...

In her book "Save Our Sleep", Tizzie firstly suggests that feeding "on demand" may be linked to obesity in later life.

"If your baby knows you will keep offering him a snack every couple of hours, he will never feel the need to have a full feed. Putting your baby on a routine gets him into the habit of filling right up when you offer the breast or bottle, because he soon learns it will be quite some time before you make the offer again."

and

"Teaching bad habits:
If you feed your baby every time he cries, you run the risk of teaching him that the answer to all his emotional ups and downs is to eat, irrespective of whether he is actually hungry. For example, if a baby is tired and crying because he doesn't know how to put himself to sleep, feeding teaches that he needs to eat in order to fall asleep. If a bored and crying baby is picked up and fed he starts to understand that if he is bored then eating will help.
My problem with this is that as your baby turns into a toddler, his whingeing will see you starting to replace bottles or breastfeeds with a piece of fruit or a biscuit which reinforces the regime of feeding him when he cries. Perhaps that is one of the reasons why we now see a lot of obesity in children and teenagers, and why others eat to solve emotional imbalance."

What doesn't get a mention in the "obesity ponderings" is that not breastfeeding has long been linked with increased risk. But that aside really just how healthy is "filling right up"? Don't recommendations now support responsive feeding regardless of how an infant is fed?

Breastmilk is digested within a couple of hours, so a baby eating every couple of hours isn't "snacking" - but eating normally. Little and often is actually exactly how humans are supposed to eat, it keeps blood sugars stable and promotes normal metabolism. Paul Mckenna's whole diet theory is based on adults learning to re-recognise when they are full, but at what point did they forget? Milk is all an infant gets, their tummies are much smaller than ours - yet I wonder how many people reading ensure no food or drink passes their lips unless three hours has passed?

Lynne Daniels, a professor of nutrition at Queensland University of Technology, Australia, and researcher with the Early Prevention of Obesity in CHildren (EPOCH) collaboration, has demonstrated routine fed infants were heavier at 14 months than those fed responsively.

The professor said:

"If the mother is responsive, she is responding to the child’s cues of hunger and not over-riding them. Whereas, if a mother feeds in schedule, she decides whether or not he is hungry."

Quite.

Tizzie goes on to say:

"I don't want to infer that demand feeding won't work for everyone. In the end, all parents have to do what it best for them and if you are one of the lucky ones that can interpret your baby's cries, that's great."

It's fascinating that someone calling themselves a "Babywhisperer" thinks babies need to cry to tell you they're hungry. Crying is the last cue of hunger - one that only comes out to play if all his earlier signs are ignored..

Secondly - Tizzie expects mothers to tell the difference between a "protest" (which she defines as the equivalent of a temper tantrum) and an "emotional" (has a need) cry, based on a description in her book - but then states mothers who can interpret cries are the lucky ones. Confused yet?

Thirdly it assumes breastfeeding is all about calories. It's not.

Truth is that the breast meets every need a newborn has except a dirty nappy - the skin to skin regulates their temperature and other vital stats, so baby doesn't need to expend energy doing so. Milk is a live substance and at night contains properties that induce sleep, whilst the act of feeding releases hormones to relax both mum and baby (strange if we aren't meant to feed our infants to sleep or during the night!). If baby is hungry or thirsty it nourishes, and it provides the ultimate security for a newborn who only has 25% of his brain fully developed at birth and who is working at a very primal level.

Furthermore breastfeeding is recognised as pain relieving, and in the early days has more antibodies than blood. If baby is feeling under the weather he often turns to the breast, and with good reason. The germ is passed to mum, she makes relevant antibodies and then passes them back to baby at subsequent feeds.

It is a baby's first "vaccination" and the most nutritionally complete food they will ever consume.

Let's look at Tizzie's list as to what she states prompts an "emotional cry" in her TV appearance with Kerry Ann::

Discomfort
Hunger
Tiredness
Wind
Thirsty
Hot or Cold

Yep - breast takes care of those. And want to know what else?

"It is now known that high levels of melatonin in breast-milk appear during the night and low levels during the day. Since melatonin is the hormone that regulates the sleep/wake cycle, these changes in breast-milk will doubtless be the signal to help the baby adapt as quickly as possible to the day/night versus sleep/wakefulness environment. (1-4)"

Yaha - so the breast even helps them start to regulate sleep cycles. Top that Tizzie ;-)

What did bemuse me a little is how simplistic Tizzie's list of needs that can cause an emotional cry is - what about scared, lonely, needing a cuddle? Tizzie claims in one of her TV interviews that she doesn't support "controlled crying" - the act of leaving a baby to cry but checking in with them every so many minutes. She states that if you return to an infant when they're "protesting", they will then start an "emotional cry", feeling rejected they've been left.

Yet walking in and out wouldn't cause any of the list above, which would seem to prove that babies cry an "emotional cry" for not only the six tangible reasons Tizzie claims, but also for reasons we can't label quite so neatly - rejection being one. Interestingly in her book she adds a seventh item to her list which is "bored" - we can accept an infant can be bored, but not scared? or that they might indeed use a cry with gaps to signal a great deal more than a "protest" or "temper tantrum".

The book describes a child falling asleep protest crying (this is from the section advising to leave a newborn to "protest" for a minimum of two minutes):

"If you are able to watch your baby without him seeing, you will see him shut his eyes and nod off before jumping and yelling again, as though he has realised he is falling asleep"

Why would any animal not want to sleep? Especially a tiny baby. Why would it be normal for them to half fall asleep, realise, panic and start "yelling" again?

All I do know is I don't observe any of this fighting, crying or jumping awake realising they're falling asleep when baby does so in a sling or next to mum. Perhaps because baby feel safe, isn't scared to sleep - ultimately is where he is supposed to be?

Tizzie talks about how many mothers nowadays don't have the community that passes down tips and knowledge - but if we follow that logic right back, Stone Age women used slings...

The psychology of how adults respond to cries is also very interesting, in studies adults responded similarly to different pitch and frequency of crying - different types of cry clearly evoke different feelings and I suspect this is for a reason; the more urgent the cry, the quicker the response (pretty important if there's a tiger near by and you're a baby on your own!) but does this therefore mean as Tizzie suggests that non intense crying, or crying with gaps should be ignored, particularly if they trigger an instinct in mum to respond?

Tizzie warns:

"it's not fair on baby to be taught that someone will respond to every protest because, as your baby grows up, other people won't like this behaviour."

What behaviour? a child who expects his feelings to be acknowledged? Yes perish the thought. I do hope Tizzie never has cause to visit Mongolia - because there babies are wrapped up like parcels and put to the breast everytime they squeak for the first six months. Imagine their behaviour! (not to mention of course they must all be obese).

Regardless, what Tizzie seems to fail to realise is that over the coming days and weeks as the mother learns her newborn and he develops - the relationship progresses so mum can understand his cries, and he soon develops lots of new ways to express himself too; which doesn't result in a comfort eating toddler! This would make no sense as the entire population would be obese prior to the introduction of scheduled feeding (which took off in Victorian times).

It also assumes toddlers "whinge", and that a mum would respond to this with food instead of communicating with her child, and that a toddler will eat a piece of fruit if not hungry - what are these assumptions based on? Clearly not cue fed infants as that results in a toddler who has retained the ability to regulate their own appetite (as long as starting solids hasn't been handled insensitively) which I guess will mean he also won't need to buy Paul's book when older....

Click Here To Read Part Two. which explores Tizzie's recommendation to also limit the duration of feeds.

RELATED POST: Suck a finger with Tizzie Hall...

References:

1. Illnerová H, Buresová M, Presl J. Melatonin rhythm in human milk. J Clin Endocrinol Metab 1993; 77: 838–841.

2. Cubero J, Valero V, Sánchez J et al. The circadian rhythm of tryptophan in breast milk affects the rhythms of 6-sulfatoxymelatonin and sleep in newborn. Neuro Endocrinol Lett 2005; 26: 657–661.

3. Cubero J, Narciso D, Aparicio S et al. Improved circadian sleep–wake cycle in infants fed a day/night dissociated formula milk. Neuro Endocrinol Lett 2006; 27: 373–380.

4. Aparicio S, Garau C, Esteban S et al. Chrononutrition: use of dissociated day/night infant milk formulas to improve the development of the wake–sleep rhythm. Effects of tryptophan. Nutr Neurosci 2007; 10: 137–143.

WBAW post - Are newborns helpless and struggling to communicate?

2011-08-05T19:16:00.000+01:00

or are we just failing to understand?

I've written this piece for www.studentmidwives.net for World Breastfeeding Awareness Week - the topic of which is communication.

I often hear it said that newborns are helpless. I also hear it said they need to “learn to feed”, or that feeding is a learning process for both parties – and at times the latter at least is true.

But it makes little sense that whilst every other mammal can feed without instruction – humans supposedly amongst the most advanced, are not born equipped with the skills for survival. That we need hours of “training” about how to hold our infants and attach them to the breast, in order to facilitate good milk transfer without pain.

We often hear that this is because breastfeeding is no longer held as the norm in modern western society, and that previously sisters, mothers, aunts and cousins would all have had handy tips and tricks to help along the way. Without doubt this of course impacts, but what if we’re missing something big along the way – what if it isn’t that an infant is utterly helpless, but that we have lost the skill of understanding?

When pregnancy and birth are “typical”, infants are born with every reflex and instinct they need to find the breast and feed – all without a whisper of positioning and attachment. We know that if we pop a healthy term infant on his mother’s chest and wait – and he will crawl to the breast, self attach and feed.

“Immediately after birth the child was dried and laid on the mother's chest. In the control group a regular behavioural sequence, previously not described in the literature, was observed. After 15 minutes of comparative inactivity, spontaneous sucking and rooting movements occurred, reaching maximal intensity at 45 minutes. The first hand-to-mouth movement was observed at a mean of 34± 2 minutes after birth and at 55+ minutes the infant spontaneously found the nipple and started to suckle.”

Widström et al, 1987 – first written observation of the breast crawl.

And that often is the key – to wait, but in modern society that often seems oh so hard to do! Babies are wiped, examined away from mum, weighed and dressed – each act killing a little more of those natural instincts. Even mothers who have their infants delivered onto their chest often only have a brief spell before they are whisked away for the above.

“Of 17 babies kept in the Breast Crawl position and kept in uninterrupted skin-to-skin contact for 1 hour, 16 attached to the breast correctly. Fifteen babies in the other group were separated after about 20 minutes for routine measuring and weighing procedures. After an interval of approximately 20 minutes, they were returned to the mother. Only seven babies in this group attached correctly (Table 4). These findings are crucial because the early suckling pattern is of prognostic value for the duration and success of breastfeeding)”

Righard and Alade, 1990

Continues HERE on www.studentimidwife.net

Suck a finger with Tizzie Hall?

2011-08-04T18:35:00.003+01:00

I've received a number of emails and Facebook comments following the blog entry examining Tizzie Hall's methods and SIDS, asking since breastfeeding is a topic I frequently cover - do I plan to address the inaccuracies in her breastfeeding information? So I looked at a few of the breastfeeding PDFs, I watched at a couple of clips of her on TV, and I thumbed through my copy of the book (second hand natch). The truth is even as a relatively prolific dedicated "mommy blogger", I'm simply not sure if it's a task even I can face! The job of tackling it all is mind boggling, the man hours it would take overwhelming - maybe I need some £300 per pop forums to fund the process? ;).

A quick ask around the grapevine and it seems there are already a number of people on with reviewing/addressing a lot of the issues, so I thought in the first instance I would write just two entries. This which I started writing prior to the SIDS piece, which I think highlights how fascinating it is that Tizzie feels qualified to give breastfeeding advice; and a second focusing just on one particular piece of advice that really worries me - I will link to any other relevant posts on the subject on Facebook (and Twitter if I remember!) and perhaps come back to this later in the year if others don't cover everything that raised my eyebrows (can you tone your face with lots of eyebrow lifts? if so I should have knocked 5 years off!).

So let's suck a finger with Tizzie!

Self styled "international baby expert" Tizzie Hall the "International Baby Whisperer," has decided that despite others training for numerous years to become lactation experts - a bit of self experience (two children is it?) and a good marketing team does her an expert make. As someone who has trained for the last seven years in this field (which is a great deal less than many!) who has analysed and dissected the last ten to twenty years worth of scientific studies and worked with hundreds of mothers in person, online and on helplines, I decided to investigate and see what I made of her advice.

The most obvious place to start was Tizzie's Facebook group - and almost immediately I found this message posted by Tizzie.

"If following my breastfeeding guide before you milk comes in you will slowly get your nipples used to the baby sucking on them which will stop you getting sore cracked, bleeding nipples or engorged breast, which can happen if a baby is feed too often and for long periods of time before the nipple is conditioned for breastfeeding. You can test this theory by picking one finger and sucking on it for 20 minutes every 2.5 hours in a 24 hour time frame for 5 days and pick the same finger on the other hand and follow the sucking times in my routines and compare the difference in the fingers."

No this wasn't a joke, yes she really was asking people to suck their finger for 20 mins, every 2 1/2 hours - both day and night for five days. Some agreed to start it and I would love to know how many completed the challenge!

I had to reply:

Hi - so many flaws in this theory without testing it out. I'm slightly concerned that when lacking understanding of the very basics such as this, you've produced a "breastfeeding guide". What qualifies you to do this please?
Firstly, babies don't suck nipples to obtain milk, they milk the breast.

Fingers are not made for regular sucking, they do not become erect when rubbed nor stretch and give as a nipple does. Fingers are not surrounded by sebaceous glands that secrete a waxy, lipoid fluid to lubricate, moisturise and protect the areola and the nipple - look at your nipple and your finger, do they look vaguely similar to you?

When feeding the infant's tongue grooves to support the nipple, fat pads stabilise and the nipple is drawn back to the point just before the hard and soft palate meet.

This is NOTHING like sucking a finger!!

IF a mum is experiencing sore/cracked nipples, her baby is not for whatever reason attaching and feeding effectively at the breast, we know this because when the baby has the nipple in the correct place - there is nothing to rub/cause friction or indeed damage the nipple. (see image above)

Engorged breasts are a separate issue to nipple trauma and occurs after milk has "come in" when mum has a supply too large or baby is not effectively draining the breast - which they wouldn't be if sucking on it like a finger!

IF a baby is wanting to suck constantly, for loooong periods and all the time - establishing WHY is essential, nipples no more need conditioning for breastfeeding than a penis does for intercourse or a mouth does for talking - it's their biological function.

Please if you have a problem and are experiencing engorgement, soreness or cracked nipples - understand this is NOT just something that happens when you start breastfeeding. Seek help from someone fully qualified to help - ensure they have the letters IBCLC after their name!

I should of course also have mentioned breastfeeding counsellors and so on, but generally that raises discussion from someone who thinks they've seen a breastfeeding counsellor, but have actually seen a peer counsellor (as this discusses) and it seems to easily end up messy, so I went for short n direct . What happened next is rather a shame as a mum who had experienced difficulties asked a question, I linked her to some free relevant information that could help her understand why she had struggled so much - and that plus following responses were immediately deleted.

Journal of Human Lactation

It genuinely baffles me when it comes to breastfeeding advice how so much evidence can just be dismissed in favour of opinion. If you are sick you see a doctor, if you have a psychological illness you might see a psychologist and so on - within those professions you will have great and not so great practitioners, but the qualifications identify a basic level of training. Furthermore few people would consider them qualified to start writing books on either of those subjects, particularly if they had no qualifications whatsoever and their ideas flew in the face of decades of science; even fewer I suspect would follow that advice if their own health was in question, particularly if their GP was pointing out all the flaws in the theory.

Yet infant feeding, which can be hugely important both for mothers who want to do it and from a health perspective, seems a free for all. Despite the fact that unlike many other areas of parenting it's not "opinion based", milk production and transfer is of sound scientific base (the formula companies have spent bucket loads in exploring breastfeeding and breastmilk in their attempts to mimic it - what has been learnt in just the past twenty years is staggering).

The problem is that as a new mum, many can't tell good advice from bad; because those who don't fully understand breastfeeding see certain people still succeed even following the advice; that reassures them it must be good and if it doesn't work for them put it down to "some people just can't breastfeed".

In reality the amount of people who really can't breastfeed biologically is tiny, in practise the amount of people who really can't breastfeed is huge - because for whatever reason nobody managed to identify their problem and resolve it. I have met mums who really couldn't breastfeed, but we have always worked as hard as possible to establish why (involving other health professionals and doctors as required). If there is a true physical explanation for what is happening, whilst a mother may feel grief at the loss of a desired nursing relationship - she can begin to understand and be supported through the rest.

Leaving mums who wanted to breastfeed with no answers, opens the door to them feeling bad when the subject of infant feeding comes up - that perhaps they should have put up with agony or constant feeding or crying baby for longer, or defensive because they know what they endured and that it really wasn't working! It hurts to read about risks of something they felt they had no other option but to do - and that sucks...Bigtime. The system that failed to support them soon forget the mum they didn't help - but the mum has that experience for life.

Sadly this creates a catch 22 situation - some experts sell the notion it doesn't really matter (appealing to the biggest chunk of their market in most cases) because otherwise they would risk making mothers feel guilty and thus their market and ultimately profits would fall. Instead they sell what they think mothers want to hear. And so the cycle of passive and frankly often "never going to work" support continues....

Telling a mum with cracked/damaged nipples that her baby is attached perfectly is akin to suggesting trainers that causes huge blisters fit brilliantly. The suggestion of finger sucking beyond bizarre.

Whether you follow Tizzie Hall as her biggest fan or not, if you have breastfeeding problems and want to succeed, please contact an expert.

What an attached parent is, and isn't.

2011-08-01T21:08:00.001+01:00

"Attached parenting" (AP) evokes images of hippies, lentils and mothers knitting their placentas whilst the toddlers run wild; no respect, routine or reliability and never sleeping until midnight. Babies constantly attached to their mother's breast in a ring sling whilst she steps over the cluttered house she will surely never have time to tidy.

Like most stereotypes, this is no more accurate than any other - so let's look at how AP is actually defined.

From Attached Parenting International (API)

"The essence of Attachment Parenting is about forming and nurturing strong connections between parents and their children. Attachment Parenting challenges us as parents to treat our children with kindness, respect and dignity, and to model in our interactions with them the way we'd like them to interact with others.

Attachment Parenting isn't new. In many ways, it is a return to the instinctual behaviors of our ancestors. In the last sixty years, the behaviors of attachment have been studied extensively by psychology and child development researchers, and more recently, by researchers studying the brain. This body of knowledge offers strong support for areas that are key to the optimal development of children, summarized below in API's Eight Principles of Parenting."

So - on to the 8 principles:

Prepare for Pregnancy, Birth, and Parenting - become emotionally and physically prepared for pregnancy and birth. Research available options for healthcare providers and birthing environments, and become informed about routine newborn care. Continuously educate yourself about developmental stages of childhood, setting realistic expectations and remaining flexible

Feed with Love and Respect - breastfeeding is the optimal way to satisfy an infant's nutritional and emotional needs. "Bottle Nursing" adapts breastfeeding behaviours to bottle-feeding to help initiate a secure attachment. Follow the feeding cues for both infants and children, encouraging them to eat when they are hungry and stop when they are full. Offer healthy food choices and model healthy eating behaviour.

Respond with Sensitivity - build the foundation of trust and empathy beginning in infancy. Tune in to what your child is communicating to you, then respond consistently and appropriately. Babies cannot be expected to self-soothe, they need calm, loving, empathetic parents to help them learn to regulate their emotions. Respond sensitively to a child who is hurting or expressing strong emotion, and share in their joy.

Use Nurturing Touch - touch meets a baby's needs for physical contact, affection, security, stimulation, and movement. Skin-to-skin contact is especially effective, such as during breastfeeding, bathing, or massage. Carrying or babywearing also meets this need while on the go. Hugs, snuggling, back rubs, massage, and physical play help meet this need in older children.

Ensure Safe Sleep, Physically and Emotionally - babies and children have needs at night just as they do during the day; from hunger, loneliness, and fear, to feeling too hot or too cold. They rely on parents to soothe them and help them regulate their intense emotions. Sleep training techniques can have detrimental physiological and psychological effects.

Provide Consistent and Loving Care - babies and young children have an intense need for the physical presence of a consistent, loving, responsive caregiver: ideally a parent. If it becomes necessary, choose an alternate caregiver who has formed a bond with the child and who cares for him in a way that strengthens the attachment relationship. Keep schedules flexible, and minimize stress and fear during short separations.

Practice Positive Discipline - positive discipline helps a child develop a conscience guided by his own internal discipline and compassion for others. Discipline that is empathetic, loving, and respectful strengthens the connection between parent and child. Rather than reacting to behavior, discover the needs leading to the behavior. Communicate and craft solutions together while keeping every one's dignity intact.

Strive for Balance in Personal and Family Life - it is easier to be emotionally responsive when you feel in balance. Create a support network, set realistic goals, put people before things, and don't be afraid to say "no". Recognize individual needs within the family and meet them to the greatest extent possible without compromising your physical and emotional health. Be creative, have fun with parenting, and take time to care for yourself.

I don't think the principles are really that out there? It doesn't mean you have no routine, never put your child to bed, carry them 24/7 and aren't "allowed" to put them down, nor do you have to breastfeed! It purely means you're up for taking a look at the evidence and responding sensitively to your infant.

Responding doesn't turn babies into spoilt brats who will control you ever more, on the contrary Penelope Leach, doctor of psychology has reviewed more than 150 scientific sources and believes the opposite is true. One study in particular examined outcome when three sets of parents looked after babies in different ways.

The first group fed their children on demand, carried them around with them, slept with them, and responded instantly to their crying. The second group was attentive but strove for the beginnings of some separation. And the third operated on the Fordesque “controlled crying” basis, only picking children up to be fed when the routine allowed.

“And at three months the distribution of crying was as you would predict,” says Leach. “The babies who were picked up most, cried less.”

So often the view of babies and children in our society seems so negative - they will attempt to control, manipulate, want to stay up all night if they possibly can (why the assumption they don't want to sleep rather than for some reason they can't?). Some propose ignoring the child's requests or cues enforcing a set routine - even though we know a one size approach doesn't fit all. To say we see ourselves amongst the smartest mammals - we seem to have almost Victorian view of babies that is so far set from a large body of scientific evidence it's baffling.

So back to the hippy earth mother that is apparently the "AP" - and a few images of some who practice AP: Angelina Jolie, Nell McAndrew & Miranda Kerr. Just a few who clearly have brains and beauty! And a thought - if the above 8 characteristics define an attached parent, is the opposite a detached parent?

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