But I couldn’t let this one pass:

http://news.bbc.co.uk/1/hi/health/10465473.stm

The study was reported as finding that:
“Women who plan home births recover more rapidly from childbirth, but there is a higher risk of their child dying”

As a woman who planned a homebirth (although X had other ideas) I researched this issue relentlessly. There is an article in the pipeline on this one…

But for now, I leave you with the NHS Choices analysis of the study that is being reported upon:

The findings are complex, and cannot simply be summed up as showing that hospital births are safer than home births. It is important to highlight that although it appears to show a greater risk of newborn deaths with home births, the absolute risk in either location is still very low (0.2% for planned home births and 0.09% for planned hospital births).
The researchers say that some of the higher mortality rate may be attributable to fewer instrumental or interventional deliveries with home deliveries. This theory cannot be proven or disproved by this research, but would need to be established by further study. Notably, although home births appeared favourable for certain maternal outcomes, the study was unable to shed any light on the risk of maternal death for either location.

And crucially:
It is also important to highlight that when the analysis only looked at homebirths that had been attended by a certified midwife, there was no difference in risk of neonatal mortality compared to hospital births.

So, for now I leave you, once again, with the sad fact that journalists often do not appear to actually read the papers they are reporting on.

X in a Close Parent sling

Before I get into this, you should know that far more knowledgeable people than I have written about baby carrying, so this will be a whistle-stop tour. Look at the further reading links at the end if you want more info.

Why do people “wear” their babies? Is it bad for the child? Bad for the parents’ back? Is it dangerous? Is it just a celebrity following silly fad?

Origins of babywearing

Let’s jump on that last comment first. Someone once told me they thought using slings was just “in fashion” at the moment because of so many celebrity Mums doing it, and these hippy-mamas would get over it soon enough.

Really? Humans have been carrying their babies with them since some early parent figured out they could make a sling with a leftover length of animal hide. This would have been around the time that the australopithecine was moving to being early Homo Erectus1,2. Some reckon it was one of the earliest inventions, alongside clothing – heaven knows it would have been a safe way for a mother to keep her child close to her, away from dangers, while gathering food and nursing the baby as she went. A baby’s survival was based on its mother being able to carry it long distances and around this time in history they lost that ability to cling on (not least because they were trying to cling on to a hairless, nearly vertical Mama), so a sling would have been a sure-fire hit in the Hominin Dragons Den. (Actually, to be more accurate, they were probably made of vegetal matter and were the first nonlithic tools that were invented3).

The pram was first invented in 1733 – a basket on wheels pulled by a goat or pony gave way to the “baby carriage” more familiar today (which was made popular by Queen Victoria buying 5 of them in 1840). What did we do before then?

Well, for a while the art of baby carrying while working seems to have been lost – at the beginning of the 18th Century, the baby was:
“…tightly swaddled onto a board. It’s head was wrapped in compressed,….pinned to a cap and further braced by a tight neck stay…While the half strangled baby hung from a nail, it’s minder could get on with other tasks.”4

(Or, in America and Sweden especially, hung on a tree – “Rockabye baby in the tree top…”).

Rembrandt's Beggars at The Door of a House. 1648

Some of Rembrandt’s pictures show babies tied to their mothers’ backs; evidence that baby carrying was taking place in Europe in the Middle Ages. In Wales and Scotland, pieces of fabric or shawls are rumoured to have been used to tie the baby to the mother5 (in case you’re interested, in Wales this was called a Siol Fagu)

Every country in the world seems to have had its own style of baby carrier:

• Mexican people use the Rebozo, a square of woven cloth tied over one shoulder with baby usually on the back.
• Guatemalans use a similar style sling called a Parraje.
• Peruvians have a Manta, which sits over both shoulders like a cape, and baby sits high on mother’s back.
• Aboriginal mothers used to keep their babies in carriers made of bark, similar to the cradleboards used by Native Americans but without the cloth covering.
• In North, Alaskan and Canadian people use a carrier called the Amauti which is a very thick arctic jacket, which has a baby ‘pocket’ in the back.
• A mother in Papua New Guinea will use a Bilum, a net bag secured at her forehead with her baby hanging behind her (they have very strong necks!).
• Indonesian mothers use a Selendang, which is a long ornate wrap.
• In other Asian countries, mothers use a variety of carriers including Mei-tai/Hmong/ Bei (China), Onbuhimo (Japan), Podaegi (Korea)
• Ethiopian mothers use a blanket with top straps, similar to the sling used in Japan.
• African mothers use a ‘Khanga’ which is a short-ish piece of cloth tied around the torso, so baby sits low on the back. Maori women carry their babies in a cloth inside their cloaks, or in a flax Pikau (backpack).
(This list is from Green Parent, see references6)

I have heard that, in England, coat pockets used to be adapted so a baby could be popped in them. However, in richer households, there were plenty of servants to carry babies around until carriages and prams were invented. In those countries which seldom wore slings from once prams became so popular, it seems babywearing had a revival in 1960s, with some now-familiar names starting up in the 1970s (Babybjorn, Didymos, and the modern ring sling invented by Rayner Gardner in the early eighties, see http://www.slingbabies.co.nz/Site/History_2.ashx).

I think I’ve made my point: clearly not a new fad then!!

Childcare books on Slings

Janey Lee Grace, author of Imperfectly Natural Baby and Toddler, is (as the title of her book may suggest) a big fan of slings: “I loved carrying my baby for long periods of time… I could breastfeed while on the phone, cook, work, walk around the supermarket and play with my toddler….It’s a fantastic bonding experience and I would absolutely recommend carrying your baby as much as you can”¹².

Contrast that with Gina Ford “I never use one as I find it too big a strain on my back… very small babies are also include to go straight to sleep the minute you hold them close to your chest, which defeats the whole purpose of my routines¹³”. She goes on to give advice on choosing a sling, including “It should offer the choice of baby facing in or outwards, and have a seat with an adjustable height position”. Later in this article I will discuss why many sling experts agree that you should not face your baby out in a sling. I am totally confused by the seat with an adjustable height position. No idea what kind of sling she has in mind.

An article on the Dr Spock website has this to say about slings:

The main drawback of slings is that using them is truly an art and a science and most parents need lessons, either from a sling distributor or a veteran parent, to make these carriers work correctly. Even then, it can take several weeks to figure out how to get the babies in and out of the slings gracefully (not to mention safely)¹⁴

Personally, it didn’t take me weeks to work out how to use my slings – not sure that I sling X gracefully, in fact I am not sure I do

A baby in a Calin Bleu wrap sling (Copyright Calin Bleu)

While it can be helpful to get the advice of a sling consultant or experienced parent, not everyone does, and many cope very well on their own. I reckon it took me two goes to be able to confidently wrap my baby in a sling.

They go on to say:

Additionally, bearing the weight of baby all on one shoulder can get uncomfortable for some parents, especially as their baby gets bigger. (Unlike front packs and backpacks, slings have no hip belts to distribute your baby’s weight, although switching the shoulder on which you wear the sling frequently can help alleviate muscle strain.)¹⁴

Clearly, they are taking about a ring sling. I have never used one, but I am reliably informed that, when used properly, they do not cause shoulder pain. Other slings, such as a Mei Tai, wrap, or semi-structured carrier (i.e. a Connecta or Ergo) do not rely on one shoulder and wrap around the waist in some way. There is some evidence that putting your baby in an ergonomically designed sling from newborn can help strengthen the muscles in the back, helping with general back pain¹⁷. That said, the Dr Spock team clearly note the benefits of babywearing.

Many baby care experts do recommend slings. Miriam Stoppard puts it simply “I won’t hear a bad word said about carrying your baby around in a sling.” ¹⁵

Dangerous Slings?

The U.S. Consumer Product Safety Commission (CPSC) in the U.S. have now withdrawn two slings on the grounds of safety. Let’s start with the Infantino SlingRider. This was a sort of bag sling – three babies have died in America with these slings. These particular pouch slings are like

The CSPC's guide to safe sling wearing. From http://www.cpsc.gov

handbags, the baby lies inside on their back. Many sling wearers have considered these types of slings dangerous for a considerable time – the baby’s chin can end up pressed against their chest, restricting their airway. The fabric can also cover the baby’s nose and mouth. The baby is also liable to turn toward the parent, pressing their face against them and again, stopping them breathing. One of the important problems is that it is difficult to see the baby once they are in the sling, so they cannot be checked easily.

The CPSC appeared to be relatively measured about the risks of slings “There are safe ways to use slings,” sais Patty Davis of the CSPC. “They’ve been used safely for centuries”. Others, reporting on the story, were not “Don’t use slings at all,” Mays [of Consumerreports.org] recommended, “There are safer ways of carrying your baby than in a sling.” Really? Like how? In my arms? What if I fall? At least with a sling you can put your arms out to protect you and your child without dropping said offspring.

So, all the CPSC withdrawing this sling seemed reasonably sensible – these handbag-style slings were known to potentially cause problems. But then, on 2nd June 2010, the CPSC7 launched this headline: “Infant Death Prompts Recall of Ring Slings Made by Sprout Stuff Due to Suffocation Risk”. A ring sling? In 2007 a 10 day old baby died in Texas in this sling. At the moment it is not clear what happened, or why this particular ring sling has been singled out – millions of women around the world safely use this style of carrier.

So, could slings be dangerous? Well, everything is dangerous if not used properly. The Consumer Product Safety Commission reports that, in the three-year period from 2002 to 2004, 16 infants died in car seat carriers (outside the context of motor vehicle accidents), nine infants died in strollers and carriages, 97 died as a result of mattresses and cribs, 28 in bassinets and cradles, and 27 in playpens and play yards8. A child has died in one of every 2,000 Playskool Travel-lite portable cribs sold9. There have been 14 deaths when the baby has been in a sling in the last 20 years.

There is a good checklist here on how to carry your baby safely in a sling.

Not all Slings are created Equally – the importance of Frog Legs

I cannot write an article like this without a quick mention of why some slings are better for your baby and you than others.

When a baby is in a sling with their tummy towards you, it is crucial that their legs are drawn up into a “frog-leg” position. Their bottom should be below their knees. This gives a nice wide him spread. If the legs dangle, all the weight of the baby is going through his/her perineum (and, sometimes for boys, through their testicles), placing a lot of pressure through the spine. Worst case scenario, if the baby’s spine is enduring this undue pressure it can adversely affect the development of the spinal curves and hips. Some popular semi-structured carriers let the baby’s legs dangle in this way, and are best avoided.

Similarly, if the baby is placed in a carrier facing outwards, their legs will dangle in this way – even if they are in a stretchy wrap. Be wary of doing this for the reasons above. Also, when the baby is facing you, or on your back, when the world starts to get overwhelming they can turn to your chest or back and switch off quickly. If they are facing outwards they can’t do this, and some experts believe this unnecessarily overloads them with sensory experiences they cannot easily escape from. Finally, facing out means the baby is not pressed close to you and, worse, their spine isn’t naturally in a slightly curved position and the ball of their hips can come out of the sockets, which (needless to say) is not good for them.

A sling or carrier should hug the baby to you and place him/her high on your body without changing your centre of gravity (do the kiss test – you should be able to kiss the top of their head, if you can’t they’re too low) – if you have back pain when wearing your baby one reason could be that the baby is hanging “off” you, rather than being pushed onto you. Hanging from you, the whole weight of the baby is on your back and shoulders, which will cause pain before too long. Carried properly, you can “wear” your baby until they are a toddler (or older!) – X is now 9 months and weighs over 21lbs, when I have him correctly positioned in a sling I can barely feel his weight. I know there is a sling out there which would mean he feels weightless – yes, they can be that good (but with a price tag to match!)

What’s so good about slings anyway?

“9 months in the womb, 9 months out” – there is a theory that all babies are born “prematurely”; in order for huge brains to be at a state small enough pass through the mother’s pelvis we have to be born earlier than any other mammal on the planet. Some people believe that we should consider the first 9 months, at least, of life as being an ongoing gestation (at 9 months most babies are at least beginning to be mobile, so can start to fend for themselves at about the level of most newborn mammals).

Babies want to be close to us, and “wearing” your baby enables you to pick up on his cues and moods, he will feel safe and secure – hearing the familiar sound of your heart beat.

Research has found the following benefits of baby wearing:
• Babies who are carried in slings cry less
• Carrying your baby can help ease colic
• The position the baby is in when in a sling (with a nice curved spine and froggy legs) aids their physical development.
• You can get on with life! Hands-free parenting: it’s so much easier to do chores, go shopping etc when you put the baby in a sling.
• You can breastfeed discreetly in a sling, on the move too! I have never done this – seems to be to be advanced sling wearing as well as advanced breastfeeding, and I am no expert in either!
• Amazingly, your periods are likely to come back much later if you wear your baby (assuming you are breastfeeding)! Something to do with the extra hormones produced when you carry your baby close to you.
• Other fascinating facts include your boobs regulating your baby’s temperature! Yes, not just baby feeding machines (and, a lifetime ago, something of a thrill for your other half), your knockers are also central heating systems for baby carrying. This is especially good for premature babies, who also benefit from having their parent’s breathing close by to regulate their own – hence “Kangaroo Care” being a recommended approach for preemies11.

For more advantages and references, including faster maturation of vision and internal ear, see www.babywearingadvice.co.uk/benefits.htm

Conclusions

We have used our pram, twice now. Personally, I don’t like it – X was already almost 9 months before we used it and both of us were so used to him being in a sling I think it just felt odd to us. So, I am a firm convert of baby wearing. I know it is not for everyone, but I do find it hard to see the downside! I’m not doing a very good job of being objective on this article, am I? That said, I must admit that it is handy to have a friend with a pram who will let me pop extra bags etc in her basket – just as many husbands and boyfriends avail themselves of their partner’s handbag from time to time. But I cope, and the ease and convenience of being hands free makes up for the usefulness of somewhere to store my shopping when I have bought too much!

Personally, I find using a sling to be simple, safe, comfortable, easy, and allows me to cuddle my baby for long periods of time – what’s not to like?

As with any other piece of baby equipment, it is only safe if used properly. And there are hundreds of types of slings on the market, which is why I would suggest going to a store that sells a variety of slings and trying lots of them on with your baby (although these stores are like hens teeth!) or going to a “Sling Consultant” who can help you try on different ones. Both of these options ensure you are wearing your sling properly as well. Alternatively, you can hire slings to try from stores online, and there are millions of youtube videos to help you with the carrying positions.

Be sensible, be safe, and wearing your baby could be one of the best things you ever did.

Many thanks to Sophie Messager, sling consultant, for all her baby wearing advice and for proof reading this article!

Further Reading/Watching

History: http://awareparenting.blogspot.com/2006/12/baby-carriers-cultural-history.html

How to wear a Welsh Nursing Shawl! http://www.youtube.com/watch?v=58APC1nA-Hk (at 3mins 50)

Sling safety: http://babyslingsafety.blogspot.com/

Correct positions for babies in slings: http://www.slingbabies.co.nz/Site/Positioning_2.ashx

Reviews of lots of slings: http://springonmars.wordpress.com/2010/05/25/i-dont-have-a-problem-well-maybe-a-storage-problem/

No pram? No problem! http://www.mamanatura.co.uk/articles.htm?article=4

Types of slings you can buy: http://www.slingguide.co.uk/types/types.php

Slingmeet – kind of like AA for babywearers! Seriously, though, a very useful resource if you want to meet up and talk slings, need advice, want to try a sling etc: http://www.slingmeet.co.uk/

References

1. Ehrenberg, M. R. (1989). Women in prehistory. Norman: University of Oklahoma Press.
2. Parker, S. T. (2000). Homo erectus infancy and childhood: The turning point in the evolution of behavioral development in hominids. In S. T. Parker, J. Langer & M. L. McKinney (Eds.), Biology, brains, and behavior: The evolution of human development (pp. 279- 318). Santa Fe, NM: School of American Research Press.
3. Zihlman, A. L. (1981). Women as shapers of the human adaptation. In F. Dahlberg (Ed.), Woman the gatherer (pp. 75-120). New Haven: Yale University Press.
4. In Goodwin, D. 2007. Bringing Up Baby. UK: Hodder & Stoughton.
5. Rose, M.B. 2006. http://awareparenting.blogspot.com/2006/12/baby-carriers-cultural-history.html
6. Corkhill, M. 2010. Wear Your Baby. Green Parent. http://www.thegreenparent.co.uk/articles/read/wear-your-baby/
7. http://www.cpsc.gov/cpscpub/prerel/prhtml10/10254.html
8. CPSC, 2008. Nursery Product-Related Injuries and Deaths Among Children Under Five. http://www.cpsc.gov/LIBRARY/nursery06.pdf
9. http://www.safetyforum.com/childsafety/
10. Cassis, R. 1990 Infant Carriers and Spinal Stress. http://www.continuum-concept.org/reading/spinalStress.html
11. Feldman, R., Eidelman, A.I., Sirota,L & Weller, A. 2002. Comparison of Skin-to-Skin (Kangaroo) and Traditional Care: Parenting Outcomes and Preterm Infant Development Pediatrics Vol. 110:1 pp. 16-26
12. Grace, J.L. 2007. Imperfectly Natural Baby and Toddler. UK: Orion Books
13. Ford, G. 1999. The New Contented Baby Book. UK: Vermillion
14. Davis, S.E. http://www.drspock.com/article/0,1510,5395,00.html
15. Stoppard, M. 2010 http://blogs.mirror.co.uk/dear-miriam/2010/04/rest-easy-baby-slings-are-the.html
16. Davis, S.E. http://www.drspock.com/article/0,1510,5395,00.html
17. http://www.slingguide.co.uk/questions.php#001

“Crying it out”

Surprisingly few childcare experts actually advocate the “crying it out” (CIO) technique. Even Ferber1, with whose name CIO is often synonymous (it is sometimes called “Ferberising”) never used the term. “Extinction training” is the closest thing to CIO, where parents are instructed not to check on their children unless absolutely necessary. Most authors who suggest a “Ferber” type technique do allow for parental checking and sometimes a soothing pat or similar.

Ferber and others2 believe that crying, for some children, is an inevitable part of learning to sleep independently. Ferber suggested only letting your baby cry for 5 minutes before comforting him/her the first time, extending this to 15 minutes the second night and up to 25 minutes after several nights of trying his methods – usually with children from 5 months. So, basically a “timed soothing” approach which would teach your child to “self-soothe”.

Dr Spock suggests a similar, if a little harsher, routine:
“The baby has to learn that there is nothing to be gained by waking and crying. This can usually be accomplished in two or three nights by letting her cry and not going to her at all. She is apt to cry for 20 or 30 minutes the first night (it may seem like much longer), 10 minutes the second night, not at all the third.”
Now, that’s more like CIO.

Ferber himself acknowledges that his approach does not “teach” a child to sleep. It simply denies them access to their parents’ soothing, so they work it out for themselves. And studies do suggest that children whose parents have used these techniques do throw less “bedtime tantrums”, sleep for longer periods of time, and settle more quickly. But why do they? One school of thought believes that babies stop crying eventually, not because they have learnt how to cope, but because they have simply “given up” and are in a state of either exhaustion or despair.

William Sears3 reckons that any method of getting your baby to sleep that involves leaving them to cry “desensitises” the mother (and father) to the baby’s needs and can mess with the attachment of baby to parent. Let’s face it, babies only have one way to communicate and it is instinctive to pick them up and comfort them when they do.

You are tired, Baby, GO TO SLEEP!

So, is any CIO or timed-soothing method going against parenting instincts? Not necessarily, I know many parents who, at the end of their tether would not immediately go to their baby when they cry for the tenth time in the night, book or no book. And, in fact, there are times when perhaps you shouldn’t go back to your screaming baby – hours after you started trying to get him/her to sleep, the end of your tether reached so long ago it is but a distant memory, and all you want to do is shake, fling, shout at this recalcitrant child who must know they are tired and need to sleep. Then, perhaps we are all best leaving the room and letting the baby cry alone. But are we still harming the baby doing this?

Evidence of the “dangers” of leaving a baby to cry

So, does it actually cause harm? Well, Gina Ford categorically states “I would like to reassure you that, providing your baby has been well fed, and that you have followed the routines … your baby will not suffer psychological damage” (pg 98). This may be true, but, while I have not found any research specifically investigating deliberately letting a child cry in an otherwise loving and nurturing household, and is no evidence of harm the same as evidence of no harm?

Studies4 have shown that crying raises Cortisol levels in babies. Concerns have been raised over the potential long-term neurological consequences of this, especially if it occurs on a regular basis. However, some experts have dismissed these worries – higher Cortisol may not be bad for a baby. In fact, research suggests that babies who are breastfed have higher Cortisol than formula-fed babies5, which may be related to the analgesic properties of breast milk – and no-one reckons breastfed babies are at risk because of this. In fact, some claim that higher levels of Cortisol in infancy is related to better performance in a number of areas including memory and executive functioning6,7.

I am a huge fan of William Sears, but was deeply disappointed in his article on the dangers of leaving a baby to cry. On the face of it, it appears quite frightening – leaving a baby to cry causes hormonal imbalances in the brain, decreased emotional, social and intellectual development, and physiological changes including heart arrhythmias. However, a quick check through the references casts doubt on how some of these findings can be applied to children of loving families whose parents try a CIO approach: several papers about prolonged crying and later development are actually referring to children who cry excessively in infancy – not because they were left to do so. Other papers are about children growing in violent society, or abusive homes, or being separated from their parents. Further papers are about primates and rat pups being separated from their mothers. Some of these take too much of a leap for me to be happy applying their findings to using a CIO technique in an otherwise happy, stable home.

There is, however, firmer evidence that, along with the raised cortisol levels, babies left to cry have raised blood pressure, elevated heart rate, and reduced blood oxygen levels 10, 11. Sutherland18, who carried out a four year study of children’s brains using scans, concluded that leaving a child to cry “can cause serious damage to their brains on a level that can result in severe neurosis and emotional disorders later in life” and that the “blunt truth is that uncomforted distress may cause damage to the child’s developing brain”. So, contrary to Ford’s categorical assertion, there is some genuine concern that leaving a baby uncomforted could cause damage. And this is an area that has not been widely and well studied yet.

Some people also worry that sometimes babies are crying for other reasons rather than “just because they want attention”, and to ignore these cries could mean leaving your child in pain – teething, tummy ache…. I heard a story recently of an older gentleman who, many years ago, had left his baby to cry until he eventually gave up and found the baby had got their head stuck in the bars of their cot. Parenting is full of enough guilt – perhaps adding more like that is unnecessary. (He never told his wife).

One of my major concerns is around attachment. At around 6 months of age babies often start to experience anxiety around being separated

Cuddles - great for attachment

from their parents. It is often around this age that sleep problems start, and around the same age that CIO-type methods are recommended to be used. At this age babies need to learn that when their parents leave the room they will return and that they are safe. What we want is for our child to develop a “secure attachment” – be a bit upset if Mum or Dad leaves them, but settle down after a while and are happy when parents return, prefer parents above strangers, and go to parents if hurt – this type of attachment is best created when a parent responds to the child’s distress promptly, consistently, and appropriately.

Why do we think children should sleep better?

In most non-western cultures, babies are not expected to sleep independently and through the night. Research has shown that when parents do not expect their child to do these things, they report less sleep problems than parents who think their child should self-soothe to sleep and sleep without parental intervention.

Some feel that leaving a baby to cry violates our most basic parenting instincts. Back in the day we slept communally and shared parenting “watches” through the night to tend to waking babies13. So a baby that cried out was instantly soothed by a parent or parent figure. This makes sense – someone to watch out for dangers in the dark – and a baby uncontrollably crying would attract predators so would need shutting up as quickly as possible. In fact, our ancestors probably didn’t have one long period of sleep, but would sleep for a few hours, wake up for an hour or so, snooze again – so even the adults didn’t “sleep through”! OK, this is all a bit of a reach, perhaps, but it’s worth remembering that the way our children behave at night is totally normal and what we are trying to do is make them fit into our modern lifestyles. Knowing this may not change what you do, but it is worth bearing in mind when someone is telling you what they think you should do about your sleepless baby.

Other approaches

Gina Ford, in The Contented Little Baby Book, advocates settling babies with a cuddle but no eye contact or talking as “it could send confusing signals” and putting the baby down when they are still awake but about to fall asleep. She recommends leaving a baby to cry for a short time before he or she falls asleep: “Because I know they are well fed, burped, and ready to sleep, I am very strict. I would let them fuss and yell for 10-20 minutes until they have settled themselves..” (pg 98). She clearly states she does not advocate a genuine CIO approach.
Despite my previous quote, Spock was not all hard-hearted. He did suggest that parents of babies who cry because they are anxious about theparent leaving could try gradually moving away from the baby, talking and stroking one night, just stroking the next etc (Extinction with Parental Presence – I’ll look at that in a sec). He, however, goes on to say: “If the baby simply won’t go back to sleep this way, or if the waking continues for weeks, you can use the less tenderhearted method.” Hmm, to be tenderhearted towards your baby or not? Tough call.

Tracy Hogg, author of the Baby Whisperer Solves All Your Problems (oh, if only that were true!), suggests using the “Shush-Pat” method. This

approach accepts that a baby may need physical intervention to help them sleep – so you whisper “shh shh shh” into the baby’s ear – not directly, as you are meant to be doing this with the strength of a “faucet on full force” and you don’t want to perforate an eardrum – while patting them. She reckons this works on babies under three months. Hogg believes that parents who rock, feed, bounce or walk their babies to sleep are giving them a prop, and this will come back to haunt the parents in the end.

Nursing a baby to sleep - a rod for your own back?

Personal interjection here – as you readers (if, in fact, anyone is reading this) will know, I firmly believe that you should do what works for you – and if it ain’t broke don’t fix it. I am pretty sure that, if you rock your baby to sleep, you won’t be doing this forever – how many 13 year olds do you know that need rocking to sleep? Hogg, however, does believe that leaving a baby to cry it out will destroy the trust they have in you.

After three months, Hogg recommends the “Pick Up, Put Down” method (PU/PD). Basically, you go to your child’s room when he or she cries. Try and comfort with words and a gentle hand on the back, or the “shush pat” (if they are up to 6 months old). If this doesn’t work you pick the baby up, and then the second the crying stops, you put him/her down (for us that would be a recipe for the crying to start again). Apparently, this usually takes 20 minutes, but can take up to an hour (as Tracey says (and there are so many things wrong in my opinion with this statement …. “if it takes 150 times, surely you’re prepared to do that in order to teach your baby to sleep and to get your own time back, aren’t you, luv?”). The difficulties with this, and any “sleep trainer” approach, is that they are based on a “one size fits all” theory.

It is worth remembering that we’ve always had one size fits all approaches, and, as generations go by they are discarded in favour of “better” approaches. And sometimes they come back. Should this tell us something? Like diets – if one diet worked for everyone there wouldn’t be a diet industry worth billions of pounds – so true with baby sleep training.

The American Academy of Sleep Medicine suggests that CIO, and similar approaches such as those above, do not have the best evidence base. The approach with the strongest empirical support is Extinction with Parental Presence5. This method does not involve leaving children alone, you put them down awake but snuggle them to sleep, gradually moving away each night, paying less and less attention to the baby who is drifting to sleep. Eventually the parent leaves the room, but returns before the baby cries, so he/she associates their parent leaving with their eventual return. The baby also learns self-soothing techniques with a parent present until he or she is ready to be left to soothe themselves alone.

Conclusions

Leaving your baby to cry on a regular basis is stressful for everyone involved. With little developing brains this could cause long-term damage, but the research base is kind of weak. Sometimes it may be the safer thing to do, and done on a few occasions – like when you’ve been trying to get him/her to sleep for hours and are about to burst a blood vessel, or you  desperately need to use the toilet  - doesn’t seem likely to cause any harm (especially if the alternative is you hurting the baby or wetting your pants).

When thinking about whether or not to use a CIO approach or something similar, I remind myself of what Kittie Franz wrote17: “Remember, you are not managing an inconvenience, you are raising a human being”. She cautions parents to consider, when looking at conflicting advice, consider whether you would put it in a “Good for the baby” basket or a “Good for the parent” basket – “Don’t talk yourself out of it by believing that some advice you read must be good because it was in a book, or the person giving the advice has five kids, or was a nurse.”

Yes, it is inconvenient to have to keep going up to my baby and rocking or nursing him to sleep, but that’s OK. Personally, I can cope with that

Sleeping like a baby - yeah, right

better than I’d be able to cope with him crying. But that is my choice – this is how X and my husband and I are happy to muddle along. It won’t work for everyone, because not all families are the same.

I would be very wary of following the advice of someone (who has never met you and your family) regarding what to do when your baby cries, especially if they are telling you to do something that goes against your instincts.

Further Reading

www.phdinparenting.com/2008/07/05/no-cry-it-out/
www.aaimhi.org/documents/position%20papers/controlled_crying.pdf
www.parentingscience.com/sleep-tips.html

References

1. Ferber, R. Solve your child’s sleep problems
2. Marc Weissbluth Healthy Sleep Habits, Happy Child
3. Levesque BM, Pollack P, Griffin BE and Nielsen HC. 2000. Pulse oximetry: What’s normal in the newborn nursery? Pediatric pulmonology 30(5): 406-412.
4. Luddington-Hoe SM, Cong X, and Hashemi F. 2002. Infant crying: nature, physiologic consequences, and select interventions. Neonatal Network 21(2): 29-36.
5. Skuladottir A and Thome M. 2003. Changes in infant sleep problems after a family-centered intervention. Pediatric Nursing 29(5):375-8
6. Cao, Y et al. 2009. Are breast-fed infants more resilient? Feeding method and cortisol in infants. J Pediatr. 154(3):452-4.
7. Haley, DW et al 2006. Cortisol, contingency learning, and memory in preterm and full-term infants. Psychoneuroendocrinology. 1(1):108-17.
8. Blair, C. Et al 2005. Cortisol reactivity is positively related to executive function in preschool children attending head start. Child Dev. 2005 May-Jun;76(3):554-67.
9. Sears http://askdrsears.com/html/10/handout2.asp
10. Levesque BM, Pollack P, Griffin BE and Nielsen HC. 2000. Pulse oximetry: What’s normal in the newborn nursery? Pediatric pulmonology 30(5): 406-412.
11. Luddington-Hoe SM, Cong X, and Hashemi F. 2002. Infant crying: nature, physiologic consequences, and select interventions. Neonatal Network 21(2): 29-36.
12. Ford, G. The Contented Little Baby Book.
13. Ekirch AR. 2005. At Day’s Close: Night in Times Past. New York: WW Norton.
14. Hogg, T The Baby Whisperer Solves All Your Problems.
15. C.M. Worthman and M. Melby. 2002. Toward a comparative developmental ecology of human sleep. In: Adolescent Sleep Patterns: Biological, Social, and Psychological Influences. M.A. Carskadon, ed. New York: Cambridge University Press, pp. 69-117.
16. Spock, B. http://www.drspock.com/article/0,1510,3975,00.html
17. Franz, K. 2005. Doesn’t the breast work anymore? Mothering Sept/Oct:132.
18. http://observer.guardian.co.uk/uk_news/story/0,6903,1345420,00.html

Baby DVDs fail to boost word power: ‘Einstein’ show could do more harm than good¹
They went on to state that toddlers watching these DVDs had worse vocabularies than those who didn’t watch them.

Is watching TV good or bad for baby?

Other headlines have added to parents’ fears that television could be bad for baby:

TV Linked to Attention Deficit
Want a smart baby? TV’s not going to help
Does watching TV cause Autism?

By the way, on that last headline (from Time in October 2006) I can assure you here and now that, no, it doesn’t.

So, is TV bad for your baby?

The Evidence – making your baby a genius

The “Baby Einstein” DVDs are part of a larger group of DVDs aimed at children. Baby Mozart came with the following press release:

“Parents should think of Baby Mozart as a gentle introduction for children to the music of Mozart. … that will stimulate a baby’s brain with musical and visual experiences. And based on the research data about an increase in spatial intelligence and physical well-being, parents who purchase the video for their babies can feel confident that their children are receiving a good head start“²

Sounds good and evidence based, doesn’t it? So where is this research?

Well, in 1993 a group of researchers found that listening to Mozart helped increase spatial awareness³ (The Mozart Effect). This was jumped on by parents – especially as other evidence suggested that Romanian orphans, previously neglected and backward, could catch up with their peers if they were placed in foster care before 2 years old – after two years their cognitive skills remained damaged³. Thus came the conclusion – we can hothouse our children….with Mozart!

However, the Mozart Effect has also been found to be a “Stephen King effect” (another study has found the same benefits after listening to a passage of a Stephen King novel⁴). The original study had its flaws – the study was conducted using only 36 participants, all undergraduates. Also the Mozart Effect only applied to an improvement in one spatial awareness task, only if listening to nothing but the music, and then the results are only temporarily (10-15 minutes). Interesting, but no great shakes, really. Finally, and very importantly for this particular subject – the research HAS NEVER BEEN CONDUCTED ON BABIES. The youngest age group has been 11 years old (and then it didn’t work)⁵.

Despite this, this is what the Baby Mozart press release said about the research:
“The data demonstrated an unmistakable link between music and increased spatial intelligence. Spatial intelligence and reasoning are crucial for higher brain functions such as complex mathematics and science, as well as the ability to play chess and solve puzzles. The finding showed that music lessons, or even simply listening to music — particularly music composed by Mozart — increased the students’ spatial reasoning performance on intelligence tests”²

A study specifically examined whether Baby Wordsworth (part of the Baby Einstein range) could improve a child’s vocabulary, as it purported to do. The children (between 12 and 15 months) who watched the DVD had no increased growth on either expressive or receptive language when compared to children in the control group, even after multiple exposures. The most significant predictor of vocabulary comprehension and production scores was the amount of time children were read to⁶.

The evidence that DVDs can help create baby geniuses is flawed

OK, so there is no evidence it can help – but can TV harm your baby?

The Evidence – TV as harmful

Research suggests that, by 3 months of age, 40% of babies regularly watch TV, DVDs or videos – at an average of 1 hour a day. This increases to 90% by 24 months, with children this age watching an average of 1.5 hours a day. Parents use TV for entertainment, babysitting, but also to help educate their children⁷.

A fascinating claim was made by some economists in 2006, who studied data from 1972 to 1989 and came up with the theory that an increase in the diagnoses of Autism are inextricably linked to an increase in television watching. They were so sure of this link that they claimed that their findings were “consistent with early childhood television viewing being an important trigger for autism”⁸. There are so many holes in this thesis it is hard to know where to start. Firstly, they did not actually measure television watching – just the growth of cable and precipitation (yes, precipitation, on the theory that where it rains more, children watch more TV). Secondly, yes, rates of Autism have been increasing. There are many possible reasons for this, including better detection and broadening of the definition⁹. To find one piece of technology and link the apparent rise with that is somewhat odd – why television? Why not something else that we use more of now than we did in the 1970s? Computers, mobile phones, energy-saving light bulbs?

What about Attention Deficit Hyperactive Disorder (ADHD)? Research has been carried out that links early television viewing to attention difficulties in childhood. The theory behind this is that television can be overstimulating yet very interesting, which leads to children developing short attention spans. One study¹⁰ found a clear link between the hours of television watched between the ages of 1 and 3 and attention problems at 7 years. It is important to note some problems with this study – attention problems are not the same as ADHD. It was not clinically diagnosed among participants in this study. Also, the hours of television watching were estimated by their parents – not necessarily a very reliable measure and what programmes they were watching was not noted. There was no measure as to whether the parents had ADHD or something similar and there was no measure of what quality the interactions were between parents and children – whether they watched TV together, or whether they read to or played with their children regularly, or just put them in front of the TV. Finally, it is not possible to assume which way the relationship went – did the children watch more TV because they have attention problems, or have attention problems because they watched TV?

Other studies into television viewing and ADHD have focussed on school age children, and many of the problems mentioned above still apply – in fact more so in children where ADHD is likely to be established (these children may watch TV because they have ADHD rather than vice versa).

Those who are adamantly against TV for children often cite a study which found adverse effects on children who watched TV before 3 years⁷. The negative effects were found on two tests of reading and one of memory. A similar study found that children with frequent television viewing have delayed development of speech, even with parental talking during television watching11.

These studies, however, have been reliably disproved by other research¹³, which found that, after taking into account a vast array of possible factors (maternal age, income, education, breastfeeding duration, average daily sleep duration to name but a few) each additional hour of television viewing was not associated with negative effects on language or visual motor skills at 3 years of age. This study was longitudinal, so the parents were asked about their children’s TV habits when they were actually 6 months, then 1 year, then 2 years, rather than being asked about what they recalled 3 years later, which is much more reliable as a way of collecting data. It is worth remembering though, while no negative effects were found, no positive ones were found either.

There may be problems with regular sleep schedules for babies and toddlers who watch TV¹⁴. But there is no proof which way this relationship goes – they may have more regular sleep because they watch lots of TV, or they may watch more TV than their peers who sleep more regularly because they are not napping so often. That said it would not be a huge surprise if babies and toddlers who watch lots of TV find it hard to have good, regular sleep. It certainly seems like a good idea to keep TV out of bedrooms due to the risk of it interfering with sleep.

The American Academy of Pediatricians recommend no television viewing for children below the age of two and no more than one to two hours per day for older children¹⁵. The reasoning behind this is that young children are very susceptible to the messages they see on TV, and very young children have trouble separating reality from what they see on TV. Couple this with the violence, aggressive behaviour, drug, alcohol use and smoking, and advertising aimed at children and it is not surprising they recommend keeping children away from it.

However, controlled television watching may give more benefits than negative possibilities – television can model good behaviour, sharing, co-operation. It can lead to conversations and debates which may not usually come up in daily life. Finally, some programmes include aspects to keep toddlers active – jumping up and down and doing yoga positions – so it is not necessary for programmes to encourage a sedentary lifestyle.

Conclusions

Television won’t help your baby become a genius, but it can be educational and it can be fun. It can encourage toddlers to move about and can teach them, and can lead to conversations within the family that may not otherwise have occurred. TV can also give parents a well deserved rest.

Some TV can be harmful due to the content – aggression, drug and alcohol use, etc, and a great deal of marketing is aimed at young children. You would want to know who was influencing your child, so monitoring what is being watched and not putting a TV in your child’s bedroom would be sensible (in the US, 19% of children under 1 have a television in their bedroom¹⁶) – perhaps the focus should be on watching TV together as a family.

The research that TV can damage children is not terribly reliable – there is certainly no good evidence to suggest it causes ADHD or Autism. That said, plonking little Johnny in front of the tube all day isn’t going to be good for him – the evidence suggests that reading to your child (singing, playing and generally interacting) gives them the best start in life.

I think that Dr Sears sums it up nicely:

“I think it is a good show if the child is interacting with it, singing along, or dancing along. If the child just “zones-out” and stares at the tube, then you should probably find a different show. This is mainly for older infants that have the coordination to respond. At four-months-old, most infants will just stare, and that’s fine, plus it gives mom a break”

Further Reading

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;107/2/423
www.commercialexploitation.org/factsheets/babies.pdf

References

1. http://www.dailymail.co.uk/news/article-1254757/Baby-DVDs-fail-boost-word-power-Einstein-harm-good.html#ixzz0iiLwbU5q retrieved 20.03.2010
2. http://www.commercialfreechildhood.org/pdf/be/babymozart020198.pdf retrieved 20.03.2010
3. Rauscher, F. H., Shaw, G. L, & Ky, K. N. (1993). Music and spatial task performance. Nature, 365, 611.
4. Rumbelow, H. 2009. Why watching TV won’t turn your baby into a genius. The Times. 29 October 2009.
5. McKelvie, P. & Low, J. (2002). Listening to Mozart does not improve children’s spatial ability: Final curtains for the Mozart effect. British Journal of Developmental Psychology, 20, 241-258
6. Robb, M.B., Richert, R.A., Wartella, E.A. 2009. British Journal of Developmental Biology. 27(19):27-45
7. Zimmerman, F.J., Christakis, D.A., Meltzoff, A.N. (2007). Television and DVD/Video Viewing in Children Younger Than 2 Years Arch Pediatr Adolesc Med. 161(5):473-479.
8. Waldman, M., Nicholson, S., Adilov, N. 2006. Does Television cause Autism? http://www.johnson.cornell.edu/faculty/profiles/waldman/autism-waldman-nicholson-adilov.pdf retrieved 23.03.2010
9. Rutter M. 2005 Incidence of autism spectrum disorders: changes over time and their meaning. Acta Paediatr. 94(1):2-15
10. Christakis, D.A., Zimmerman, F. J., Guisseppe, D.L., McCarty, C.A. 2004. Early television exposure and subsequent attentional problems in children. Pediatrics 113: 708-713
11. Zimmerman, F.J. and Christakis, D.A. 2005. Children’s Television Viewing and Cognitive Outcomes: A Longitudinal Analysis of National Data Arch Pediatr Adolesc Med. 159:619-625
12. Tanimura, M., and Okuma, K.M.A. 2007. Television Viewing, Reduced Parental Utterance, and Delayed Speech Development in Infants and Young Children Arch Pediatr Adolesc Med. 161(6):618-619.
13. Marie Evans Schmidt, Michael Rich, Sheryl L. Rifas-Shiman, Emily Oken and Elsie Taveros, M. 2009. Television Viewing in Infancy and Child Cognition at 3 Years of Age in a US Cohort. Pediatrics 123: 370-375
14. Thompson, D.A. and Christakis, D.A. 2005. The association between television viewing and irregular sleep schedules among children less than 3 years of age. Pediatrics 116(4): 851-856
15. American Academy of Pediatrics. 2001. Policy statement: Children, Adolescents and Television. http://aappolicy.aappublications.org/cgi/content/full/pediatrics;107/2/423. retrieved 23.03.2010
16. Rideout, V. & Hamel, E. (2006) The Media Family: Electronic media in the lives of infants, toddlers, preschoolers and their parents. Menlo Park, CA: Kaiser Family Foundation

In America, weaning usually means stopping breast milk or formula – in the UK it means starting solid food, which is how I am using the term throughout this article.

X and I recently went to a talk from our children’s nurse on weaning. Among other things we were told that weaning may help your baby sleep through the night – specifically that not sleeping through the night may be indicative of the need to be weaned.

One parent of a 17 week old baby asked whether, as her baby was looking around when drinking her expressed breast milk, could she be unsatisfied by the milk and need weaning? She was very reluctant to wean so early, but worried about her baby. The nurse commented that, yes, weaning could be worth a try. From my experience and reading, the baby is more likely to have become more alert and interested in her surroundings. The message seemed to be that it would be OK to wean at 17 weeks.

The government guidelines used to suggest we wean at 3 months, then 4. Now the guideline is exclusive breast feeding for the first 6 months. Whether breast or formula feeding, the guidance is that babies should not be weaned onto solids until they are 6 months old. If weaning earlier, babies should not be given solids until at least 20 weeks.

Why is this? As parents we were probably weaned earlier than this and we survived! So what is the fuss about?

Historical background to weaning

Evidence suggests that in Egypt, 2300 to 4700 years ago, they were starting solids at around 6 months of age, as were the Romans  1550 to 1750 years ago³.

By the early 1900s through to around the 1920s, paediatricians were advising no solid foods until 12 months of age, supplemented by cod liver oil and orange juice (to prevent scurvy). That said, this was obviously not the case everywhere – especially in lower socio-economic households where some babies were found to have been fully weaned by 6 weeks, putting them at significant risk. This varied throughout the country, however, with towns in the North recording higher rates of exclusive breastfeeding for the first year. In the Midlands exclusive breastfeeding was normally for a shorter duration, in other towns babies were often weaned as young as two months⁵. In 1913-1914, 85% of babies were exclusively breastfed at birth, but only 68.5% by the end of the second month. In 1918-1919, 38.4% were still exclusively breastfed by 6 months⁵. However, it is difficult to know how many of these babies were weaned onto “solid food” and how many onto the “infant formulas” available since the late 1860s. It is likely that they were primarily weaned onto “pap” and similar soft foods, as infant formula was often prohibitively expensive until around the 1920s-1930s when evaporated milk became widely used as an inexpensive base.

Over the next 30 years the age at which solids were given became earlier, as there were concerns that babies were missing essential iron and vitamins when given breast milk alone. Flash forward to the 1950s and 1960s and it was not uncommon for babies to start solids as young as 3-6 weeks of age, and it was generally viewed as a milestone achievement. An MD in Miami in 1953 wrote a paper boasting about his success with feeding babies solids from 2 days old, and a 3 meal a day plan at 3 months (his schedule was backed in the paper by other medics)¹⁰:

Weaning Schedule (Sackette, 1953)

In the 1970s a study in the UK found that the commonest age of starting solid food (usually in the form of rusk or cereal added to the bottle) for babies in the UK was between 3 and 4 weeks, with the youngest being 2 days⁷. Another study in the early 1970s found that 80-95% of babies were weaned onto solids by 3 months. In 1974 the Department of Health and Social Security (DHSS) in the UK advocated the delay of solid foods until after 4 months of age. By the late 1970s, however, a study found that bottle-fed babies were being weaned at an average age of 8.3 weeks (13.8 weeks for breastfed babies)⁸.

In the 1980s the European and American paediatric committees recommended solids be introduced after 3 months, but ideally not before 4 months⁹. However, a UK study in 1980 found that 56% of infants were given solids before 3 months of age. The research was repeated in 1985 and the number had increased to 62%⁹.

Before 1994 the National Health Service (NHS) recommended the minimum age for starting solids was 3 months, in 1994 they altered this to 4 months. By 1995 the World Health Organisation had settled on between 4 and 6 months, but no later than 6 months. In 2003 they had changed this recommendation to “exclusive breastfeeding for 6 months”, a recommendation then echoed by the NHS. The American Association of Paediatrics also recommends starting solids “somewhere during the second half of the first year” – often assumed to mean at 6 months⁶.

However, a study in UK in 2004 found that, of 707 babies, the mean age of weaning was 3.5 months, with 21% starting solids before 3 months. Only 6% of parents waited until after 4 months of age¹³. Reasons for weaning early were that the parents felt that their baby was hungry or because they felt it was the “right time”. However, 39% of those who weaned before 3 months did so following advice from a healthcare professional, as did 40% of those who weaned between 3 and 4 months.

When to give solids

Many mothers start weaning before the current recommendation of six months. Is this a problem? Are there any risks or any benefits from starting solids early? Or late? Or on time?!

The study in 2004, mentioned earlier, found that babies weaned before 3 months were significantly more likely to suffer from diarrhoea – twice as likely as those weaned later – and were more likely to see their GP over the weaning period¹³. Weaning too early stresses the baby’s system, which still has an immature gut, kidneys and immune system which may not be ready to cope with food¹³. Whereas waiting until 6 months to wean has been found to lead to fewer cases of gastrointestinal problems as by then the baby’s digestive system (which until about 4-6 months is “open” meaning that large proteins and disease-causing pathogens can pass through, making the baby susceptible to allergies) is more mature and ready for food. Fat and protein digestion is incomplete until at least 6 months. Weaning before 4 months has also been found to lead to higher body fat and body mass index, and respiratory problems in early childhood.

However, weaning “too late” is thought to risk problems with nutrition and feeding problems later in life¹³. That said, other studies have found that it is possible to exclusively breastfeed for about 9 months without leading to problems with iron levels or weight gain¹. There does still seem to be a fallacy floating around that at 6 months breast milk suddenly becomes nutritionally inadequate for your offspring, a out of date idea that has since been disproved¹.

To add to the confusion, other studies have found that complying with the current recommendations doesn’t necessarily help protect infants. One large study found that a delayed introduction of solids (past 4 or 6 months) was not associated with decreased odds for asthma, allergic rhinitis, or sensitization against food or inhalant allergens at 6 years of age. On the contrary, food sensitization was more frequent in children who were introduced to solids later. However, waiting to wean may protect against eczema¹⁴.

The European and the North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition have concluded that there is no convincing scientific evidence that avoidance or delayed introduction of foods which could cause allergies (like fish and eggs) actually reduces the chances of those allergies (for both at risk and not at risk children). They suggest that you should start solids no sooner than 4 months but no later than 6 months¹⁵. However, they also say that breast milk does not provide enough iron for babies after 6 months, which has been hotly disputed.

Confused yet?

The “signs of readiness” don’t help. The HIPP (baby food) website suggests signs include “putting toys and objects in their mouth”. Oh, OK. X was ready about 4 months ago then…

Cow and Gate are equally helpful with their “signs of readiness”: “Where they’ve previously slept through the night, they now wake up for a feed” (this often happens around 4-6 months anyway, as they move through the next developmental stage – there is no proof that weaning your baby will help him or her sleep through the night) and the equally insightful: “Your baby looks fascinated when you eat” – yes, he does and has done since he could focus on us. He is also fascinated when we drink wine – should we pass him a glass?

Weaning has been thought of as the solution to many “problems” including slowing of weight gain, losing weight, poor sleep, having a big baby, having a small baby, baby having a “hungry cry”….²⁰. While each baby is different and each parent should trust their instincts, it is important to know that starting solid food has not been found to alleviate these issues. Not surprising when you consider that the first few months (at least) of solid food introduction is about fun and exploration, not adding calories into the diet. The baby will still get a majority of his/her calories from milk – breast or formula – until they are about 1 year old.

The latest signs the NHS suggest could mean that your baby is ready to be weaned include when they can:

• Stay in a sitting position and are able to hold their head steady
• Co-ordinate their eyes, hands and mouth, can look at food, grab it, and put it in their mouths all by themselves
• Swallow their food. Babies who are not ready will often push their food back out, so get more around their faces than they do in their mouths.

In 2008 Gill Rapley (deputy director of Unicef’s Baby Friendly Initiative and a health visitor for 25 years) suggested “Baby Led Weaning” as an approach to give baby’s solid foods – where the baby self-feeds finger foods rather than being fed purees. She advocated starting the process at 6 months, but also notes:

“Some babies are always going to be ready before others and some later – they don’t all crawl or walk at the same age….When we put a newborn baby on the floor to kick we are giving him the opportunity to walk – the only thing holding him back is his own developmental ability. What I suggest we should do is simply apply the same principle to self-feeding….. The baby doesn’t ‘know’ his gut has sealed any more than he knows his legs are strong enough to support him when he gets up to walk it just seems to be that nature has ensured that all the various systems (gut, oral skills, immunity and manipulation) develop in parallel. So if a baby can’t pick up a piece of food and get it to his mouth it’s a fair bet his gut is still too immature to receive it.”¹¹

Of course, this assumes that a baby’s motor control matches their internal development, which some disagree with¹⁶

What start with?

In the late 1870s, the following advice was given:

“What food, when a babe is 6 or 7 months old, is the best substitute for a mother’s milk? … The one I have found the most generally useful, is made as follows – Boil the crumb of bread for two hours in water, taking particular care it does not burn, then only add a little lump sugar to make it palatable. When he is six or seven months old, mix in a little new milk – the milk of ONE cow”⁹

Mmm. Yummy.

During the 18^th and 19^th century, there was a belief that fresh fruit and vegetables were not tolerated by children and they were best weaned onto bland and starchy food. Most thought sugar was nourishing and often added salt to babies’ food⁹.

With the promotion of feeding solids earlier and earlier, the food became a substitute rather than a supplement for breast or formula milk. This coincided with the acceptance of the importance of vitamins in the diet as well as the mass production baby food, which became more affordable for more people, meeting the need for quick solutions for those living the faster-paced lifestyle of the industrialised age¹⁹. Manufactured baby foods have been criticised due to the additives often used in them. Sugar and salt are often also added, despite these ingredients being best avoided by babies. It seems reasonable to suggest that, just as adults should not eat pre-prepared packaged foods regularly, nor should our babies.

Purees (which are often homemade) made good sense when we were giving food to our babies at 3 months or less. However, some feel that if we wait until 6 months, babies can handle finger food straight away, and missing out the puree stage helps babies handle different textured foods better, eventually be less fussy about food, and minimise gastrointestinal problems¹². Advocates of purees argue that some babies need the interim puree stage to help them get the hang of foods that they will eventually chew gradually¹⁸. Parents also worry about their baby choking if they go down the baby led weaning route. However, it seems that babies using this approach are more likely to gag than choke, and possibly not much more than babies fed purees (especially when lumps start to be introduced).

Conclusions

X has his first taste of pears

Perhaps the answer with this, as in most of these parenting decisions is that “one size fits all” is an unhelpful approach. Treating babies as individuals is only sensible – they all walk and talk and so forth at different ages, it makes sense to start solids at different ages too. That said, the evidence certainly suggests that before 4 months is too young. Baby-led weaning is an approach that allows the baby to dictate when they are ready, which is a nice idea…. follow our successes and failures with this approach on Twitter:
By: Twitter Buttons

Further Reading

http://mainstreamparenting.wordpress.com/2008/09/29/is-there-an-advantage-to-delaying-solids/

www.kellymom.com/nutrition/solids/solids-how.html

http://brilliantbirth.blogspot.com/2007/06/delaying-solids.html”>http://brilliantbirth.blogspot.com/2007/06/delaying-solids.html

References

1. Børresen, H.C. 1995. Rethinking Current Recommendations to Introduce Solid Food between Four and Six Months to Exclusively Breastfeeding Infants. Journal of Human Lactation 11:3 201-204
2. Cunha et al. 2004. Enamel hypoplasias and physiological stress in the Sima de los Huesos Middle Pleistocene hominins Am J Phys Anthropol. 125:3. 220-31
3. Dupra, T.L., Schwarcz, H.P., & Fairgrieve, S.I 2004. Infant feeding and weaning practices in Roman Egypt. American Journal of Physical Anthropology. 115:3 204-212
4. Eden, A. 2006 Postpartum Nutrition Guidelines.  18 September 2006.  HowStuffWorks.com. <http://health.howstuffworks.com/postpartum-nutrition-guidelines-ga.htm>  27 February 2010.
5. Fildes, V. 1998. Infant feeding practices and mortality in England 1900-1919. Continuity and Change 13:2 251-280
6. Palmer, L. F. 2008. Beyond Breastmilk. http://thebabybond.com/Beyond%20Breastmilk.pdf retrieved 28.02.2009
7. Oates, R.K. 1973 Infant Feeding Practices. British Medical Journal. 2: 762-764
8. Wilkinson, P.W. & Davies, D.P. 1978 When and why are babies weaned? British Medical Journal 1: 1682-1683
9. Forsyth et al. 1993. Relation between early introduction of solid food to infants and their weight and illnesses during the first two years of life. British Medical Journal. 306:1572-1576
10. Sackette, W.M. 1953. Results of three years experiences with a new concept of baby feeding. Southern Medical Journal 46:4 358-363
11. Rapley, G. 2007. Baby Led Weaning Webchat with Gill Rapley. 17^th November 2007. http://www.iwantmymum.com/site/articles/baby-led-weaning-webchat-with-gill-rapley/56 retrieved 07.03.2010
12. Rapley, G & Murkett, T. 2008. Baby-led Weaning. Vermillion: UK
13. Wright, C.M., Parkinson, K.N.,  Drewett, R.F. 2003. Why are babies weaned early? Data from a prospective population cohort study. Arch Dis Child 89:813-816
14. Zutavern, A. Et al. 2008. Timing of Solid Food Introduction in Relation to Eczema, Asthma, Allergic Rhinitis, and Food and Inhalant Sensitization at the Age of 6 Years: Results From the Prospective Birth Cohort Study LISA. Pediatrics 121:1 44-52
15. Agostoni et al. 2008. Complementary feeding: A commentary by the ESPGHAN Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition. 46: 99-110
16. Esther. 2008. http://mainstreamparenting.wordpress.com/2008/09/29/is-there-an-advantage-to-delaying-solids/ Retrieved 09.03.2010
17. Goodwin, D. 2007. Bringing Up Baby. Hodder & Stroughton: UK.
18. BBC News. 2007. http://news.bbc.co.uk/1/hi/health/6762795.stm retrieved 10.03.2010
19. Bentley, Amy. “Baby Food.” Encyclopedia of Food and Culture. 2003. Retrieved March 10, 2010 from Encyclopedia.com:http://www.encyclopedia.com/doc/1G2-3403400056.html
20. Anderson, A.S. et al. 2001 Rattling the plate -Reasons and rationales for early weaning. Health Education Research Theory and Practice. 16:4 471-479

“It also concludes that the Medicines and Healthcare products Regulatory Agency (MHRA) should not allow homeopathic product labels to make medical claims without evidence of efficacy…

The Committee carried out an evidence check to test if the Government’s policies on homeopathy were based on sound evidence…..the Government acknowledges there is no evidence that homeopathy works beyond the placebo effect (where a patient gets better because of their belief in the treatment).”¹

Homeopathy is a commonly suggested remedy for pregnant women, babies and children. The NHS even has four homeopathic hospitals and estimates it spends around £4million a year on homeopathic treatments² (not including running and maintaining the hospitals). The USA is alleged to have spent close to half a billion dollars on homeopathy in 1999. Personally, I have heard of people having real success with teething granules and our midwife suggested homeopathic arnica tablets post birth. Others say there is no scientific evidence that homeopathy is any more effective than taking a sugar tablet.

Why is homeopathy so revered by some and reviled by others? Should you and your baby take homeopathic remedies?

What is Homeopathy?

The Society of Homeopaths describes homeopathy as

“a system of medicine which is based on treating the individual with highly diluted substances given in mainly tablet form, which triggers the body’s natural system of healing. Based on their experience of their symptoms, a homeopath will match the most appropriate medicine to the patient”

Homeopathy was discovered by Samuel Hahnemann (1755-1843) he believed that, by vigorously shaking the original substance in water, the substance leaves behind a “spirit-like” essence that while being “no longer perceptible to the senses” is “remembered” by the water. In Hahnemann’s day when curing illness the symptoms were the thing to focus on. He believed that “like cures like”, so the cure needed to replicate the symptoms. If a cold caused watery eyes and a runny nose, and so did an onion, then an onion was the thing to cure a cold. This approach would have the potential to aggravate the condition, which is not what the aim was, so he deduced that the way to cure the problem was to use diluted versions of these remedies. By reducing the medicines, Hahnemann noticed that their effects were less damaging (which makes sense – a small amount of arsenic is bound to be less damaging than a large amount, regardless of what you are hoping to cure with it) – he then came to

Homeopathic remedies are diluted to such a degree that no discernible molecules of the original substance remain.

the conclusion that this was because the more dilute the remedy, the more potent it was. So he took a natural substance (crushed), put it in water or alcohol, then took a drop of that solution and diluted it, and took a drop of that and diluted it, and so on. Between dilutions he would vigorously shake or bang the solution on a springy surface (known as succession).

The homeopathic “Principle of Similars” (the theory that “like cures like”) leads to an approach which allows the body to heal itself. However, this theory has been refuted.

So, how does it work? From the Society of Homeopaths:

“Scientifically it cannot yet be explained precisely how homeopathy works, but new theories in quantum physics are going some way towards shedding light on the process. What we do know is that a carefully selected homeopathic remedy acts as a trigger to the body’s healing processes.”

Quantum physics? OK, let’s start there.

Bear with me here, one of the guys who came up with Quantum theory has said it is so weird it is fundamentally incomprehensible…. Put simply, Quantum theory describes the relationship between energy and matter on the atomic and subatomic levels. Put very simply, Quantum mechanics explains how very very small things behave.  Things so small we can’t actually see them; we can only ascertain what they are doing by the effect they have on other things. That is why the theory works so well for homeopathy – the molecules of the original substance that are left in the water are so small that we have to rely on the effect that they have on the person who consumes the tablet to know that they are there and working. Unfortunately, we know that something does not have to be potent in any way for it to have an effect on someone – that is why placebos (i.e. sugar tablets that people are told will make them feel better) work. More on this later. For me Quantum Theory does not give me any reason for homeopathy to work. So, the jury is still out as to why homeopathy succeeds – if it works at all.

There has been research that suggests that “homeopathic water” and ordinary water are not the same. For example, a popular article “proving” this claimed to show that even though they should be identical, the structure of hydrogen bonds in pure water is very different from that in

Does water have a memory?

homeopathic dilutions of salt solutions. This confuses me – it seems that the water only remembers what the homeopath wants it to – i.e. the “substance” being used to cure the disease. For some reason it doesn’t “remember” the tea bag seeped in it, the fish that drank it, or the urinary tract it once went through. This was raised in the recent Parliamentary briefing about homeopathy:

“Dr Harris [Member:   Science and Technology Sub- Committee]: On that basis then why is it that when you have a solution of water that used to have some homeopathic substance in it but it has been diluted that the water is said to retain that memory but does not remember all the poo, you could call it, that has been in it, because all water has bits of our effluent.”³

Doubt has been cast on the research mentioned above. The researcher tested frozen samples bathed in radiation and measured the peaks of light released as they warmed up (the peaks are stored energy being released). The sample which had the diluted chemical (10^-30 grams per cubic centimetre) released different peaks to pure water and a saline solution. However, the process of freezing the water would have rearranged the hydrogen bonding. Also, tiny impurities or inefficient mixing could have lead to the same results³. Others disagree with these criticisms, saying that the research was carried out scrupulously and these possibilities could not account for the results.

The theory that water has a “memory” came from Jacques Benveniste⁴, who claimed to have found that water had a memory of a substance if it was violently shaken prior to dilution. When his study was replicated with other scientists, the results could not be replicated and further studies have also failed to replicate them⁶. Benveniste claimed this is because his original methods were not adequately followed. This would lead me to be concerned that – even “the water has memory” theory is true – if a group of scientists cannot replicate the effect under controlled conditions, how do we know that the people making homeopathic tablets are following the protocol strictly enough for it to work? This concern was touched on in the Parliamentary briefing:

“Dr Harris: How much do you have to shake it?

Dr Fisher [Director of Research, Royal London Homeopathic Hospital]: That has not been fully investigated.

Dr Harris: A random amount of shaking?

Dr Fisher: You have to shake it vigorously but exactly how much you have to shake it, no. If you just gently stir it, it does not work.”³

So, let’s look at the evidence that homeopathy works. Or doesn’t. Firstly, anecdotal – and here I point out very very fervently: the plural of anecdote is anecdotes, not data. Hundreds, thousands, probably millions of people swear by homeopathy. Unless they all took part in a randomised, controlled, double-blind, peer reviewed piece of research their experiences cannot be considered proof. Why not? Because there are many reasons why people experience a positive effect from treatment such as homeopathy that does not prove that the tablets have any potency.

The Placebo Effect

The placebo effect: tablets do not have to contain any active ingredients to have an effect

Don’t rule out the placebo effect, and don’t think that it means that the effect is not worth something. We have a long way to go to figure out why a placebo works, but measurable biochemical effects can be found following someone taking nothing more than a sugar tablet. The placebo effect is strongly linked to the cultural meaning of the treatment (4 sugar tablets clear up ulcers more quickly than 2 sugar tablets)⁸.

In fact, there is evidence that the placebo effect is becoming stronger (which is causing huge problems for drug companies who have to prove their drugs are better than a placebo). In November 2008, a new type of gene therapy for Parkinson’s disease was withdrawn from Phase II trials after it did not show a good enough effect against a placebo, trials for a treatment for Crohn’s disease were stopped after an “unusually high” response to placebo, and in the same year volunteers testing a drug for schizophrenia showed double the expected level of placebo response. Studies have also shown that the response to well known drugs (i.e. antidepressants) compared to a placebo has changed significantly since the 1980s, with some suggesting the placebo effect has nearly doubled⁹.

The “placebo effect” (or something similar) has been found to work in animals and babies – why is this? Well, babies and animals alike respond to their parents’ (or owners) expectations and behaviour⁸. When we think someone is ill, we usually treat them as if they are ill, if we think they are getting better we treat them differently. However, importantly, the placebo effect only works if people (or parents, or owners) do not know they are taking a placebo. Interestingly, there is also a “Nocebo” effect – if you have negative expectations, you may experience negative symptoms (which is why some people may experience side effects from a placebo¹²¹³¹⁴).

Other Effects

Another important reason for some homeopathic treatments to work that is slightly different from the placebo effect is the mode of delivery. The teething granules, for example, that many parents find to be helpful in relieving symptoms of teething, are (as their name suggests) granulated. Babies may find the granules themselves comforting or distracting and they therefore experience some relief.

Furthermore, medicines given at the same time can confuse the evidence when relying on anecdotes – using the example of the teething granules again, these are sometimes given alongside baby Bonjela or Calpol, making it impossible to know which treatment is the effective one.

Peer reviewed “scientific evidence”

“Chairman: In terms of Government policy in terms of homeopathy you are not really saying that it is evidence-based other than that there is a community who believe that they work?
Mr O’Brien: Yes.”³

“Chairman: …. do they work beyond the placebo effect?

Mr Bennett [Professional Standards Director and Superintendent Pharmacist, Boots]: I have no evidence before me to suggest that they are efficacious, and we look very much for the evidence to support that” ³

This second quote is slightly alarming, inferring as it does, that those that sell homeopathic remedies – such as Boots – believe that there is no scientific evidence supporting homeopathy.

So, why do some people see evidence where others do not? Some research indicates that there is a measurable effect for homeopathy above that expected for a placebo. However, analyses of the available research indicates that the sample sizes are often very small (a review of 40 randomized controlled trials found that the median number of patients per group was only 28¹⁰). It seems that, for every article which proposes evidence supporting homeopathy, someone else can cite one that shows that it is no more effective than a placebo. One way of summarising the evidence is to look at meta-analyses of published papers – these analyses review the available literature and analyse the findings – in this case looking at papers on homeopathy and seeing whether, when you pool all the data, there is a clinically significant result. This means that these papers benefit from a much larger sample size than the original papers alone. These reviews, however, are not infallible – some research may be missed, and the researcher may unconsciously affect the results through their own bias.

There have been hundreds of systematic analyses of available studies. Rather than go through them all here, there is a paper that has done that for me – an analyses of the analyses. In 2002 Ernst attempted to review all available articles since 1997¹¹. He reviewed 17 meta analyses and found that there was no evidence that homeopathy is any more effective than a placebo and concludes that homeopathy should not be considered an evidence-based treatment – it is worth noting here, that Ernst is the Director of the Complementary Medicine Group at the Peninsula Medical School and a qualified Homeopath, so if any researcher bias was present one would expect it to be pro, rather than against homeopathy.

At the Science and Technology Sub-Committee evidence hearing, the British Homeopathic Association (BHA)  claimed that:

“Four out of five comprehensive systematic reviews of RCTs in homeopathy have reached the qualified conclusion that homeopathy differs from placebo” ²

However, on further investigation by Ernst disputed this. He analysed the five reviews:

1. 1. The Kleijnen review is now 18 years old and thus outdated.
2. 2. Boissel et al merely combined p-values of the included studies. This article is now also outdated. Furthermore it is not unambiguously positive.
3. 3. Cucherat et al is the publication of the Boissel document which was a EU-sponsored report. [The authors themselves noted that “there is some evidence that homeopathic treatments are more effective than placebo; however, the strength of this evidence is low because of the low methodological quality of the trials.”
4. 4. Linde et al has been re-analysed by various authors, including Linde himself, and all of the 6 re-analyses (none of which were cited in the BHA’s submission) have come out negative.
5. 5. Shang et al very clearly arrived at a devastatingly negative overall conclusion.²

When presented with all the evidence, the Parliamentary Science and Technology Sub-Committee concluded that:

“In our view, the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos. The Government shares our interpretation of the evidence. We asked the Minister, Mike O’Brien, whether the Government had any credible evidence that homeopathy works beyond the placebo effect and he responded: “the straight answer is no”"²

Conclusions

Could homeopathy cause harm to you or your baby? No, unless you take homeopathic remedies when you should be taking medicine that has been recommended by your medical professional. Other than a placebo effect, which you or your baby may experience, the only actual effect, it seems, will be to your bank balance. Some forms of homeopathic treatment, like teething granules, may help your baby due to their texture.

However, we should not rule out the placebo effect – it can be very potent and it does lead to people feeling better. It is not, however, evidence to support the widespread use of homeopathy.

References

1. http://www.parliament.uk/parliamentary_committees/science_technology/s_t_pn21_100222.cfm
2. http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/4504.htm#a4
3. http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/uc45-i/uc4502.htm
4. Youngson, R & Schott, I. 1996. Medical Blunders. Robinson Publishing Group; UK
5. E. Dayenas; F. Beauvais, J. Amara , M. Oberbaum, B. Robinzon, A. Miadonna, A. Tedeschit, B. Pomeranz, P. Fortner, P. Belon, J. Sainte-Laudy, B. Poitevin and J. Benveniste (30 June 1988). “Human basophil degranulization triggered by very dilute antiserum against IgE” (PDF). Nature 333: 816–818. doi:10.1038/333816a0.
6. P. Ball (8 August 2007). ”Here lies one whose name is writ in water”. Nature. doi:10.1038/news070806-6.
7. 7. Milgrom, L. 2003. Icy claim that water has memory. New Scientist.
8. Goldacre, B. 2007. A Kind of Magic? The Guardian, Science. 16^th November 2007. http://www.guardian.co.uk/science/2007/nov/16/sciencenews.g2
9. Silberman, S. 2009. Placebos are getting more effective. Drug companies are desperate to know why. Wired Magazine. 17:09
10. Hill, C. & Doyon, F. 1990. Review of randomized trials of homeopathy. Rev Epidemiol Sante Publique. 38(2):139-47.
11. Ernst, E. 2002 A systematic review of systematic reviews of homeopathy Br J Clin Pharmacol. 54(6): 577–582.
12. Myers MG, Cairns JA, Singer J. 1987 The consent form as a possible cause of side effects. Clin Pharmacol Ther. 42(3):250-3.
13. Liccardi G, Senna G, Russo M, Bonadonna P, Crivellaro M, Dama A, D’Amato M, D’Amato G, Canonica GW, Passalacqua G. 2004 Evaluation of the nocebo effect during oral challenge in patients with adverse drug reactions. J Investig Allergol Clin Immunol. 14(2):104-7.
14. Levine, M.E, Stern, R.M.,  Koch. K.L. 2006. The Effects of Manipulating Expectations Through Placebo and Nocebo Administration on Gastric Tachyarrhythmia and Motion-Induced Nausea  Psychosomatic Medicine 68:478-486

Further Reading and Useful Links

http://www.bmj.com/cgi/content/full/339/dec15_1/b5432?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=homeopathy&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT

http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/4504.htm#a4

http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/uc45-ii/uc4502.htm

http://www.guardian.co.uk/science/2007/nov/16/sciencenews.g2

http://www.badscience.net/category/complementary-medicine/homeopathy/

3 in the bed and the little one said…..

Co-sleeping and bed sharing: This was one of the first “controversial” areas we ventured into. There is a lot of misinformation about co-sleeping in books, on the net, and from professionals. It is very very difficult to make an evidence-based decision about bed sharing – if it is what you think you may want to do.

When pregnant I was adamant that I would never put X in bed with us. What if I rolled onto him? Don’t all the guidelines say never sleep with your baby? But I developed Bursitis in my shoulder from lifting X in and out of his Moses basket to feed him. I was knackered from trying to feed sitting up as I worried about falling asleep if I fed lying on my side. I even had raw elbows from propping myself up in bed on my elbow to check on him in the night… is he still breathing??

So, we had to make a call – do we put the baby in bed with us or not?

A Moses basket is a popular option in the early days

It is worth bearing in mind that co-sleeping is just that – sleeping at the same time as your baby. It is taken to mean the baby has to be in the bed with you (bed-sharing) but there is more than one way to co-sleep with your baby, including “side-car” cots, having the baby on their own mattress next to yours with your mattress on the floor….

For centuries in this country and still in many countries around the world it was and is considered totally normal to put the baby in bed with his/her parents.

Most of us get our advice from books and websites, as well as official recommendations (and our GPs, midwives etc). Dr Sears (www.askdrsears.com) is one of my favourite websites, he defines co-sleeping as mother and baby being within arm’s reach of each other, and is an advocate, although he acknowledges that it doesn’t work for everyone – I love his statement: “There is no right or wrong place for babies to sleep. Wherever all family members sleep the best is the right arrangement for you and your baby”. I totally agree.

Gina Ford’s Contented Baby website recommends that it’s a good idea for the baby to have his own room as soon as possible, to prevent unsettling him later. She adds “While you and your partner might not mind sharing a room or bed with your baby, you must ask yourself whether you are doing so for your own sake or your baby’s”. In her book The Complete Sleep Guide for Contented Babies and Toddlers she also states that “Bed sharing . . . more often than not ends up with parents sleeping in separate rooms” and exhausted mothers, which “puts enormous pressure on the family as a whole”.

I have not seen research based evidence for these statements, and, while I am sure she has seen families who have had difficulties following bed-sharing (and, undoubtedly, families with difficulties who did not bed-share), I am aware of many people who have bed-shared without problems later in life.

I would agree with Ford, you must always ask yourself whether you are doing something for your own sake or your baby’s – some babies hate not to be within reaching distance of the person they spent 9 months inside of. Others prefer their own space. It has to be a family decision.

A recently publicised article on bed sharing and SIDS¹ was widely reported to give “evidence” that “co-sleeping” was very dangerous and should be avoided at all costs. In fact, in most of the reports on the article, there was no differentiation between sharing a bed with a baby and sleeping on a sofa. The authors actually found that 38% of SIDS occurred in cots, and 38% occurred when the parents were bed-sharing with their children (and out of this 38% some had consumed drugs or alcohol). The overall conclusion I would draw from this most recent research? Bed-sharing is no more dangerous than putting your baby in a cot (it may even be safer).

This is not the only paper on the potential negative consequences of bed-sharing. Others have asserted that it is stressful for the

Bed sharing and the impact on a couple's sex life: Parents may need to be creative....

baby². Concerns are also raised about the interference of having a baby in the bed on the parents’ own relationship (in particular their sex life), and that modern day bedding is not suitable for bed sharing with young babies.

Studies that link bed-sharing with SIDS often do not adequately take into account important aspects when analysing their findings, such as weight, smoking, alcohol and drug consumption in the parents. All of which are risk factors when sharing a bed with your baby. Furthermore, there is a real problem with some of the research which doesn’t adequately define SIDS – for example, a baby being trapped on a sofa and dying of asphyxiation, or a baby in bed with a parent and dying as a result of overlaying, is not SIDS. SIDS, by definition, is a death which cannot be adequately explained by medical history, a post-mortem examination, or a death scene investigation. However, it appears that an autopsy cannot always discern between SIDS and asphyxiation¹⁸. For more information on this subject, see http://www.phdinparenting.com/2008/06/05/faulty-logic-from-the-ontario-coroner-regarding-bed-sharing/

There are some people who also worry that bed-sharing will lead to the baby having attachment problems – that you’ll never get the baby to sleep on his/her own if you bed-share. I could only find one study which looked into this and they concluded that children that had co-slept were more self-reliant and more socially independent than non bed-sharing children¹⁵. While it would be very hard to separate bed-sharing from other parental behaviours which may have given rise to such positive attributes, it does seem to indicate that bed-sharing will not lead to a maladjusted child.

Finally, in terms of concerns about bed-sharing, people worry that if you bed-share, your baby will never learn how to relax and self-soothe on their own. This is a whole other article! Some people believe that a baby will learn this in their own time and are happy to wait for them and to continue to rock, cuddle or nurse the baby to sleep. Others feel that babies need to be taught how to self-soothe by leaving them to independently settle in one way or another. I will discuss this in another article in future.

On the side of pro-bed-sharing, lots of research suggests that bed-sharing aids breastfeeding and promotes mother-baby bonding⁵¹⁶¹⁷, ensures that the family get more sleep, and actually helps prevent SIDS⁶. The case for helping prevent SIDS  is compelling – studies show that infants that bed-share have more regular breathing patterns, more stable temperatures and regular heart rhythms^789101112. There is also evidence that the mother’s breathing right next to the baby “reminds” the baby’s system to breathe¹³¹⁴¹⁰.

Safe bed-sharing

When bed sharing baby should sleep next to Mummy. Although she may get up in the night...

You must never bed-share if you have taken drugs or consumed alcohol. This has always been recommended. In fact, it is one of several situations when you should not bed-share with your baby.

Please, do not bed-share if you:

• Smoke
• Are significantly overweight
• Have taken drugs or alcohol
• Are extremely tired
• Have a waterbed

Also:

• Avoid bed-share on soft surfaces
• Use a big bed – King size is ideal (or bigger!)
• Do not sleep with more than one child in the bed
• Do not put your baby’s head on a pillow
• Keep duvets and very heavy blankets away from your baby (we scoot all covers under me and let X have his own space in the bed, sleeping in a grobag. But others find that their baby is fine under their covers with them)
• Keep curtains and dangly things (fairy lights? Strings for blinds?) away from your baby.
• Avoid putting your baby where there is a crevice – i.e. between the mattress and the wall, where they could get trapped
• Never co-sleep on a sofa
• Don’t put your baby between you and your partner – he/she is safer next to Mummy. As a Mum you usually find yourself curling yourself round your baby in a C-shape with your baby nestled in the curve.

So where should your baby sleep?

The simple answer: wherever it feels right for you and your family.

X has a cot attached to our bed

Our solution was to buy a “side car cot” which attaches to our bed- the baby is within arm’s reach and close for checking, breastfeeding etc, but has his own space. We bought http://www.bednest.com/ and it was great – their customer service was also brilliant. I still scoot X in with me at some point in the night. He grew out of his bed nest recently and we simply took the side down and adjusted the height of his cot so it is flush with our mattress. As long as the two mattresses are flush and tight together, I consider it safe

When will he leave our bed or bedroom? We’re not sure right now. Probably not while I am still breastfeeding so often at night. Will he sleep with us forever? I doubt it – how many 13 year old boys still want to sleep with their parents? I am in no hurry though, and nor is he – as far as he is aware he sleeps next to his two favourite people in the whole world. So do I.

Other links you may find helpful if you are considering bed-sharing:

http://www.phdinparenting.com/2009/01/11/co-sleeping-safety/

http://www.askdrsears.com/html/10/T102200.asp

http://safebedsharing.org/safetyguidelines.html

The full article for this blog

References:

1. Blair, P, Sidebotham, P,  Carol Evason-Coombe, C, Edmonds, M,  Heckstall-Smith, EMA, Fleming, P, 2009 Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. British Medical Journal

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