controlled crying

Controlled crying... oops sorry controlled comforting

The Macquarie Dictionary defines control as:

to exercise restraint or direction over; dominate; command; to hold in check; to curb.

The basic tenet of most childcare books written last century has been that parents need to control their children right from birth. For many years controlled crying was the catch phrase. Has the change to controlled comforting altered this prescriptive model of parenting? I believe the semantics of whether it is controlled crying or comforting means nothing and the overriding impact is of dominance and restraint - a dominant attitude by the parent of 'you will do what I say' and a restraint from nurturing - an 'I mustn't let you get too close to me because I will no longer be in control' attitude. Any relationship built on dominance and restraint will not flourish and fulfil the parent's goal.

Why did these ideas of controlled parenting develop? One imagines mainly to increase the hours of sleep parents wanted or felt they needed. Ask any group of women who are well into the third trimester, 'How many of you slept through the night last night?' and you will find that nine out of ten have needed to get up at least once during the night. How many books have been written about Bladder Taming in Pregnancy and even if they were would the reader feel a failure and not tell her friends that she was still getting up for her bladder because they might think she was not in control?

As the old forms of control through corporal punishment have been shown not to have a good long-term outcome, educators around the world are concentrating on ways of bringing the best out in their students. Speak to any schoolteacher nowadays and you will find that they no longer rule with fear but with patience and finding an appropriate level at which to understand the student. Some may say that this is impossible in bringing up infants and children but let us look at the real needs of human infants and in what ways these might be provided.

In the womb the requirements of the foetus are nutrition, excretion, warmth and movement. The foetus can be exposed to bacterial, parasitic and viral infections such as listeriosis when the pregnant woman eats foods containing Listeria or from toxoplasmosis from simply putting out the kitty litter. The baby may also be infected if the mother has viral infections including hepatitis C, rubella, HIV and chickenpox. It can be affected by the mother's excessive use of recreational drugs, overuse of prescription and some over-the-counter drugs or use of illicit drugs. Knowing this, we focus our pre-conceptual and antenatal education on discussing with a woman how to care for her foetus so that it will be born in optimal health.

A lesser amount of this education time is spent in discussing how the infant should be cared for, not only to ensure optimal physical health but also optimal psychological health. For many years a saying at our hospital has been that the baby needs to be pink, fed, warm and loved. The first three are easily assured by any caregiver. But what of love? Once again I have consulted the Macquarie Dictionary which defines love, among other things, as: a feeling of warm personal attachment or deep affection as for (or between) friends, parent and child.

Why, as parenthood is developing, are parents being taught to dominate and control their infants when during the pregnancy they have expounded their ideal of parenthood as one of becoming deeply attached and affectionate with their offspring? I believe it calls on us to develop strategies to assist parents to attain their goal instead of falling back on the tired old dogmas, mostly written by males who were probably not there to parent their children because they were busy writing books on child care. We need to ensure that the biological, physiological and psychological requirements of human babies are met as they are by other parents in the animal kingdom.

So far we have taken a look at the gurus who have shaped the history of breastfeeding and parenting over the past century. To finish I would like to jump a few decades to brighten you up with the fascinating findings from Dr James McKenna's wonderful research on co-sleeping.

Dr James McKenna

Dr James McKenna is the Professor of Anthropology and Director at the Centre for the Study of Maternal-Infant Sleep and Breastfeeding Behaviour, University of Notre Dame, Indiana, USA. The following notes are from one of his talks.

He started with a quote of D Winicott: 'There is no such thing as a baby, there is a baby and someone.' which set the scene for the basis of his presentation - babies physiologically require a carer. It has never been scientifically explored but there have been many cultural changes, ie culture changes much more quickly than biology. One of his main themes was that the human brain has not changed biologically in 150,000 years and that there are no scientific studies to support the cultural norms of the past 200 years in Western society, when the most potentially significant cultural experiment of a baby sleeping alone has occurred. This has separated the baby 'from the host of physiological needs he receives from his parents.'

'At birth the human infant is the least neurologically mature primate of all, and the most reliant on physiological regulation by the caregiver for the longest period.' The trade-offs of being born so neurologically underdeveloped were offset by the co-evolution of immediate and effective parental caregiving. This assured maximum contact, and protection, which included co-sleeping and exclusive breastfeeding for the first 6-12 months.

Professor McKenna defined co-sleeping as not about sharing a physical area, ie a bed, but having the baby within arm's length. He continued on by saying that breastfeeding and co-sleeping are the same adaptive complex designed by natural selection to maximise infant survival and parental reproductive success; there is no documented scientific study to show deleterious consequences of co-sleeping in safe environments; we have come to think of the abnormal as normal; and we are mistaking parental best interests for the infant's best interest. He suggested that current Western beliefs are based on Western European cultural history in which infanticide by 'overlying' existed and was so commonplace that same-bed co-sleeping was outlawed. This cultural history also favoured the notion of romantic love, patriarchal household authority and sanctity of parental privacy.

He reminded the audience that the content of human milk is such that it requires continuous contact and feeding on demand. Humans are a carrying species, like other primates, and have a low-calorie milk (low fat, low protein, and high carbohydrate) for short feeding intervals. On the other hand 'cache' animals, those animals that hide their babies between feeds while they forage for food, have high-calorie milks (high fat, high protein and low carbohydrate) and a long feeding interval.

Seventy five percent of human brain development, more than any other mammal, occurs after birth. As a consequence of its immaturity, the human infant is forced to rely on external regulation and support, especially in the first year of life. The development of the kangaroo mode of care has allowed human babies to return to what was previously normal baby care. The physiological outcomes are that the baby has the advantages of preservation of energy stores, higher blood glucose levels, low cortisol levels (cortisol indicates stress), increased immune efficiency, significantly higher armpit and skin temperatures, less frequent crying and of shorter average duration, breastfeeding established earlier, and accelerated weight gain. On the other hand he reminded us that the negative effects of short-term mother-infant separation, from primate studies, are that the offspring is less able to fight infections with a depressed antibody count, has increased stress hormones, irregular heat rate, abnormal pauses in breathing rate, lower body temperature, disrupted sleep patterns, behavioural abnormalities with excessive self-stimulation, hyperactivity and depression.

I guess it is a sobering thought for all of us who put pen to paper on the subject of breastfeeding that we need to ask the women what works and understand the physiology thoroughly before making any suggestions on parenting.

Reprinted with the permission of The National Association of Childbirth Educators (NACE), originally published in Interaction 16(3), September 1998, Interaction 16(4), December, 1998 and Interaction 17(1), March, 1999.

References:
McKenna JJ 1998 Breastfeeding and Mother-Infant Co-sleeping as an Adaptive System: Historical and Biocultural Perspectives. "Breastfeeding The Best Investment," CAPERS August Seminar, Melbourne, Australia.
The Macquarie Dictionary, Macquarie Library Pty Ltd, 1982.