Category Archives: 2. The Infant

From newborn to 17 months.

Interaction and Relationships in Breastfeeding Families: Interview with Dr. Keren Epstein-Gilboa

By Rita Brhel, managing editor and attachment parenting resource leader (API)

Having nursed one child and not the other, I can say with confidence that there is something truly magical about the breastfeeding relationship. So much more than a transfer of nutrients from mother to baby, the act of breastfeeding touches on each of the Eight Principles of Parenting from nurturing touch and safe sleep to consistent care and personal balance. Breastfeeding is, as Attachment Parenting International co-founders Barbara Nicholson and Lysa Parker write in their book, Attached at the Heart, the very model of an attachment bond.

author Keren Gilboa-EpsteinAnd as Dr. Keren Epstein-Gilboa of Toronto, Ontario, Canada, explains through a new book intended for professionals working with new parents — Interaction and Relationships in Breastfeeding Families: Implications for Practice — the choice to breastfeed positively impacts much more than the attachment bond between mother and baby, but also among all members of the family unit, from siblings to the father, even after the breastfed baby has weaned.

A nurse psychotherapist with a long list of credentials behind her name (PhD, MEd, BSN, RN, FACCE, LCCE, IBCLC, RLC), Keren has been working with new parents and families with young children for the past 25 years as a counselor, lactation consultant, childbirth educator and birth supporter, researcher, and preschool teacher. She is also well published in scientific journals and other publications on topics ranging from pregnancy and birth to breastfeeding and early parenting. Interaction and Relationships in Breastfeeding Families was borne out of Keren’s own clinical and research experiences.

I devoured the information presented in this book. It reveals to the reader the psychological aspects of breastfeeding on the whole family, not just through the intimacy between mother and baby but how breastfeeding literally shapes family development and promotes sensitive interactions between all family members. And then, it follows up with implications for the professionals working with young families. Interaction and Relationships in Breastfeeding Families also gives another dimension to breastfeeding education for lactation consultants, counselors, and others who work with new parents in their transition to family life.

RITA: Keren, how did you first become interested in Attachment Parenting?

KEREN: My experience as a nursing mother is the basis of my interest in Attachment Parenting and interactions in breastfeeding. I parented in a style that might be defined as Attachment Parenting without knowing that there was a name associated with this behavior. My own experiences taught me the importance of mothering in tune with child needs, including cue-based breastfeeding into early childhood. I also learned how this style of breastfeeding and parenting seems to be misunderstood and is criticized by others.

RITA: What led you to write your book?

Interactions and Relationships in Breastfeeding FamiliesKEREN: Insights from my personal experience influence my clinical work and research interests. My aim is to increase the understanding and respect for physiologically based nursing and associated parenting through research. I use recognized theories of development to clarify and validate behaviors in my writing. The material in Interactions and Relationships in Breastfeeding Families reflects my first study on maternal-infant interaction during breastfeeding that was published in a peer-reviewed journal of psychology in 1993. Later training as a family therapist demonstrated to me how important it is to look at the entire family in order to understand more about the interchanges between the nursing mother and child. In 2006, I completed a study that used a family systems approach to describe the entire nursing family. The results of this study are described in my book.

RITA: How do you hope for your book to benefit families?

KEREN: I hope to help families in two ways:

  1. By providing them with information about themselves that will hopefully normalize their experience and fortify their behaviors
  2. By enriching families’ interactions with professionals by describing physiologically based breastfeeding patterns and associated parenting to services providers.

I talk about the feelings that might arise for those providing services to families whose lifestyles and attitudes might differ from their own view of family life. Many services providers in Western contexts criticize cue-based nursing, nursing into early childhood, and ongoing respect for children’s needs for closeness. I believe that helping services providers’ recognize their bias may enrich their ability to listen to and to provide optimal information to families.

RITA: How does your book fit into API’s Eight Principles of Parenting?

KEREN: I think that the work Attachment Parenting International does is very important!

My book demonstrates how families apply many of the Principles of Attachment Parenting to real life and also discusses the implications of this style of parent-child interaction for parent development, positive child outcome, and family function:

  • Preparing for Pregnancy, Birth, and Parenting — The book demonstrates that parents’ attitude toward birth affects their nursing behaviors.
  • Feeding with Love and Respect — Most of the families described in the book see birth and breastfeeding as a part of a physiological continuum, and this seems to facilitate cue-based nursing. Physiologically and cue-based nursing implies that parents respect and respond to infants’ and older nursing children’s needs and signals for nursing. The practice that parents get responding to infants and children’s cues for nursing seems to enhance the development of a parenting style that respects children’s needs and focuses on responding to children’s signals.
  • Responding with Sensitivity — This responsive style of interaction is called sensitive or attuned parenting in the literature and appears to contribute to healthy child development. Cue-based and child-focused parenting also implies that parents suit their interactions to children’s individual characteristic and evolving capacities.
  • Using Nurturing Touch and Ensuring Safe Sleep — The sensitive parenting style associated with cue-based actions through nursing in infancy carried on into other behaviors, including children’s needs for proximity and touch at all hours. Most of the families respond to their children’s needs for closeness by holding, carrying, and sleeping with or near their children. Children’s changing needs for proximity are respected and responded in an individual manner.
  • Practicing Positive Discipline — Open communication, sharing, and parents’ capacity to tolerate children’s unique needs, including in difficult situations, seems to be the central means that parents use to guide children.
  • Providing Consistent and Loving Care — Sensitive tactile interactions evolve into a warm communication style that helps parents meet their children’s changing developmental needs. Parents see their children as individuals, enabling them to suit interventions to the specific needs of each child.
  • Striving for Personal and Family Balance — Open communication and reverence for all of their children’s needs seem to help parents establish and also restore balance to the family system. Parents share joint values and alter couple interactions to reflect infants and children’s changing needs. Older children’s experiences of being heard seem to help them tolerate younger siblings’ needs and also enrich their capacity to understand others – an important tool contributing to family function.

RITA: What tips do you have for parents seeking a closer bond with their baby?

KEREN: Parents should use nursing as a method of learning how to read and respond to babies’ signals. The physiological and psychological meaning of nursing for infants prompts them to cue frequently to nurse. Parents may learn about their child and parenting by observing, interpreting, and responding to children’s cues for nursing. Cues include signs of readiness to commence and finish a nursing session. In addition, women in particular learn how to mother by interacting with their babies during the nursing sessions. Men internalize sensitive fathering by participating in cue reading for nursing, by observing mothers, and also by matching their supportive actions to the changing needs of the nursing dyad. Both parents may use the touch associated with nursing to learn more about sensitive parenting.

RITA: Thank you, Keren, for your time and insights. Do you have any closing thoughts you’d like to share?

KEREN: I go back to my reasons for studying and writing about breastfeeding families and issues related to an Attachment Parenting style: I want to help strengthen parents and enable them to see birth and nursing as normal, rather than medically owned events. I hope to help parents feel comfortable responding to their infants’ and children’s cues, and to feel that their role as parents is important. One might recall that an important insight that I brought from my parenting experience to my clinical and research work was that professionals misunderstood cue-based nursing and parenting. Hence, I also directed my book towards professionals and dealt with the bias that they might have toward cue-based breastfeeding into early childhood and associated parenting. I hope that parents will tell their health care and other professional services providers about the book and encourage them to read it.

Spotlight On: Snuggle Me Cushion

Interviews by Rita Brhel, executive editor of The Attached Family

Snuggle Me CushionNo doubt you saw the two Snuggle Me Cushions included in the Spring 2010 Giveaway through the New Baby edition of The Attached Family magazine.

Shell Rasmussen, creative director of the magazine, opted to try out the Snuggle Me Cushion for herself with her infant son. She spoke with me afterward about her impressions.

RITA: What is your opinion of the Snuggle Me Cushion?

SHELL: The cushion is a nice alternative to just laying your baby flat onto a blanket. Before I has the cushion, I would often use pillows or blankets to push around him when I laid him down so that he would feel snuggled. So this was certainly a good alternative to that!

I wish the middle part of the cushion was more padded on the bottom-side. The cushion is mostly just padded on the outer rim, but the bottom of the cushion is not so much. Continue reading

Ensuring Peaceful Nights with Your Baby

By Naomi Aldort, author of Raising Our Children, Raising Ourselves, www.authenticparent.com

Q:

Naomi Aldort
Naomi Aldort

We cosleep with our baby, but she keeps waking up every hour or two to breastfeed. I put her to sleep at 7  p.m., and she wakes up two hours later. I join her at around 10 p.m. and then she keeps waking up and nursing. Should I move her away from our family bed to help my baby sleep better?

A: I am delighted that your baby sleeps with you. If she woke up in another bed or another room, she would have had to go through anxiety and crying every time she needed to breastfeed or to feel reassured that you still exist. She would have given up half the times, and she would have learned a painful lesson, “When I need care, I have to cry loudly.” This is the early training for tantrums and anger.

When babies are carried on our bodies and sleep with us, they hardly have to make a sound to get the care they need. As they grow older, they will keep asking for what they want in gentle ways.

Waking at night is nature’s clever design. Babies grow in their sleep and can become easily hungry. Sensing the presence of the mother’s body reminds them to wake up and nurse. In addition, since their breathing is still immature, nature makes sure that they wake up often enough to avoid very deep sleep and apnea. Nature makes no mistakes.

Your expectation that she should wake up less frequently causes you undue stress. The good news is, she is thriving and you are meeting her needs wonderfully. Without your misled expectation, you can respond to the way she is with joy. I recall waiting impatiently for the sweet moments of my babies waking up at night so I can kiss, smell, breastfeed, and feel the baby. These times are heavenly, but resisting and worry steal our joy away. The more you follow your baby’s needs, the easier it becomes. Of course, make sure to eat well yourself, avoid stimulating foods, and provide a dark, quiet bedroom for your family.

The baby is always right. The baby never asks for something wrong. The basic needs she signals for are what she absolutely needs. Your job is not to alter your baby but to respond to the way she is. You only doubt yourself when under the influence of other people. Listen to your little baby and to your own heart. She is needing to sleep with you and to wake to breastfeed as often as she does. There are ways for you to get enough sleep without going against your baby’s needs.

Couple Time and Bedtime

Many couples with a first or even a second baby are still “hoping” to resume life the way it was. They want to put the baby to sleep and have time for themselves. However, more often than not, sleep proves itself far from a good babysitter. Bedtime becomes a struggle because of an unspoken goal of getting rid of the baby or child. The baby senses this intent and may become resistant to sleep or simply not wanting to be excluded. Because it seems to work for some when the baby is still young, we are fooled to believe it would keep working.

In reality, your baby needs your uninterrupted presence when sleeping. The baby has no idea of future and no sense of existing without her body being touched. She can therefore experience terror when alone. This is the reason that nature gave babies a built-in reaction of crying when away from our bodies. Nature never meant for babies to sleep away from their mothers. And, mothers naturally want to hold their babies. There is no reason to train mothers and babies out of their healthy attachment.

When you put your baby to sleep at 7 p.m., she is not cosleeping for a good part of her night. She is alone. Waking up to find herself without you is scary for her. She can develop into a light sleeper who wakes up frequently to guard that you are close by. Your daughter’s emotional well being, confidence, intelligence, and health depend on taking for granted that mom is always present. This may require a lot more than you thought you were ready to give, but at the end, it is the easier way and it results in a well-behaved, content child. Be gentle with yourself by avoiding guilt, and instead, learn and grow daily by listening to your baby and exploring inside of you the thoughts that drag you away from enjoying her fully.

In natural societies, parents never put their babies or children to bed. A baby sleeps when she sleeps. She is in arms at all times and regulates her own sleep. In this way, the baby learns self-awareness and self-regulation without becoming dependent on adult control. Let your baby fall asleep on the breast anywhere you are, at her own time, so she can become self-aware and develop healthy sleep.

Full-Time Cosleeping

I often say that I was a lazy mother. I wanted to do everything the easiest way. Amazingly, I found that this was also the kindest way to babies and children. I always went to sleep with my children in the same bed and the same time. They had no stress about bedtime and are terrific sleepers. I never put them to bed. Every night was a slumber party, and we always had enough sleep and sometimes I even read in bed in the morning while the children were still asleep.

We must move on and depart from old expectations. Sex and couple time don’t have to be always in the evening and in the bedroom. Trying to impose couple time in the evening, when the baby needs you the most, is a struggle against nature. Find new times and settings for your relationship and realize that being together as a family is romantic, too. It is not about sex but about love and sharing the child you are nurturing together.

Your baby needs to be in body contact with you at all times, including the first hours of her night’s sleep.

Use these principles in your own creative ways. Respond to the flow, nurture your daughter’s natural ability to recognize her own tiredness even if she fights it — it is her self-discovery — and provide constant, stress-free physical closeness. Your baby wake-ups are wonderful and healthy; without struggling against it, you can cherish each moment of cuddling with your nursing little angel.

The Breastfeeding Father

By Jarold Johnston, CNM, IBCLC

BreastfeedingDad’s job is to take over the job of the lactation consultant when the family goes home from the hospital. The father is who will be available to answer questions at 3 a.m.

Many mothers struggle with confidence when breastfeeding: They doubt the baby’s desire to breastfeed, they doubt their family’s support for breastfeeding, and most of all, they doubt themselves and their ability to breastfeed. A new mother struggles with confidence almost every day, and her shaky confidence is easily destroyed by a doubting father. When you say something foolish like, “I don’t know, Honey, maybe we need to give him a bottle,” you have just damaged your family’s chances at breastfeeding success.

So, if you’ve come this far, you’re still with me and it’s time to learn how to breastfeed. Continue reading

How Does Your Baby Sleep?

By Pinky McKay, IBCLC, CIMI, author of Sleeping Like a Baby, www.pinkymckay.com

Sleeping babyJust like us, each baby is unique and needs a different amount of sleep. Even within the same family, we can have “high energy” children and those requiring more sleep. While most babies fit somewhere along a spectrum of “normal” sleep requirements, it can help to realize that most infant sleep charts were compiled many years ago when breastfeeding rates were at their lowest, so these observations were based on mostly formula-fed babies sleeping in rooms by themselves under laboratory study conditions.

Settling the Cosleeping Controversy: Get the Facts About Cosleeping, SIDS, Bedsharing and Breastfeeding with special guest Dr. James McKenna

Click here to register for this API Live! Teleseminar to hear hosts Lu Hanessian and Lysa Parker talk with Dr. McKenna about:

  • Why the cosleeping debate?
  • What if the baby won’t transition out of our bed?
  • Can we put the baby in the middle?
  • Can’t there be siblings near the baby?
  • Until what age are the guidelines relevant?
  • Can I nurse lying down? How?

More recently, studies have shown that babies who are fed formula do generally sleep longer at an earlier age than breastfed babies because formula is more difficult to digest. However, if you are thinking that a bottle of formula and banishment to the nursery may be the answer to your baby’s — and your own — sleepless nights, please consider the accompanying risks of premature weaning: You could find the trade-off being hours pacing the floor with an unwell baby. Also, young babies are much safer sleeping near their parents. Since no parents would knowingly trade their baby’s well-being for an uninterrupted night’s sleep, it is better to measure normal by what is safe and healthy.

It may help – or not, if you are suffering from sleep deprivation — to realize that in most infant sleep studies, “all night” is defined as five hours. If you are thinking that even five hours of uninterrupted sleep would be a dream come true, there are some gentle strategies you can try to help your baby, and you, to get more sleep:

  • Learn your baby’s language — None of us like being kept awake when we are craving sleep, so rather than waiting until your baby is “past it,” help her to calm and get ready for sleep as soon as she shows sleepy signs such as becoming quiet, yawning, making jerky movements, losing interest in people and toys, and fussing. If you miss this window of opportunity, your baby is likely to become grumpy and difficult to settle.
  • Offer womb service — Ease the transition from womb to room by snuggling your newborn against your bare skin and heartbeat. Carrying your baby in a sling next to your body is another perfect way to help him feel secure and snug, just as he was in your womb. As well as reducing your baby’s stress levels and relieving symptoms of colic and reflux, which can cause wakefulness, carrying your baby may also help him adapt more quickly to a day/night sleep cycle.
  • Feed your baby — Tiny tummies don’t hold enough food to go long between feedings, day or night. Babies also have appetite increases to match growth spurts. If you are breastfeeding, remember, the more your baby sucks, the more milk you will produce. He needs to suck long enough to get the more satisfying hindmilk, which is higher in calories and will help him sleep more soundly. The best way to do this is to watch your baby, not the clock, and allow him to decide when he is finished with the first breast before you switch sides.
  • Respond quickly — You can’t spoil a little baby, but if you leave her to cry, she will become more upset as her crying picks up momentum. Soon she won’t even know why she was crying in the first place – she will just be crying because she can’t stop and will be much harder to settle. If you are breastfeeding, it is particularly important to respond quickly to hunger cues: A baby left to work up to a full-blown cry will have a more disorganized suck and may have difficulty latching on correctly (when babies cry, their tongues are pointed towards the roof of their mouths), or she may only suck for a short time before she falls asleep with exhaustion. Then she will wake sooner because she is still hungry.
  • Introduce bedtime rituals — Bedtime routines can become cues that help even tiny babies wind down and become conditioned to fall asleep. From the earliest days, give her a deep, warm relaxation bath (sharing a candle-lit bath with your baby will relax you both) just before bedtime and sing her a song (she won’t mind if you don’t have perfect pitch) or use some gentle sleepy words.
  • A magic touch — Silent nights could be at your fingertips: Research from Miami University showed that infants and toddlers who were massaged daily for one month, for 15 minutes prior to bedtime, fell asleep more easily by the end of the study. Gently introduce massage a few strokes at a time when baby is calm so he associates your touch with feeling relaxed. A massage and a bath will be too much for a newborn to handle at once, but when your baby can manage it, try massaging before a bath, then snuggling your baby in a warm towel so he doesn’t become cold and distressed.
  • Soothing sounds — The calming, repetitive sounds of traditional lullabies recall the “womb music” your baby heard before birth: your heartbeat, and fluids whooshing through the placenta. Humming to your baby will calm you both, and baby music that incorporates elements such as the rhythm of the maternal heartbeat and womb sounds can have remarkable soothing effects, especially if played continuously on a low volume through the night.
  • Rock-a-bye baby — The motion of a rocking chair, being carried in a sling, or gently bouncing on a fit-ball (try humming a lullaby as you rock) will lull baby to sleep. So will a special-purpose baby hammock — and as baby moves and arouses during lighter sleep cycles, her movements will start the hammock rocking.
  • All snuggled up — The startle reflex, a primitive survival reflex that produces spontaneous, jerky movements even in sleep, can be disturbing (literally). If your baby isn’t sleeping in a sling or with you, provide a sense of security by swaddling your newborn — wrapping him in a gauze or muslin sheet in summer, or a soft shawl in winter. Gradually swaddle more loosely and discard the wrap as this reflex disappears, at around three months.
  • Cut caffeine — If you are breastfeeding, caffeine can create a vicious circle: You drink coffee (or tea or cola) to give you a hit, baby gets a boost of stimulant through your milk and becomes restless. Newborns are particularly vulnerable to caffeine: A newborn may take up to 97 hours to get rid of caffeine, so the effects will be accumulative.
  • Food intolerance — If your baby’s wakeful, crying spells seem to be related to your diet, keep a food diary. If there appears to be a link, eliminate the suspect food for at least a week. Common culprits include dairy products (milk, cheese, yogurt), citrus, chocolate, and peanuts. Some babies may also react to food additives in soft drinks or processed foods, or chemicals such as salicylates present in a range of otherwise healthy foods such as grapes, citrus, berries, and tomatoes.
  • Do not disturb — Avoid waking baby fully during nighttime feedings by keeping lights dim and talking quietly. If you need to change a diaper, do this either before or half way through a feed, not when baby is all groggy and full. If baby is falling asleep during feedings and only having a short feed, try changing the diaper half way through, then offering the breast again.
  • Let your baby suck up to the boss — Falling asleep on the breast is one of the easiest ways for most babies to settle. This is due to hormones released while your baby feeds, but if you are concerned about it becoming a habit, alternate feeding with other sleep cues.
  • Share sleep — Research shows that mothers and babies who cosleep share the same sleep cycles, so these mothers get more sleep overall.
  • Stop the clock — Simply knowing how long you are awake can be enough to make you too tense to get back to sleep, or it may encourage you to rush your baby and make him feel anxious. If you see your baby’s waking as a genuine need, it could help you to enjoy this precious cuddle time: feel the softness of his skin, breathe in his delicious smell, and snuggle!

#1 on the Breastfeeding Team –> Daddy

By Jarold Johnston, CNM, IBCLC

fatherAs a midwife, lactation consultant, and father of seven beautiful breastfed babies, I’m often asked to share my perspectives with new parents. First, let me say, I have found through personal and professional practice that almost everything is hard the first few days or weeks with a new baby — and breastfeeding is no different.

You will do yourself a favor if you prepare for the challenges by learning all you can before your progeny is born. I encourage you to talk to your health care provider, lactation consultant, and especially friends who have successfully breastfed for more than six months. Learning from successful and experienced breastfeeding friends is a good way to get honest, accurate information and avoid the myths that make breastfeeding so very challenging. I warn you to ignore the advice of couples who failed at breastfeeding, as their perspectives, while honest, may not always be accurate.

Before we can talk about your role in breastfeeding, we have to first answer the most fundamental question: Why would anyone want to breastfeed? In the old days, we used to talk about the benefits of breastfeeding and you will still hear some people mention it, but not me. Believe it or not, breastfeeding doesn’t make your baby bigger, stronger, faster, or smarter. Breastfeeding doesn’t make him super-human, it just makes him human. Continue reading

The Grandparent Challenge

By Sonya Fehér, contributing editor for the API Speaks blog, leader for API of South Austin, Texas, USA, and blogger at www.mamatrue.com

Sonya FeherHow many of us arrived at Attachment Parenting because we wanted to parent differently than we were parented? I have had the (mis)fortune recently of witnessing exactly how I was parented. First my mom came to visit, then my dad. It’s hard to get the distance to observe our relationship objectively, but watching each of them with my son was illuminating.

Unclear Boundaries

First was my mother’s inability to say no. While I am certainly not interested in the “no” that frequently is an automatic reaction in parenting, what gentle discipline means to me is that it is my responsibility to help my son by setting appropriate limits. Parental guidance means he doesn’t have to figure out what is okay or safe on his own. Continue reading

Infant Massage, Demystified (& Interview with massage therapist Robin Gillies)

By Robin Gillies, LMT, www.breathingroomnyc.com 

Infant massageThe secret of infant massage, in my opinion and experience, is this: Mothers and fathers — especially those who practice Attachment Parenting and therefore really in touch with their children — will know instinctively how to touch their babies.

Here is what I think you need to know: Most babies prefer to be touched with lubrication. Their skin is so sensitive that dry touch can feel tickle-like.

Always use a pure, food-grade oil that is free of preservatives and fragrances — ideally, organic. Babies put their body parts in their mouths, so they are likely to ingest whatever you’re using. Also, the skin is the largest organ of the body and it absorbs everything that is put on it. So if you wouldn’t spoon-feed it, don’t apply it to the skin. In the same vein, never use any products that contain parabens or any petroleum derivatives. Mineral oils are linked to lung problems and skin disorders. And, obviously, they are non-renewable resources. Other than being incredibly cheap for cosmetic companies, they have no value.

Interview by Art Yuen, leader for API of New York City USA & member of the API Board of Directors

ART: Where did you receive your training in infant massage?

ROBIN: I was trained and certified through The Loving Touch Foundation. Interestingly, it was in these classes that I learned all about Attachment Parenting for the first time.

ART: You mention that effective massage isn’t about the strokes. Can you expand on this?

ROBIN: All groups that train and certify teachers have some protocol of strokes that they teach. And this isn’t a bad thing. It gives parents and teachers a way to organize their approach. All of us like to have direction when we’re feeling at a loss as to “where to start.”

But if parents feel like they’re not “qualified” to be massaging their own babies simply because they don’t know the “strokes,” I feel it’s my job to quickly demystify the whole thing.

Also, a checklist of strokes is often a challenge for perfectionist types or anyone who finds it difficult to leave a task undone, like me. I’ve seen parents insist on finishing a stroke ten times on one leg because it is on their handout, even though their baby is writhing and pulling away. They just can’t stand to leave the stroke undone.

So, now when I teach, I try to teach parents a variety of approaches while highlighting the ones that seem to work. I’ll say, “Wow, look at that: She’s really smiling when you do that. Keep that in mind and see if it’s as big a hit next time.” This seems to help parents remember a relevant stroke, and I hope it helps to reinforce responsiveness.

What I tell parents: Don’t worry about the strokes — just touch your baby a lot and often — so long as baby seems to like it.

Infant Massage 

Infants move through a cycle of “alert” states:

  1. Drowsy
  2. Quiet Alert
  3. Active Alert
  4. Crying

We want to massage our infants in the quiet alert state. I find it interesting that so many books and teachers encourage after-bathtime massages — which usually precedes sleep time — when babies are restless, irritable, and tired. Bath time is great because our babies are conveniently naked. But if they are not in the quiet alert state, it is not a good time for massage.

How do we know if they are in the quiet alert state? Their bodies are relatively still. They are not crying. And they make or keep eye contact with you. Usually after waking and a feeding, babies will be content to be massaged.

How to do it:

  1. Find a place that is comfortable for you and baby. On the floor is a great place, if you are comfortable. Have a small pillow or rolled-up blanket to place under Baby’s head to assist him or her in easy eye contact. The comfort of the massage “giver” is fundamental. So find a position that you enjoy that keeps you both stable, relaxed, and in eye contact with one another.
  2. Baby should be in just a diaper, or naked on some sort of wee-wee pad or water-resistant surface.
  3. Make sure the room is very warm, and select soft  music that your baby seems to relax to. Ideally, use the same music every time, as the baby will begin to associate it with relaxation time.
  4. Use a little bit of oil on your hands, rubbing them together to warm both your flesh and the oil before touching the baby. Feet or toes and legs are a good, non-invasive but nerve-rich places to start. Play with pace, rhythm, direction of your touch and just observe your baby’s responses. Giggles, smiles, and coos? Or a grimace and a withdrawn limb? This is the art of infant massage. The silent body language communication. If your baby expresses dislike, try more or less pressure, or a broader surface — using your palms versus finger tips is usually a good rule of thumb with babies. If that doesn’t work, move on to another body part.
  5. Approach the tummy gently. Downward and clockwise strokes can assist movement of gas and digestion. Then maybe the chest, and arms, hands, or fingers. Face massage is taught, but very few babies like it. Try it with yours: forehead, cheeks, chin, ears, and scalp. But watch closely for cues of irritation.
  6. As you touch your baby, notice your breath and your thoughts. We convey so much through our hands. So breathe, be present, and talk to your baby using language that they can associate with this sort of touch. Use words like “breathe,” “relax,” and “melt.” If this feels inauthentic to you, maybe sing a lullaby or hum along with the background music. Be especially mindful of your state of mind when your hands are in your baby’s heart and energy center — the chest and tummy. We are all extra, extra perceptive and vulnerable here.
  7. You can be playful, too! Make up fun sounds with the strokes. Look for sounds that make your baby laugh or smile. Feel free to creatively name the strokes, like “airplane taking off” and make an airplane noise. Your infant will become a toddler soon enough, and this will be a fun familiar massage experience for him or her.
  8. You may flip the baby over on to his or her tummy for back massage. I always take off the diaper for this because, while necessary, diapers energetically “cut off” the torso from the lower body and  long connective strokes with the whole palm of the hand from nape of the neck down to the toes can be very, very helpful. I have found that because most babies have a limited tolerance for massage and for tummy time, it is often better to do the work on the back in an entirely different session. Let it stand alone. And let it be brief. Sometimes a mirror or satisfying rattle or soft toy in baby’s hand while on their belly can keep them peaceful for a few more minutes.

How long should massage last? Ask your baby! It will vary every time. And while massage is relaxing, it is also stimulating for babies. So watch for cues that the quiet alert phase has passed. Averting eyes, squirming, and crying out are all signs.

Frequency is going to be more important than length. So don’t worry if it’s only two or three minutes. Don’t get hung up on thoughts like, “I haven’t gotten to the chest yet!” Just remember where you left off and start somewhere else next time.

Always end your session with lovies and huggies and snugglies and, “I love you’s.”

Never give massage if you’re not in the mood. I cannot say it enough: Everything comes through your hands. If you are anxious, impatient, tired, worried, or not present, your baby will begin to learn these emotions to be associated with the experience of massage.

Massage as a Part of the Sleep Routine

Therapeutic and loving touch can be incorported in to bedtime routines even if the child is not in a quiet alert state, but the approach will differ. Best to have the baby clothed and try long-holding techniques.

Some babies really get grounding from holding of the feet. If they kick and pull away, let it go. Another move all humans love is to have one hand under the small of the back and one hand resting gently on the tummy. This embrace of the solar plexus can be so comforting and quieting. Experiment with a hand just under the small of the back, just on the tummy, and then both at the same time. See how baby responds. Also, holding the baby’s head in your palms with your finger tips gently resting at the place where the skull meets the neck may work.

Holds should be patient and long and still — as long as you observe a gradual quieting of the baby as opposed to agitation or irritability. This is a great time to close your eyes and enjoy your loving thoughts about baby. Think about all the adorable positive moments you had all day. Picture your baby’s beautiful face, smile, and body; remember how it feels to hold them in your arms. Let the energy of these thoughts wash over you. You will — without having to try — be transmitting this to the baby. If you are in to visualizations, try inhaling a bright white light in to the crown of your head and exhaling it out of the palms of your hands in to your baby’s body. If negative thoughts come to you, such as regret or guilt over those moments of the day when you lost your patience or let yourself down, use this time to give some self-love talk: “I love myself when I’m less than the parent I want to be” or “I love myself when I am impatient.”

Your baby will tell you how long the holds should last. Some babies will drift off to sleep. Others will quiet but then crave the rest of their bedtime routine: rocking, nursing, singing, or whatever it may be. Follow their cues.

Massage for Toddlers & Older Children

My son is now 26 months old, and I have not been able to massage him regularly since he was about 16 months old. I miss it, but I’m not worried about it. He must come to it himself now. I was taught that if you massage your baby consistently as an infant, he’d simply grow to be a toddler who craved it. But this seems to conflict with all of my experience, both with Jackson and with my friends’ and clients’ children. All of us who are in or who have been in toddler land, know that having them sit still long enough for a diaper change is challenge enough. So I will offer some ideas for introducing massage to the toddler or older child, but the most important guideline here is, as ever: Let them lead.

After almost a year of disinterest, Jackson has suddenly become interested in massage after seeing me give a massage to my sister. He was fascinated. She was on the floor, and I was doing some combination of Thai, Shiatsu, and Deep Tissue with Oil and he just jumped right in. He was palming her back, rubbing her feet, tickling her, and playing with her hair. Ultimately, I just backed away and watched him respond to her experience of his touch. He saw immediately that she liked having her head rubbed, so he did it for a long time.

The next day, we were on the subway and he licked his finger and then wiped it on my arm. Again and again and again. I asked him what he was doing and he said, “Giving Mommy massage.”

So, my idea about toddlers and older children is rooted in this limited, but I sense also universal, experience: Let your children see you massage someone else that they know, love, and trust.

Again, you don’t have to be a professional massage therapist. Just get some good oil, sit across from a friend, partner, or family member on kitchen chairs with one of their feet resting on your thigh, and give a little foot or calf rub in front of your child. Or while watching your child play, lay another person down on the floor right in the middle of the child’s play space and start to squeeze shoulders — even through the clothes is fine. If  you’re not sure what to do with your hands, just think: how would your tired back, neck, arms, or head like to be touched?

Oil in a colorful container can get a child’s attention. Encourage your massage recipient to give directions or to express pleasure in a way that is natural and authentic for them: “That feels so good,” “a little lower,” “not so deep,” or simply, “mmmmmmm…..”

An instructional video: http://lovingtouch.com/catalog/product_info.php?cPath=11&products_id=47&osCsid=jgave8p2dr9lilgpp21nked9f1

Books: A Vital Touch by Sharon Heller & Touch by Tiffany Field

We live in a touch-deprived society wherein most of our kids learn touch in either a violent or sexual context. Introducing massage gives babies, toddlers, and children a healthy experience of touch. Offer massage in your household. Make therapeutic touch a part of your everyday life and I believe that in his or her own time, the toddler or older child will be attracted to its power. Never force it. Always stop when they say stop. It should be an empowering experience. When they know how it feels to be touched in a way that feels good, they will know what it means to not like certain touch. They will develop body awareness, boundary awareness, and respect for both their own and other’s bodies.  Enjoy being a part of this priceless lesson in life!

Editor’s Note: Read an in-depth interview on infant massage with Linda Storm and Suzanne Reese of Infant Massage USA in the New Baby 2010 issue of the quarterly The Attached Family magazine, due out to readers in June.

The Danger of Pharmaceuticals

By Adrienne Carmack, MD

Danger of PharmaceuticalsIn April 2005, Rani Jamieson gave birth to a healthy baby boy, Tariq. She was given Tylenol #3, a medication containing acetaminophen and codeine, for postpartum pain. She took two pills twice a day, less than the prescribed amount, and cut this dose in half two days later after experiencing fatigue and constipation. She was told it was safe to take this medication while breastfeeding, and did so.

When he was seven days old, Tariq became excessively sleepy and had trouble breastfeeding. His mom began pumping and froze her extra breastmilk while continuing to nurse. She brought Tariq in to see his pediatrician when he was 11 days old for poor feeding; the pediatrician noted he had regained his birth weight and nothing further was done. On his 13th day of life, Tariq became unresponsive. When the ambulance crew arrived, he was already dead. Six months later, an autopsy showed a deadly overdose of the codeine his mother had been taking.

Codeine is generally regarded as a safe medication for use by breastfeeding moms immediately postpartum. In 2001, the American Academy of Pediatrics issued a report stating that codeine had not been reported as causing signs or symptoms of problems in breastfed infants and that it had no effect on lactation. It was included in a list of medications “usually compatible with breastfeeding.” Actually, several reports of apnea in infants whose mothers were taking codeine had been previously reported, in 1993 and 1984, according to a study published in the January 2007 issue of Canadian Family Physician.

Even today, the Academy of Breastfeeding Medicine, a breastfeeding advocacy organization, reports that codeine is generally a suitable choice for postpartum pain. In their report on pain control in breastfeeding mothers, they advise limiting doses of pain medications to the minimum amount necessary and suggest that nonpharmacologic means of pain control such as hypnotherapy may be better. However, they ultimately conclude that codeine is generally safe because it has been widely used by millions of women worldwide.

How can a medication that has been safely used in millions also be dangerous enough to kill a newborn baby, even when used at lower doses than the standards recommended? Scientists have recently begun studying the role of genetic variations in drug reactions. They have found that individuals with certain forms of genes are more likely to metabolize drugs in ways that lead to higher side effects. For example, the chemotherapy drug cisplatin causes hearing loss in some of the people who receive it, particularly children. However, until recently, no one knew why this was. It’s now been shown that certain forms of genes are responsible for this side effect, as published in the September 2007 issue of American Journal of Human Genetics.

For codeine, the answer lies in a gene called CYP2D6. Those with a certain form of this gene metabolize codeine very rapidly. Codeine works as a pain medication after it is metabolized to morphine, which then acts on pain receptors in the body. Those who metabolize codeine very rapidly end up with very high levels of morphine in their bodies very quickly. In the case of Tariq, his mother had symptoms early on, suggesting that she was a “fast-metabolizer” of codeine. Tariq was found to have morphine levels of 90 ng/mL, much higher than the level usually seen in infants receiving intravenous morphine, about 12 ng/mL. Rani’s frozen breastmilk contained 87 ng/mL of morphine.

Why, before codeine was deemed safe for the infants of nursing mothers, weren’t morphine levels in breastmilk studied? They were. A study published in The Journal of Human Lactation in 1993 measured the levels of morphine in the blood and milk of seven mothers taking codeine and in the blood of their infants. The levels of morphine in the infant’s blood never exceeded 2.2 ng/mL, which is generally considered a safe level, and is much lower than the levels found in Tariq’s blood.

Claims of medication safety are usually made after drugs have been tested in uniform populations at standard dosages, not in diverse populations that represent our society. In the case of CYP2D6 gene variations, the fast-metabolizer form occurs in up to 29 of every 100 people, depending on ethnicity, as published in the Canadian Family Physician study. It’s easy to see how measuring the levels of morphine in the milk of seven mothers of an ethnicity with a 1% rate of genes causing fast metabolism of morphine would be unlikely to include a mother with this variation. Had the study been done in mothers of Ethiopian descent, who have the highest chance of having this form of the gene, the researchers likely would have seen very high levels of morphine in the milk of at least one of the mothers.

Given these facts, it is likely that millions of infants worldwide go through their first days of life sedated and drowsy, while their mothers are reassured that the medication they are taking is harmless. Many new moms, unfamiliar with an infant’s behavior, may not recognize that their babies’ behavior is unusual. If they do worry and seek medical care, many doctors would fail to recognize the symptoms as a drug effect. One can only surmise the effects of this early drug exposure on brain development.

Genetic mutations such as this also account for other side effects of medications. For example, the CYP2D6 gene is also important in how the body handles another pain medication, tramadol. Those with the gene variation causing rapid metabolism are much more likely to experience nausea than those who do not. Half of rapid metabolizers develop nausea, compared to only 9% of those who are able to metabolize tramadol completely, according to a study published in the February 2008 issue of Journal of Clinical Psychopharmacology. Similarly, individuals with this form of the gene who take codeine have a 91% chance of becoming excessively sleepy with the medication, compared to 50% of those without it. Those who metabolize codeine very rapidly have 50% higher levels of morphine in their systems.

This new understanding of the role genes play in the way our bodies process drugs illustrates the reasons why pharmaceuticals that seem safe can still be very dangerous. Since this report was published, some strategies that have been recommended are using medications such as ibuprofen instead of codeine in breastfeeding mothers, using codeine for a shorter time after the baby is born, or even performing genetic studies in all mothers to determine if it is safe for them to use codeine while breastfeeding. These strategies are flawed. Simply reducing or changing the pain medication used is not likely to be effective in controlling a mother’s pain. Carrying out mass genetic screening would be extremely costly and time-consuming.

Not only are these strategies impractical, they fail to address the real issue. Pharmaceuticals are dangerous. Reports indicate that adverse drug events occur in 67 of every 1,000 hospitalized patients and are fatal in 3.2 of every 1,000 patients, according to a study published in the April 1998 issue of Journal of the American Medical Association. Worse, 95 of every 1,000 hospitalized children experiences an adverse drug event. Of every 1,000 children admitted to the hospital, 20.9 are admitted because of drug reactions. Almost half of these are life-threatening reactions. It’s estimated that 14.6 of every 1,000 children who are not hospitalized will experience an adverse drug reaction, as published in the July 2001 issue of British Journal of Clinical Pharmacology. According to the United States Food and Drug Administration, if these rates are accurate, adverse drug reactions are the fourth-leading cause of death in the United States. Even when drugs are thought to be safe for many years, using them can still have devastating consequences.

The best strategy, one that isn’t commonly proposed, is simply avoiding medications in the first place. Medications are widely overused. In the case of postpartum pain, choosing a natural childbirth, with alternate methods of pain control if needed, provides the safest environment for the baby. This option avoids the risks of codeine in particular and also lets women avoid all of the drug effects that are not yet understood and can’t be predicted. If a mother does feel that taking a medication is important for her health or that of her child, she should diligently watch for any side effects. Mothers are wise to listen to their bodies and to not hesitate to seek alternate treatments if concerning symptoms occur while taking a drug.

Some mothers who chose to avoid drugs while pregnant and breastfeeding do so because they are aware of studies showing the harms this can cause to their infants. Most, however, likely are led to this choice by their innate wisdom. The choice to have a natural childbirth is often criticized as unnecessary because of claims that drugs such as codeine are safe. The new understanding of genetic variations provides evidence that the instincts of mothers who choose to avoid these situations should be trusted.

Mothers who are in a situation where they are offered pharmaceutical treatments should carefully weigh the potential, unknown risks of taking these medications. Because the effects a drug will have on one individual cannot be predicted by what has happened in others, one cannot be too cautious in making this decision. As with many parenting decisions, the choice to use pharmaceuticals cannot be taken lightly. It is prudent for all individuals, but especially nursing mothers and growing children, to avoid these potentially toxic chemicals whenever possible.

Parenting without Punishment or Reward…Really?

By Larissa Dann, Australia’s parenting editor for The Attached Family

Really?I was 31 years old. In my arms, I held another life. He was warm, pliable and soft, caked in afterbirth, and seemed breakable. He had huge blue eyes and now he relied on me. Such a huge realization: I had to grow up now as I was largely responsible for meeting all his needs – his nutrition, his physical and emotional needs, his safe passage through life.

I was also, overwhelmingly, in love.

There was, I realized, a dilemma for me. In my entire life, I think I had only ever held one baby. I did not know how to change nappies or what to do when he cried. All I had to guide me through this parenting jungle was the dimly remembered and experienced way I was brought up.

That way meant lots of affection. It also meant lots of smacking — at least once every six months because, as I recall my mother saying, we just needed that spank to get us back in line.

When my son was eight months old, he bit me during an exuberant breastfeeding session. I did not know what to do: I thought the only tool at my disposal was to punish him, so I tapped him lightly on the foot. I still remember how he pulled off the breast straight away, and looked at me, his round eyes totally puzzled. I was lost: This did not feel good. What else could I do?

Putting the Relationship Back into Parenting

Serendipitously, around that time, a friend asked if I’d like to take her place at a parenting course called Parent Effectiveness Training (P.E.T.) that teaches a relationship — and, I now believe, an attachment — approach to parenting. I had no idea what it would entail — I just knew I needed all the tips I could find on this new journey.

The course was life changing for me. I learned that children were people! I learned they deserved respect, but the most mind-blowing and challenging tenet of this approach to parenting was that I could eschew the use of rewards and punishment.

Wow!  This was big! All my assumptions about being a “good” parent, which was based a lot on my experience of being parented — that was all being questioned and, ultimately, thrown out the window. Now, my guide to being a parent was about building a relationship with my child, not trying to control him. This was a fundamental shift in the foundations I had been preparing for parenting.

Meeting Skepticism with Resolve

Could I do it? Could I really bring up a considerate, caring child in today’s world, without bringing him into line using the old carrot and stick? Wouldn’t he end up spoiled and self-centred? I proudly told my mother of my plans, and excitedly described all the new skills and philosophy I had just learned.  She listened, skeptically.

A week or so later, my mother relayed a story and advice from her golfing friends. She had told them I was planning to bring up my son without smacking him. They all laughed, saying I would soon find out that was impossible. I bowed my head, more determined than ever. I was going to do this, and my son would benefit!

I was influenced to take change my attitude toward parenting by authors such as Thomas Gordon who wrote Parent Effectiveness Training and Teaching Children Self Discipline, and Louise Porter who wrote Children are People, Too. These authors demonstrated a strong case against using rewards or punishment. Daniel Goleman’s Emotional Intelligence further cemented my resolve to rely on relationship skills.

Change Begins with a New View of Children

And so, this journey through positive parenting began. How was I going to avoid using praise, or star charts, or stickers? What would I do when I couldn’t put my child in timeout, count to three, plan a consequence for his actions, or be able to smack him?

I was helped by an underlying ethos from my parent training — that children do not “misbehave.” Instead, they behave simply to meet a need. If I could understand that need, rather than blame my child or see him as deliberately wanting to “get at” me, then I might find it easier to respond to him, rather than punish him.

The Trial of the Toddler Years

Soon, we came to the toddler years. How could I entice him to use the toilet without reward? How could I stop him drawing on the fridge without some consequence? And surely he was too young to understand my verbal communication, and I would need to smack him or put him in timeout?

Somehow, I managed. I did not use timeout or rewards. Instead, I used the relationship skills I’d been taught, with the core belief that he was not being “naughty” or “bad” but simply being a child with unmet needs. I was also guided by the incentive to develop emotional and social intelligence in my son, for him to become empathic and considerate.

Making a Long-term Commitment

Having emerged relatively unscathed through the toddler years, I decided I wanted to teach this style of parenting. One motivation was that teaching the skills would help keep me on track with using the skills personally. I have now been teaching P.E.T. for more than 13 years and love it!

Attention Parents: Attachment Parenting International Leadership is a great way to continue educating yourself on Attachment Parenting — and “keep yourself in line” — while also getting the added benefit of educating and supporting other parents. Learn more here.

Parenting in this way has resulted in some interesting judgements by family and friends. I have been seen as “giving in” to my children, because I don’t insist they do everything my way. “You let him win that time!” is a never-forgotten comment by my grandmother. My take on those same  situations, however, has been to see the outcome as a win-win for both my child and myself.

Being a teacher of parenting has it’s own social issues. I was once meeting my cousin and her friend who had been a student in the course. The ex-student was reticent with me and later told me that she had warned her children to behave as they were going to be seeing the parenting teacher! In my eyes, I’m just a mum, who happens to have taken a certain path.

Still Learning

It hasn’t all been smooth sailing. I am no perfect mother — just ask my children! They will happily fill you in on where I could do better. I make heaps of mistakes, but I forgive myself because I am human and then apologize — a lot! And I continue to delight in my children.

My son is now a teenager, and I am thoroughly enjoying walking beside him as he negotiates this difficult stage in life. I am excited by who he is becoming and I value our relationship every day. I have not grounded him and he is aware that this is not an option for me.

My younger child is another delight, and I marvel at her sparkle every minute I am with her. We have our moments, as does any relationship, but our attachment bond is strong. I hope that her entry and movement through adolescence is as exciting and wondrous for us both, as the journey her brother is taking.

Validation

Recently, my mother complimented me.  She acknowledged that she thought it would be impossible to bring up children without physical punishment. Now, when she looks at my children, she sees that it is possible.

For me, taking this approach to parenting seems to be fulfilling my goals as a parent. It may not be everyone’s cup of tea. I just wanted to share that choosing to parent in this fashion — relying on relationship rather than behavior management — is possible…if you trust yourself, your children, and your motivation.