Tag Archives: infant care

What’s the Big Deal with CIO?

By Margaret Chuong-Kim, MA

Among parents of infants these days, there is constant debate about how to respond to a baby’s cries. On one hand, there are proponents of the “cry it out” method, where the baby is left alone to cry in the hopes that he or she will eventually stop. On the other hand, there are the attachment parents who respond immediately to their crying babies and attempt to soothe them using various methods including holding and cuddling. While the cry-it-out (CIO) method has been popular in previous years, Attachment Parenting (AP) is gaining a foothold among new parents today. Results of studies in psychology indicate the AP approach to crying is most likely to result in an emotionally and physically healthy child.

The Origins of AP

Attachment Theory originated in the late 1960s, when psychologist John Bowlby postulated that a warm, intimate relationship between caregiver and infant is necessary for optimal health as well as for basic survival. As such, each individual is born well-equipped with reflexes and instincts for interacting with a primary caregiver, which is often the mother. For example, infants quickly learn to recognize and prefer both their mother’s voice and smell. As babies develop some locomotor control, they display their desire to be close to their caregivers by reaching toward their mother or father to be picked up or by crawling toward them. From an evolutionary perspective, these behaviors have survival value. Babies who lack such attachment behaviors will stray from their caregivers and are more likely to get lost, attacked, and perish. An infant’s cry is also intended to increase the likelihood of its survival, as a mother’s instinct is usually to go to her child at the first sign of distress.

We live in an age where we can know that the baby is safe in another room, despite the loudness of his cries. Does this mean we should leave babies to cry on their own? CIO proponents often advise that babies left to cry will eventually stop, and the duration of future crying bouts will decrease. What are the emotional consequences of crying for the infant when she is left unattended? Bowlby and colleagues initiated a series of studies where children between the ages of one and two years old who had good relationships with their mothers were separated from them and left to cry it out. Results showed a predictable sequence of behaviors:

  1. Protest consists of loud crying and extreme restlessness.
  2. Despair consists of monotonous crying, inactivity, and steady withdrawal.
  3. Detachment consists of a renewed interest in surroundings, albeit a remote, distant kind of interest.

Thus, it appears that while leaving babies to cry it out can lead to the eventual dissipation of those cries, it also appears that this occurs due to the gradual development of apathy in the child. The child stops crying because she learns that she can no longer hope for the caregiver to provide comfort, not because her distress has been alleviated.

AP and CIO Effects on the Amount of Crying

Do babies cry more when they are attended to? A 1986 study concluded just the opposite: The more a mother holds and carries her baby, the less the baby will cry and fuss. Cross-cultural studies also show that parents in non-Western societies are quicker than parents in Western societies to respond to their crying babies, and babies in non-Western societies cry for shorter spans of time. Caregivers in 78% of the world’s cultures respond quickly to an infant’s cries. For instance, Efe caregivers in Africa respond to a baby’s cries within ten seconds at least 85% of the time when the baby is between three and seven weeks old, and 75% of the time when the baby is 17 weeks old. !Kung caregivers respond within ten seconds more than 90% of the time during the baby’s first three months, and more than 80% of the time at one year old. In contrast, American and Dutch caregivers have been found to be deliberately unresponsive to an infant’s cries almost 50% of the time during the baby’s first three months. Infants in non-Western societies have been found to fuss just as frequently as those in Western societies, but due to the prompt response of caregivers in non-Western societies, the overall cumulative duration of crying is less than what occurs in Western societies.

How AP Works

According to Attachment Theory, many babies are born without the ability to self-regulate emotions — that is, they find the world to be confusing and disorganized, and do not have the coping abilities required to soothe themselves. Thus, during times of distress, they seek out their caregivers because the physical closeness of the caregiver helps to soothe the infant and to re-establish equilibrium. When the caregiver is consistently responsive and sensitive, the child gradually learns and believes that she is worthy of love and that other people can be trusted to provide it. She learns that the caregiver is a secure base from which she can explore the world, and if she encounters adversity, she can return to her base for support and comfort. This trust in the caregiver results in what is known as a secure individual.

Children who do not have consistently responsive and sensitive caregivers often develop into insecure individuals, characterized by anxious, avoidant, and/or ambivalent interactions. Long-term studies have shown that secure individuals, compared to insecure individuals, are more likely to be outgoing, popular, well-adjusted, compassionate, and altruistic. As adults, secure individuals tend to be comfortable depending on others, readily develop close attachments, and trust their partners. Insecure individuals, on the other hand, tend to be unsettled in their relationships, displaying anxiety (manifesting as possessiveness, jealousy, and clinginess) or avoidance (manifesting as mistrust and a reluctance to depend on others). North American parenting practices, including CIO, are often influenced by fears that children will grow up too dependent. However, an abundance of research shows that regular physical contact, reassurance, and prompt responses to distress in infancy and childhood results in secure and confident adults who are better able to form functional relationships.

The Dangers of CIO

It has been suggested in the past that CIO is healthy for infants’ physical development, particularly the lungs. A recent study looking at the immediate and long-term physiologic consequences of infant crying suggests otherwise. The following changes due to infant crying have been documented:

  • Increased heart rate and blood pressure
  • Reduced oxygen level
  • Elevated cerebral blood pressure
  • Depleted energy reserves and oxygen
  • Interrupted mother-infant interaction
  • Brain injury
  • Cardiac dysfunction.

The study’s researchers suggested that caregivers should answer infant cries swiftly, consistently, and comprehensively — recommendations that are in line with AP principles.

CIO or AP as a Matter of Perception

CIO supporters tend to view their infants’ cries as attempts to manipulate caregivers into providing more attention. Holding this view can be detrimental to the immediate and long-term health of the baby. In the field of cognitive psychology, there exists the premise that our thoughts underlie our behavior. Thus, if we think positively about an individual, our behaviors toward them tend to be positive as well. Conversely, if we think negatively about an individual, we will behave correspondingly. Consider people in your own life whom you consider manipulative — how does that perception influence your behavior toward them? It is unlikely that the interpretation of a manipulative personality will result in the compassionate, empathetic, and loving care of that individual. Infants, quite helpless without the aid of their caregivers, may suffer both emotional and physical consequences of this type of attitude.

When faced with a crying baby, it may be prudent to ask yourself the following questions: Why am I choosing this response? Do I want my baby to stop crying because he feels comforted and safe, or do I want my baby to stop crying for the sake of stopping crying? What is my baby learning about me and the world when I respond in this manner? If I was a baby and was upset, how would I want my caregivers to respond?

Reprinted with permission from http://drbenkim.com.

UK Study on Orphaned Chimpanzees Could Benefit Human Orphans

From API’s Publications Team

ChimpanzeeA study published in the Development Pyschobiology journal involving the care of orphaned chimpanzees could help change the way human orphans are cared for.

According to an article in the European Union’s CORDIS News, “Chimp Study Highlights Importance of Emotional Care in Childhood,” orphaned chimps that were mothered by humans fared better emotionally than chimps raised in a more institutional setting.

The study, which was conducted at the Yerkes National Primate Research Center’s Great Ape Nursery in Atlanta, Georgia USA, was funded by the FEELIX GROWING project. In the study, the chimps that received emotionally responsive care — which included time with human caregivers doing grooming, playing, and other interactions — were happier, smarter, and more emotionally adjusted than chimps given standard care, which focused solely on meeting physical needs.

The mothered chimps were less easily stressed, less often attached to comfort items such as blankets, had healthier relationships with their caregivers, and were more cognitively advanced.

The insitutionalized chimps were more likely to display disorganzied attachment behaviors such as rocking or clutching a comfort item when distressed instead of turning to the caregiver. Because similar behaviors have been noticed in human orphanages and with neglected and abused children, the study’s authors believe  theproposed strategies of increasing emotionally sensitive caregiving to orphaned chimps can be translated to orphaned humans.

“The attachment system of infant chimpanzees appears surprisingly similar to that found in human infants,” said Professor Kim Bard of the University of Portsmouth in the United Kingdom. “Early experiences, either of warm, responsive caregiving or of extreme deprivation, have a dramatic impact on emotional and cognitive outcomes in both chimpanzees and humans. Parental sensitivity is an important factor in human infant development, and it would seem the same is true for great apes, as well.”

To read the entire article, go to http://cordis.europa.eu/fetch?CALLER=EN_NEWS&ACTION=D&SESSION=&RCN=30417.

Planning for the Postpartum Period

By Molly Remer, MSW, CCE

**Originally published in the Spring 2008 New Baby issue of The Journal of API

Molly and son
Molly and son

When my first baby was born in 2003, I made a classic new mother error – I spent a lot of time preparing for the birth, but not much time truly preparing for life with a new baby.

I had regularly attended La Leche League meetings since halfway through my pregnancy and thought I was prepared for “nursing all the time” and having my life focus around my baby’s needs. However, the actual experience of postpartum slapped me in the face and brought me to my knees.

Hurrying to Rejoin the World

My son’s birth was a joyous, empowering, triumphant experience, but postpartum was one of the most challenging and painful times in my life. I had not given myself permission to rest, heal, and discover. Instead, I felt intense internal pressure to “perform.” I wondered where my old life had gone, and I no longer felt like a “real person.” A painful postpartum infection and a difficult healing process, with a tear in an unusual location, left me feeling like an invalid. I had imagined caring for my new baby with my normally high energy level, not feeling wounded, weak, and depleted. Continue reading Planning for the Postpartum Period

Sibling Spacing: Two Years Apart and Getting Easier with Age

By Melissa Hincha-Ownby, API Resource Leader of Arizona, API’s Technology Coodinator, and API’s Forum Administrator

**Originally published in the Spring 2008 New Baby issue of The Journal of API

Melissa's son and daughter
Melissa’s son and daughter

One of the most common questions that parents ask themselves when they are considering expanding their family is, “What is the ideal spacing between children?” There is no right answer to this question, as what is ideal to one family may make no sense to another.

The answer for our family was two years. My sister and I are three and a half years apart, and while we are the best of friends now, the age difference left us both alone in high school. Based on my personal experience with my sister, I knew that I didn’t want my children quite so far apart.

Although two years was on the maximum end of what my husband and I were hoping for, fate stepped in and had other ideas. Ultimately, my daughter was born when my son was two years and three months old. In hindsight, the 27-month difference has turned out to be great. However, in the early years, at times, things were definitely tough. Continue reading Sibling Spacing: Two Years Apart and Getting Easier with Age

Anna’s Story: The Importance of Hearing Screenings in Newborns

By Kathie Dolce, HBCE

**Orginally published in the Fall 2007 Special Needs issue of The Journal of API

Anna & her cochlear implant
Anna & her cochlear implant

When my granddaughter Anna was already over a year old, her parents began to realize she did not hear. Before this, Anna had made lots of sounds, including “mama,” “dada,” and everything else babies usually say. She seemed very tuned-in to everything around her, knew when her mom came home and made the sign to nurse before mom even came into view. But she had never startled to sound of any sort.

Her older siblings played a game of coming up behind her and tapping her shoulder, whereupon Anna would spin around and laugh hysterically. Her parents realized that she did not hear her siblings sneaking up on her. As Anna stopped vocalizing, her parents became concerned that she was losing her hearing.

Her audiogram at 15 months showed Anna to be profoundly deaf and subsequent CT and MRI imaging indicated that she was missing more than two-thirds of her cochlea – inner ear structures that form at six to nine weeks gestation. She was also missing the acoustic nerve on one side. Anna never had hearing. (There is no prenatal testing or imaging that could have shown this.)
Continue reading Anna’s Story: The Importance of Hearing Screenings in Newborns