CAVEAT EMPTOR: “Let The Buyer Beware”

Some of you will have heard me speak of other people in my field of work: many capable, competent, qualified and caring people who do a great job. You may also have heard me speak of those I call Somewhat Less Qualified: people with five-minute internet “diplomas”, and those with no relevant qualifications at all: just the gift of the gab, plus or minus a well-timed publishing deal.

It is hard to find somebody who does what I do: actual Mothercraft Nurses are uncommon nowadays. The need for the care we provide has not. The gap has been partially filled by people whose websites give equal emphasis to generic mentions of what their philosophy might be and how much they charge for their services. It’s a business. Sure, many of these people are well meaning. Their websites tell me they succeeded in settling their own kids, their neighbours’ kids, so they thought hey, why don’t I do this while the kids are at school. That would be great, if the courses they paid a lot of money for placed more emphasis on science based, peer reviewed knowledge and less on how much to charge for a Phone Consultation (I do not charge a cent for a Phone Conversation. Never have, never will.)

Despite my tone, I am generally loath to poo-poo on the advice my clients have been given prior to us meeting: with three exceptions. Firstly, safety. Never compromise on safety. Secondly, I will always respectfully disagree with advice which is at odds with the baby’s developmental state. You cannot force a baby to do what he is not yet capable of doing. Thirdly: I will never, ever support “sleep training” that tries to force a baby into category two. I only condone methods that combine an awareness of what is developmentally appropriate with a gentle approach.

It is so important to be really aware of a few simple facts regarding babies:
1. They are not scaled down adults; their bodies and brains are immature and constantly growing.
2. This growth means change. What he did last week is not always an indication of what he will do this week.
3. All growth spurts, developmental leaps, etc come in “two-steps-forward, one-step-back” format. They rarely happen in one giant, simple “click”.
4. No matter how hard you try, you cannot “train” a baby who is not physically ready to do what you want him to do.

Babies are not puppies. They cannot be “trained”. Semantics, I hear you say. Perhaps. But when dealing with sleep deprived and anxious parents, I find that the language used is very important. So what do I do then, if it’s not sleep training? I teach my parent clients what I call responsive settling. In a nutshell:
1. Learn to know your baby. Get an understanding of where he is at developmentally.
2. Learn what is average, and what is normal for his stage, and remember the difference between the two:
NORMAL………………………………..AVERAGE………………………………..NORMAL

3. All babies are individuals. Babies without a health issue or disability follow a fairly predictable path, but allow for your baby’s individuality along that path.
4. Don’t rush it! Your baby may not yet be capable of what you want him to do.
5. Find a qualified and experienced professional person to help you on your way: if they can’t expand on the points above without resorting to terms like “sleep training”, keep looking.

“Sleep training” is a big business now. Be careful to take a good look at the actual qualifications and experience of anyone you consider asking for help. Don’t be afraid to ask lots of questions, and if they can’t explain their methodology to you in a way that makes both you and your baby feel at ease, then they are not the right fit for you and your family.

Dads and boys: toddler sons, and emotional development…

An acquaintance and I were discussing his child’s behaviour, specifically his emotional development, and our viewpoints were very different.

Tom’s view is that, as a father, he should display a degree of disinterestedness in his two year old son’s emotional behaviour (for example, when he falls and cries) in order for his son to learn to “toughen up”. He also sees this as a necessary foil to his wife’s perceived over-reaction to the same scenario.

Interestingly, I’ve had similar conversations with several fathers recently, and all of their children are boys, between two and five years old.

Here’s the general theme: when my son is hurt, he displays an exaggerated response, to which my wife over-reacts. I under-react, to balance it out, and so that my son will learn that his overly emotional behaviour will not get a response from me. If I ignore his emotional behaviour, he will learn to toughen up.

I have two responses to this.

Firstly, when your son falls over, I suggest that both you and his mother should display the same response: wait a moment to see if he’s hurt. If he is hurt, he will hold his breath a second from fright, then begin to genuinely cry. This is when, obviously, you do pick him up and assess what’s hurt, and provide first aid (if needed) and love, cuddles and reassurance. He’s hurt. He needs you to make it better, both practically and emotionally.

If he’s not hurt, give him a little clap – the “golf clap” – and say something like “whoops-a-daisy, up you get, you’re okay!” Your tone (cheerful and calm) and your words reassure him that he is okay: sometimes, with a fright, toddlers aren’t sure! Remember how very much our toddlers take their cues from us. If he falls and you freak out, before seeing if he’s actually hurt, he will think there is a reason for distress because Mummy (or Daddy, or Nanna) seems upset. If your little one is in the habit of throwing on the drama with every stumble, try consistently responding with the golf clap and the cheery reassurance. You’re fine, let’s go and climb on the slide. Distraction works wonders. (Don’t distract with a treat for every stumble. I have a friend whose well meaning mother in law dealt with every whine with a chocolate biscuit. That’s another story…!)

Secondly: We need to be emotionally available to our children, as needed, in an appropriate way. If your consistent response is as outlined above (i.e. a little reassurance when child is not hurt, comfort and aid when child is hurt) then your child will know that help is there if it is needed. That knowledge helps him develop feelings of security and resilience. Resilience and security lead to independence.

 

 

FAQ: Controlled Crying

In discussing the pros and cons of letting babies cry, there is one very important point that must be made first:

If your baby is crying and you feel that you are about to lose control and become upset with your child, leave the room. Leaving baby to cry for a few minutes while you calm yourself will not harm him.

What is controlled crying?
“Controlled crying” is currently used as an umbrella catch-phrase for all sorts of settling techniques, including what can only be called “uncontrolled crying” (the practice of repeatedly leaving a baby to cry himself to sleep).
Actual “controlled crying” or “controlled comforting” requires the parent/carer to wait a prescribed amount of time before entering the room to provide comfort to a crying baby / child.

Does it work?
It can be a useful tool, in some instances, with older children. I find it counter productive with children under two.

Does it harm my baby?
This recent study shows quite clearly the harm that uncontrolled crying can do; an abstract of the research is here:
http://www.earlyhumandevelopment.com/article/S0378-3782%2811%2900270-2/abstract
What this means, in a nutshell, is that babies who are left to cry do stop crying, but they do not stop being stressed.

Do you practice controlled crying?
I neither condone, support, teach nor practice controlled-crying-type methods with small babies.

LEARNING THROUGH REPETITION

Babies learn by experiencing repetition. No matter what you do, if you do it regularly, your child will expect it as normal. Keep in mind that, from their perspective, it’s been done this way all their life. If, for example, you always make a cup of tea every morning when you first get up, your little one will expect that to happen. Or if you always play a CD of Brahms lullabies when you put your baby to bed, then they will come to associate hearing that music with going to bed and going to sleep.

The point is, you need to be consistent and persistent with whatever you do. Because littlies learn through repetition. Babies and toddlers can’t tell the time: they learn to predict their day through the regular circumstances that occur throughout their day, and they build a feeling of security based on this “knowledge of routine”. So if you check the mailbox at 10am every day with Mister Three, he’s going to expect it. If you read three stories to Miss Two before bed every night, she’s going to expect it. If you change Miss Seven Month’s nappy and play peek a boo in the middle of every feed, she’s going to expect it.

There are two types of consistency: consistency of routine, and in the case of older babies/toddlers and older children, consistency of boundaries.Consistency of routine provides security through the ability to predict events. Consistency in the setting of boundaries provides a framework for the ability to predict outcomes. Babies and children who have consistency (both of routine and of boundaries) are more secure and settled in their behaviour because they know what to expect (routine) and what is expected of them (boundaries).

Examples:

Routine: If you are consistent in your habit of making a cup of tea every morning when you first get up, your child will expect that circumstance, and derive security from the familiarity of it.

Boundaries:

Babies: One good example of setting a boundary for babies is an obvious physical boundary that keeps them from harm, such as stair gates.

Toddlers:You buy a new lounge suite, so you decide that you will have a family rule that there is to be no eating or drinking on the new lounge suite. If you are consistent in enforcing the rule, the child knows what is expected of him. He also knows that if he takes food to the couch, he will be told to go and sit at the table. Knowing that he may not sit on the couch with his Vegemite toast helps him understand what is expected of him. If he can do it sometimes and not others, he will not understand the difference, and certainly not understand why he is in trouble for doing something he did not get in trouble for yesterday. (This is an excellent example of a rule that must be enforced by all the adult-carers, and should apply to the whole family too!)

 

Mentoring New Mums

Something I’ve been doing a lot more of again lately – and meaning to blog about – is mentoring new mums. After meeting for an initial consultation, we meet again either weekly, or every couple of weeks, to build on Mum’s brand new skills, to discuss Baby’s development, perhaps to keep an eye on Baby’s feeding / weight gain, or to deal with an ongoing issue such as sibling rivalry, or postnatal depression. I am also available by phone and email to touch base with these families between visits.
Having a new baby is a really steep learning curve for many Mums, especially if there is no family support available. One of the Mums taking part in this program said that having me around is like knowing that the “safety net” is there.
For more information, please call me or email me.

Choosing Our Words Carefully…

I speak a lot with parents about discipline, about behaviour, and about how to approach handling their children’s behaviour. What we say and what we do has an enormous effect on our kids, not only in the here and now, but in the broader, long term sense. I sometimes see things that are good examples of what not to do.

A couple were eating out with their 12 month old. The little chap was handed a china cup, which he promptly threw on the tiled floor. I imagine you’re thinking, well, who gives a twelve month old a china cup? Yes… but it was Dad’s reaction that prompted me to blog about it. “Naughty boy!” he shouted, in a stern voice. Now, in the first place, we don’t give smashable objects to babies. Secondly, babies that age throw everything on the floor, it’s a perfectly normal phase of development: I chuck it, you pick it up, I therefore have your attention. All babies do it, and it’s not naughty. His wife quietly objected, to which he loudly replied “he’s got to learn!”. I lost count of the number of times I heard “naughty boy” after that.

That father needs to learn what is developmentally appropriate behaviour for his child. There are plenty of good books about it: Penelope Leach’s Baby and Child being one of the best. Expecting a 12 month old to sit still for over an hour, to eat food he has never tasted before, and to not chuck things off his high chair? All a bit much, don’t you think?

On the same trip, I was so sad to witness a little boy of about six being berated by his carer for being naughty, bad, trouble, etc. I don’t even care what he had done to deserve the vitriolic lecture he was getting: all he was hearing is “you are a bad person”.

The important issue here is to separate the behaviour from the child. If you constantly tell a child that he is a naughty boy, he is going to believe it. He will believe that he does not deserve your love, that he is a bad person. Kids are grimly literal: it is well worth learning to phrase things more carefully right from the start. Some of the alternatives that I teach parents to use include:

-Look for a positive way to phrase things (eg: “when you have finished your sandwich, you can play with your toys” rather than “you can’t play with your toys if you don’t eat your sandwich”)

-Find alternatives to “no”, such as “stop” (eg: “stop that”, vs “no don’t do that”)

-Separate the child from the behaviour (eg: “that was a naughty thing to do”‘ vs “naughty boy”)

It’s so easy to fall into the habit of saying things like “naughty girl” – try to cultivate the habit of phrasing things in a different way.

Article: Sharing bed raises infant death risk

Sharing bed raises infant death risk
October 1, 2010
THE risk of sudden death is greatly increased for babies if they share a bed with their parents, a coroner has found.

But South Australian coroner Mark Johns said babies could benefit from sleeping in the same room as their parents, with the extra stimulation reducing the risk of sudden infant death syndrome.

His findings followed an inquest into five babies who died in South Australia between July 2007 and November 2008. The youngest was aged three weeks and the oldest 10 months.

While the cause of death remained undetermined in four of the cases, the infants were all sharing a bed or were sleeping with an adult when they died.

In one case an autopsy concluded a month-old baby girl had suffocated after becoming trapped between the cushion and the back of a couch after falling asleep with her father.

”The message to be drawn from these five tragic deaths is that the risk of sudden, unexplained death in infancy is greatly increased where a child sleeps in the same bed with one or more parents or other adults, whether the mechanism of death is asphyxia due to overlaying, bedding or otherwise,” Mr Johns said.

”On the other hand, there are benefits to parents sharing a room with an infant where the infant is sleeping in a safe cot.

In evidence to the inquest, forensic pathologist Roger Byard said Western culture had turned co-sleeping into something dangerous. He said in some cultures babies traditionally slept with their parents, but usually on firm bedding or the floor and without the weight of heavy coverings.

In the West, adults were sharing soft, high beds with young babies and covering themselves with continental quilts or blankets.

What we’ve done in the West is we’ve made co-sleeping dangerous,” he said.

Professor Byard said infants aged under six months were particularly at risk when bed-sharing. Because of their age, they were unable to rescue themselves from a dangerous situation, such as their nose and mouth being covered, he said.

AAP

Another article we all should read…

Breastmilk push is stressing mums

By Kate Sikora

The Daily Telegraph

November 28, 2009

FIRST-TIME mothers feel they are leaving hospitals as failures because they are being pressured to breastfeed at all costs, with many saying breastfeeding was harder than giving birth.

In an exclusive The Daily Telegraph online survey, more than 500 new mothers shared their experiences and experts said the striking findings show how a fragmented and biased system is letting down NSW families.

One in two mums said they felt pressured to breastfeed, while 42 per cent said they were given no information about alternatives and 65 per cent of women said they were given contradictory advice by midwives.

Nearly one in two mums reported they hated breastfeeding and said they found it tougher than the actual labour, while a third of mothers surveyed said they moved to using formula after eight weeks.

The World Health Organisation recommends babies should be breastfed for at least 12 months.


The results came as no surprise to midwives and motherhood experts who say the system is “fundamentally” failing women and blame short stays in hospital and little post-natal care for creating the culture of failure surrounding new mothers.

University of Technology midwife lecturer Associate Professor Jennifer Fenwik said research showed one in every three mothers go into hospital feeling normal but leave troubled and emotionally fraught.

“Hospitals have become so driven on breastfeeding, they are ignoring the needs of mothers who may not be able to cope,” she said.

“Midwives should be discussing alternatives with mothers.

“You used to be able to store a tin of formula under the (hospital) cupboard but not any more.

“You have to ask what is wrong when women are entering hospital normal, but walk out with emotional distress. Our hospital system is so fragmented and it is not supporting mothers. It is focused on the birth.”

One new mother responded to The Daily Telegraph survey saying she was not prepared for how arduous breastfeeding would be and called for better education for mums-to-be.

“Breastfeeding is one of the most difficult experiences of my life, made more difficult by the fact that I was wildly ignorant as to how truly challenging it could be.

“More women would stick it out through these challenges if they were made aware, prior to birth, just how hard it can be.”

What Women Want founder and mother-of-seven Justine Caines said the current model of care was not supportive of mothers.

“The system is not about women but about clinicians and what they want,” she said.

“If women feel like a failure, I don’t see that as a good sign. Our system is absolutely failing women.”

Misleading article in today’s paper…

Just a brief blog about an article I have just read in today’s Age entitled “Depression found in 15% of preschoolers”. (I have the whole article if anybody wants to read it. Email me.)

The part that I found really disturbing reads “Almost 15 per cent of preschoolers have abnormally high levels of depression and anxiety, and a difficult temperament at five months of age is the most important early warning sign, a study has found.”

Why do I find this disturbing? Because every normal, healthy baby goes through a significant growth spurt at around the 4 ½ to 5 month mark. This growth spurt encompasses intellectual, social and emotional development as well as physical growth. Their little brains switch on, and they stop acting like newborns. Just one example: they go through the first of the “separation anxiety” phases, where they recognise familiar from not familiar faces, and can be clingy and distressed as a result. In short, it is utterly normal for a 5 month old baby to be “difficult” in comparison to how they behaved before this growth spurt. It is not a sign that, down the track, you’ll have an anxious or depressed toddler!! Gosh I’m sick of reading hyped up and/or misquoted stuff like this which only serves to raise the anxiety level of the average new parent.

Massage… not just for babies!

I have been a big fan of baby massage since way back in my training days when I was privileged to meet Sr Amelia Auckett, one of the pioneers of baby massage. The techniques she taught us that day have proved very useful ever since.
I often recommend massage for both my antenatal and postnatal Mums, for relaxation and for pain relief.
About a year ago I met a marvellous massage therapist, Karyn Wheeler. Karyn has qualifications in all sorts of massage modalities: baby massage, relaxation, remedial and sports massage, as well as lymphatic drainage and bowen therapy. This is a lady who knows her stuff: I can guarantee that she’s marvellous, because I see her regularly myself!
I am very happy to recommend Karyn to all my clients. To arrange a home visit, or for further information, contact me and I will pass on the number.