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Archive for the ‘General parenting’ Category

I had an article published today on mamamia.com.au – you can read it here.

I wrote the post not long after my first child was born – over two years ago now, and finally submitted it a few months ago to mamamia. It’s essentially the story of an experience I had on one night in hospital after my daughter was born, and my feelings of powerlessness after an interaction with one particular night nurse. It’s been really interesting reading the comments on the article, particulalry to hear about others’ experiences – good and bad. I do want to point out that I am definitely not ‘anti’ hospitals or ‘anti’ midwives at all, but rather I wanted to share one experience that I had to highlight how hard it can be to ‘speak up’ and follow your instincts when you are exhausted and vulnerable.

I have had lots of positive experiences too and with my second child, my experience was far better. The midwives caring for me at the moment with my third pregnancy are great and I am having my third child in a hospital too. With each child though, I am of course more experienced and secure with my plans and choices.

Do feel free to comment – it’s an important area to discuss I think…

 

 

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Every parent will have had the experience of their toddler having a screaming fit in the middle of Target over some bright pink shoes with flashy lights in them. As frustrating as they are, tantrums are a completely normal part of childhood development. There are lots of theories about what is happening for the child at this age, and the one that makes most sense to me is that of Erik Erikson.

Erik Erikson was a psychologist and psychoanalyst mist famous for describing a list of stages that he believed every person passes through in their lives – from infancy to old age. The second stage that he described, occurring at the toddler stage (18 months – three years) is the stage of autonomy – v – shame/doubt.

Erikson believed that a toddler’s task is to develop a sense of autonomy, and if the toddler doesn’t do that, she will be left with shame, and doubt about her ability to function independently.

 

It can be a difficult stage for us as parents to negotiate as the toddler challenges our authority. On one hand, we want to let our child become more independent: to learn how to put her own shoes on and make decide what kind of sandwich she wants (inevitably jam), but on the other hand we also need to set boundaries and limits. Outside of the house, children need to learn social rules, and of course, be safe.

I think the best way to manage the battle of wills with a toddler is to pick your battles. If a toddler wants to wear a fairy dress over their pajamas, along with a sun hat, sunglasses, scarf and pink slippers, then that really doesn’t matter. It does help to give the child that sense of control over their day and their life.  But if they refuse to sit in the pram and insist on walking, then they must hold mum’s hand. There will be tears and anger, and little ones become overwhelmed by their feelings very easily. But by being firm, while telling the toddler that you understand how they feel when you stop them from climbing up the bookshelves in the shop, the tantrum will pass. And in time, the child will develop a sense of independence and autonomy, and have no doubt in their own ability to be a big kid.

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Moving a little one from their cot to a big girl/boy bed is a major transition: for children and for parents, but there are a few things that can help make the  the transition a bit easier. I think it’s important to either move the toddler a month or two before a new baby arrives, or a month or two afterwards, so that she doesn’t feel resentful about the new baby taking her cot as well as her parents’ attention. The toddler should also have some sense of ownership of the decision, such as being involved (or thinking that they’re involved!) in choosing the bed and linen. It is also worth talking to them in advance about beds and big girls/boys, letting them try naps on grown up beds, and showing them older siblings/friends’ beds. Also, using dolls or toy animals to demonstrate can be a way to explain it. Ensuring that the toddler still has the same teddy, or blanket (see my post on transitional objects) can make the new bed seem more familiar. I’ve read that some people leave the cot in the room as well as the bed and allow the child to choose. I feel that it’s better to just make the transition straight away and it is ultimately less confusing for the child.

It is bound to be frightening initially for toddlers: all they have ever known is their cot, with high sides to keep them in. It is also anxiety-provoking for parents, who worry that their child will be frightened, or fall out and hurt themselves. As with all big developmental changes in our little ones, there’s a mixture of excitement about them growing up, and some sadness that they’re taking another little step towards independence. And as always, I think it’s more of a big deal for parents. Our children seem to take it all in their stride, and they love growing up and being big kids.

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At around 18-24 months, children begin to enjoy scribbling: they are able to draw a squiggle and tell you that it is a ‘lady’ or a ‘doggie. This is the stage at which children use  symbolism, ie representing things with symbols. Language is also a form of symbolism, as well as art.

This has been described by the developmental psychologist Jean Piaget as part of the ‘preoperational reasoning’ stage of child development, beginnning when children are around 2 years old. Children also start to use pretend play at this stage.

In child psychiatry, we use play as a method of communication and ‘therapy’ with children, as play is used by children in the same way as complex language is in adults. A child will explore events that they have experienced, or worries that they have, through play. For example, a child who has been traumatised may act out that trauma with their toys, or a child who is being bullied may reenact this with toy animals.

This developmental stage is a huge leap for children who previously could only express their frustrations directly, such as by crying when upset. It is exciting for both the children and their parents.

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In dealing with newborn infants, I have found the concept of the fourth trimester very helpful. This is a phrase that I associate with Dr Harvey Karp, who has previously commented on this blog. He talks about the need to create an atmosphere similar to that of the womb while the newborn adjusts to life in the outside world, and his suggestions include swaddling, settling the infant on their side, suckling, and white noise. This phase lasts for the first few months of the infant’s life.

I also like the ideas of Dr William Sears, who advocates for attachment parenting. I have previously discussed his book ‘Nighttime Parenting’ on this blog, and his suggestions include frequent breastfeeding and co-sleeping, both of which I have used (note: co-sleeping is not recommended by ‘Sids and Kids’ or the health department.)

From an evolutionary point of view, it makes perfect sense that a newborn baby wants to be held all the time. I have blogged before about mother-infant attachment, and this is linked to the belief that infants are hard wired for survival. Survival for a tiny baby means being close to their mother. Being alone in a quiet room would be frightening for an infant, as they have absolutely no means of surviving on their own – their only chance is to display attachment behaviour which allows them to be in close proximity to their mother. My number one piece of baby equipment, and the one I recommend to everyone I know, is a sling: these help infants to feel safe and secure, and also allows the parent’s hands to be free to get things done around the house.

There is a perception in our culture that things like feeding/rocking/cuddling babies to sleep, responding to every cry, holding them all the time, or co sleeping creates ‘bad habits’ or ‘spoils’ babies, which is ridiculous. They are not infants for very long and our job is to help them transition from being completely dependant to secure children and adults.

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Kangaroo care refers to early skin to skin contact between a mother and her newborn infant. It involves the newborn infant being placed straight onto the mother’s chest immediately after birth. The infant is covered with a blanket on top, but has bare skin to skin contact with mum for as long as the mother and infant are happy.

There seems to be a culture in our society of taking the baby away to be weighed and examined, cleaned up and wrapped before being given to the parents to hold. Obviously if there is any concern about the infant’s health, then they need to be given the appropriate treatment, but in healthy babies, there is now evidence of the positive benefits of early skin to skin contact.

The Cochrane Library publishes systematic reviews of existing studies on particualr topics. By collating all the data and assessing the methodological merit of the studies, they aim to provide evidence based papers. They have a review, last updated in 2007, on early skin to skin contact (Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003519. DOI: 10.1002/14651858.CD003519.pub2).

This review found statistically significant evidence that early skin to skin contact had positive effects on the success and duration of breastfeeding, and trends towards positive effects on maternal affection behaviour during feeding and attachment. The infants also cried less and one group (late preterm infants) showed more stable cardiorespiratory function.The authors  also commented that there were no negative associations found.

It is completely natural and instinctive for mothers and their young to be in close contact after birth, and it makes sense that this creates the optimal physiological state for the pair. I am not against hospital births at all; both my children have been born under obstetric care in modern hospitals and personally, I wouldn’t have had it any other way. However, within that medical system, there are ways to make sure that you and your infant start your relationship in the best way possible, and one way is to make sure you have early skin to skin contact.

 

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Yesterday, I had two experiences which would have been beautiful to catch on film to highlight the attachment system at work. In the morning, A was playing and I went to the next room to vacuum. When I switched the vacuum cleaner on, I heard a squeal over the noise and A appeared in the doorway crying and speed crawling towards me. She must have been very quick to cover the distance so rapidly. She avoided the machine and reached me quickly, then stood up holding on my legs and reached up to be picked up.

In the afternoon, a plumber came to fix the tap. When she heard the door, she smiled as I think she was expecting her dad to come in, but when she saw it was a stranger, she clung to me.

The attachment system is activated at times of fear. As I’ve mentioned before, the  ‘strange situation’ scenario demonstrates attachment behaviour because it places infants under increasing levels of stress. Yesterday at home, A felt stressed. In attachment terms, she was proximity seeking: coming close to me for security. It is easy to see the evolutionary benefits of this, and it can also be seen in the animal kingdom. Bowlby developed attachment theory based on observations in the animal kingdom, and Harry Harlow in the 1960s did some experiments with monkeys to show some principals of attachment.

Infants are vulnerable: they can’t move very quickly; they can’t climb trees to get away from a predator; they can’t defend themselves. Their best chance of survival, be it from a lion or a vacuum cleaner, is to get close to mum and up in her arms. And we need to pick them up and let them know that they are safe.

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Can you tell us how we should be going about developing a secure attachment? I’m also interested to read how the insecure – avoidant and insecure – ambivalent types come about.

This question was posted in response to my blog post on attachment, and I wanted to respond to this, as it’s probably a question that all parents who read about attachment theory are interested in.

Studies show that the attachment style that we had with our own mother (again, mother can be substituted for primary caregiver) is generally predictive of the attachment style that we have with our own children. We generally parent in the way in which we were parented. There is evidence of neurobiological brain changes in infants and children which relate to their early experiences, and there is therefore an argument that our attachment style is hard- wired from a very early age.

Most children — and adults — are securely attached, so for the majority of people, we can just do what comes naturally when it comes to parenting and our children will develop secure internal working models. The factors which help this are parents being warm, empathic and consistently responsive. Parents respond to their children when their attachment behaviour is activated (crying, trying to get close to mother), and are able to empathise ie put themselves in the child’s shoes and recognise what they need at that time, and provide it.

Parents with insecure attachment styles  with their infants will generally have had that pattern with their own parents(analysed with an interview called the Adult Attachment Interview). Other factors which may influence the development of an insecure attachment include maternal mental illness (postnatal depression, psychosis), trauma, illness of the child, separation of the pair in early life etc – basically anything which affects a parent’s ability to respond to their child as above.

For this group of parents, there are things that can be done to promote secure attachment at-risk groups and individuals. The aim is to help parents develop an awareness of both their own and their child’s internal mental experiences — their reflective functioning –(Slade, 2005); to be able to put themselves in their child’s shoes; and to help with basic parenting skills.

I think that the most important thing to remember that the vast majority of parents are doing the best that they can with what they have. It’s such an important area of intervention for infants that has huge implications for the future health of our communities., and is still under-recognised and under-funded.

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At work, I use attachment theory to guide my clinical practice, and in my new work as a mother, I have been observing this every day, so I thought it was about time that I wrote about it.

Attachment, in child psychiatry, refers to a quality of the relationship beytween an infant and her mother (I’ll say mother as that is the usual attachment figure, but it could be the father or other primary caregiver). John Bowlby and Mary Ainsworth are the two people most associated with this.

                                                                                                                                                                                                                                         Bowlby studied juvenile delinquents in the early 1950s and believed that delinquency (antisocial/psychopathic traits) was associated with maternal deprivation, or being separated from their mothers at an early age. He also looked to work that had been done in the animal kingdom such as baby animals following adult animals around to ensure survival (imprinting). He concluded that infants have an inbuilt attachment system — activated at times of stress — to ensure that they stay close to their mother for physical survival.  

The idea is that the mother’s response to an infant gives the baby an internal working model of relationships. It’s as if they file away the expectation of what will happen when they are distressed and how their mother will respond. A mother who is warm, empathic and responsive to her baby’s cries teaches that baby trust and security.

Mary Ainsworth worked under Bowlby, mainly at the Tavistock clinic, and developed a laboratory ‘test’ called the strange situation to categorise attachment styles. This involves a room with video cameras, a 12 month old infant, her mother, and a ‘stranger’. The infant is exposed to increasingly stressful situations while being filmed, eg being left alone with the stranger. The child’s reaction to this stress, and behaviour on reunion with their mother, is analysed to put them into one of 3 categories:

Secure

The infant gets upset when mum leaves the room, seeks comfort when they are reunited, settles quickly with mum, and goes back to play.

Insecure – avoidant

The infant doesn’t show she’s upset when mum leaves the room, is distant when mum comes back in and doesn’t cling to her.

Insecure – ambivalent

This infant is often anxious even before  mum leaves, and becomes very upset when she goes and doesn’t settle. When they are reunited, the child is angry yet clingy and difficult to console.

What is the significance of this?

Studies have shown that the attachment style at 12 months is predictive of the attachment relationship throughout childhood and into adulthood. Our own attachment style generally predicts the attachment relationship that we will have with our own children. Insecurely attached children/adults have higher rates of mental health disturbance and social and emotional difficulties; a secure attachment is protective.

At the moment, I can’t leave the room without A crying, crawling after me and clinging to my leg. Last week, we went to dinner at a friend’s house. When we first got there, A took a look around and cried while clinging to me. AFter 5 or 10 minutes, she settled and started to explore, though if she became too stressed, she’d crawl back over to me for some reassurance. When A cries, and I respond, I know that I am teaching her that I am a secure base for her. Sadly, in our society, we seem to value children who don’t cry or protest – those with avoidant attachment styles. How many times have you heard “Oh, she’s a good baby – she’ll go to anyone, she hardly cries!” It is normal and desirable for babies to cry, and they should be clingy and wary of strangers. This is the way they have been designed so that they can survive. This is attachment at work.

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Do working mothers raise couch potato kids?

It was reported in the news last week that ‘children are healthiest when mother works part time’ A study done by NSW’s University of New England found that children of mothers who worked part time ate less junk food, watched less television, and were less likely to be overweight compared to those whose mothers worked full time or were stay at home mums.

At first glance, this could make sense if we think about mothers who work full time as they probably have less time to cook and do activities with their children. Part time mothers, it could be assumed, are more likely to ensure that the time they do spend with their children is of higher quality.

In that case, why would stay at home mothers have unhealthier children? Perhaps when you are at home full time with your children, you are overwhelmed with them and it is easy to stick them in front of the television to give yourself a break. But why would they eat more junk food and be more obese?

The news reports have assumed that there is a causative relationship, ie, that staying at home full time leads to unhealthy children. However, it is probably more likely that there is a factor which is common to both being a full time stay at home mum, and unhealthy children, that hasn’t been examined (a confounding factor).

For example, we know that people of lower socioeconomic status and with lower incomes are more likely to be overweight, obese and unhealthy. It is not clear from the reports on this study whether the mothers were working before having children, or what income or educational achievements they had. Perhaps mothers are at home full time because it makes no financial sense for them to work once they factor in childcare because their income is low. Or, if they have no specific ‘career’ and worked in unskilled jobs, giving up work may not be as difficult a decision for them. So, it may appear as if being a stay at home mum causes childhood obesity, but the reality may be that there is a casuative factor common to them both.

There are more details that are important too: are the parents overweight and how much television do they watch? For working mothers, who is caring for the child while they are at work? A child in day care is less likely to watch television (I assume that child care centres don’t switch on televisions) that one being looked after by a family member. And where are the fathers? Are mothers working full time because they are single parents? This would make it more likely that they have lower incomes, which again is a risk factor for obesity.

It’s easy to see the results of a study like this reported and make assumptions. Mothers have enough to deal with without headlines making them feel guilty and inviting the wider community to make judgements on their work choices.

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