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Posts Tagged ‘Parenting’

Sleepy Sheepy drying off after a wash

Lots of children have a favourite cuddly toy that they use to help them go to sleep. Donald Winnicot, who I have mentioned before in this blog, coined the term ‘transitional object’ for such items, which are usually soft toys or ‘security blankets’ and parents will know how important these are for their children. As young infants, babies do not know that they are separate from their mother: they believe that they are one unit. The baby’s every need is met.

As she grows older, the baby realises that her mother is actually a separate person, and that she depends on others to get what she wants. Baby realises that her mother cannot be there all the time, and this can be a difficult time. Separation anxiety is common (and normal) with the baby looking and crying for mum when she is not there. The transitional object provides the baby with something that bridges the gap, something that reminds her of  her mum and of maternal care. It is an important part of the baby’s growing independance from mum.

The transitional object is a way for a child to settle herself, relieve anxiety and provide comfort. It is the first ‘not me’ object, an object which the baby knows is not herself – this helps her to develop a sense of self and separateness.

 

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When I was browsing in the book shop yesterday, I looked at all of the parenting books, especially those for babies. I was amazed at how many there are which seem to be focussed on enforcing routines on babies. There are a few great parenting books, and my favourite is definitely Robin Barker’s ‘Baby Love’. Robin Barker has  lovely, sensible approach and manner to parenting.

Virtually all the other books in the bookshop essentially promoted various were ways to let your baby ‘cry it out’. They tell you what babies ‘should’ be doing and what they are ‘capable’ of doing. One in particular, which I won’t name, has rigid routines to follow from birth, and reading it horrifies me.

It seems that there is an emphasis on getting babies to fit into our lifestyles, rather than mother and baby working out a way of managing together. The books which emphasise routines are purely ‘parent-led’ routines: getting the baby to fit in to our lives as soon as possible. They tell you when they should nap, and eat, and how much milk you should express and from which breast so that the baby can have a bottle at night. They tell you that you shouldn’t give your baby much affection at night when they wake, and they will learn to sleep through. All of these things go against both my instincts, and my professional philosophy.

It’s probably true that these babies will sleep all night, but what are we teaching them by doing this? We teach them that there is no point in crying, as you won’t get what you need. Sadly, our society values children who seem to be self sufficient, and who don’t cry or complain. The opposite should be true: children should feel secure enough to cry if they need help, and know that someone will come and help them.

Babies will get into their own routines: our job is to support them in that. We need to recognise when they are tired and put them somewhere quiet to sleep, and we need to recognise when they are hungry and feed them. We shouldn’t be telling them when they should eat, sleep or play. I believe that babies will lead us into the routine that they need and want.

When we make the decision to have children, we are making a decision to change our lives forever. We can’t expect to still have dinner and watch TV in peace, and sleep all night, and have lots of rest. Deciding to have a baby means that you are inviting them to be part of your family: everyone has to fit around each other, and we should not try to mould a little person into what we think they should be.

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Returning to work, for a new mother, is a big and difficult decision. Once a parent has decided to do this, the next step is looking for childcare.

Child care is talked about as if it is one entity, but of course there are many options and huge variations in the quality of it. Options range from hiring a nanny to come into your house, giving a consistent one on one figure in the familiar surroundings of your home, to home day care, and centre based day care. And of course, the outcomes for children will depend not only on the type and quality of day care, but also on the age at which they go into care and the length of time they spend there. A child who has full-time day care from eight weeks is a different situation to one who attends three half days a week from age three. And the variable that is often not considered is the quality of the relationship with their parents.

In the 1980s, there were a couple of studies which said that having more than 20 hours a week of childcare in the first year of life was associated with a more insecure attachment relationship between mother and child, but these results were controversial. Other studies found no such difference, and a study was designed to answer this question: The NICDH (National Institute of Child Health and Human Development) Study of Early ChildCare and Youth Development. This followed up 1364 children randomly chosen from birth from across the USA, and is still going as the children become older. They found that child care factors themselves (hours, age at entry, quality, frequency of changes in child care) did not predict poor attachment. Children were more likely to be insecurely attached when they had ‘dual risk’  i.e. problems in the relationship with their mother/parent as well as child care factors. Also, good quality child care could ‘compensate’ for a poor mother-infant relationship more than in low-quality care.

(Howes & Spieker: (2008). Attachment Relationships in the context of Multiple Caregivers. In Cassidy and Shaver, (eds.),  Handbook of Attachment, 2nd ed (pp 324-325). New York:  The Guilford Press.)

The study is large and there are many more factors to take into account, but it seems to confirm that child care itself – particularly if it is high quality – is not a risk factor for poor attachment relationships, and probably what is more important is the quality of the mother-child relationship.

As with most things in parenting, each family makes the choices that are right for them. A mother who feels isolated when she isn’t working, or a family under financial stress, is potentially much more of a problem than a child being in some form of child care.

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In their first year of life, babies start to play the ‘lets drop toys from the highchair’ game. This is the start of a phase which a psychologist called Jean Piaget called ‘Object Permanence’.

Piaget theorised that young infants believe that their world consists of only what they can see. So, when they can’t see a toy, or a person, they believe that the object no longer exists.  So, a young infant believes that when their mother leaves the room, they have disappeared from her world, and that frightens them.

As babies get older, they start to learn that things exist even when they don’t see them, and this is what Piaget called object permanence. A child at this stage throws a cup away, she realises that it is still nearby, so looks for it as and delights when it reappears. This can also be seen in playing ‘peek a boo’. With time, she will gradually learn that even if her mother is not with her, she still exist and will come back to her (this links into infant attachment). Their separation anxiety will lessen, and the appeal of throwing toys down on the floor will diminish…

 

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“The good-enough mother…starts off with an almost complete adaptation to her infant’s needs, and as time proceeds she adapts less and less completely, gradually, according to the infant’s growing ability to deal with her failure”

This was written by Donald Winnicott, a paediatrician and child psychoanalyst, in 1953 . I have thought a lot about the concept of a ‘good enough mother’ in my new role as a mum. At face value, the phrase can be taken to mean that as a mother, you don’t have to be perfect all of the time; that you can simply be good enough.  In clinical practice, I used to think of this phrase daily. When I saw mothers who were struggling to care for their children through mental health or drug and alcohol issues, I had to remember that they may not be parenting in the ideal way, or the way in which I thought they could be, but they were doing their best, and that best was usually (not always) ‘good enough’.

But Winnicott meant more than this when he coined this phrase. He actually thought that a ‘perfect’ mother, one who is constantly responding to her child’s communication and distress is hindering the child’s development. He believed that when a baby is born, mothers do – and should – respond very quickly to their distress, as the infant is not capable of doing much independantly. However, as the baby ages, she can tolerate her mother’s ‘failure’ to respond more and more, ie the baby can deal with some distress on their own, which allows the child to experience success, failure, and to learn new skills.

I like the concept of being good enough. None of us is perfect – and doing everything for our babies potentially stops them from developing confidence, skills and independance.

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Baby led weaning

I went to a seminar today by the Australian Breastfeeding Association which was about ‘baby led weaning’. I hadn’t heard of this until a friend told me about it, so I had a look online first and was intrigued.

The basic principle seems to be that rather than feeding the baby pureed food by spoon, that you allow the baby to experiment themselves with tastes and textures and eat when they are ready. So, they suggest that when the baby is ready for solids at around 6 months, you offer the baby a modified version of what you are eating and you all sit down together. The baby uses her hands to pick up pieces (cut into wedges/chips) and suck/bite them when she is ready. They say that developmentally, a baby who can pick up a certain size of food can eat it, and that there is less risk of choking than when we ‘force’ food into their mouths by tricking  them. They showed videos of babies eating florets of brocolli  – shoving it into their mouths!

As a child psychiatrist, I have worked on a team for children with feeding difficulties, usually children who have had aversive experiences with food due to medical issues. One of the main things I would recommend to these families is giving the child control, and allowing them to have small successes to build on rather than pushing food on them and ending up in a battle.

I believe strongly in baby led play (again, something I would teach at work) and baby led routines rather than routines being forced on babies to suit parents’ lifestyles (as suggested by at least one popular parenting book). So this intutively makes sense to me. When in doubt, I always think of the bigger view around the world, or through the ages. Have babies always had rice cereal fortified with iron? No. And do children around the world have their food pureed? No. Babies are pretty well designed to tell us what they need and like and we should allow our child to experiment and experience success and failure until she finds what suits her.

 

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When to start baby on solids

I am amazed at the huge amount of – often conflicting – advice about starting food, as well as most other baby issues. Most advice (including from the Australian Breastfeeding Association and most paediatricians) is that babies don’t need anything other than breastmilk until about six months. The reason for this is that around this time, the baby’s iron stores are becoming depleted and they need the extra nutrients that food can give them.

There is also a lot of talk about the early introduction of solids being associated with food allergies and atopic conditions (asthma, hayfever, eczema). I had a look on the net for the evidence of this (being a good evidence based practitioner!) and struggled to find much. There was, however, an article published in Pediatrics in 2008 (PEDIATRICS Vol. 121 No. 1 January 2008, pp. e44-e52) which looked at over 2000 kids from a birth cohort study, and found that there was no evidence that introduction of solids before 4-6 months was associated with food allergies, asthma or allergic rhinitis. They found that food allergies were actually more common in children who had been started on solids after six months. The results for eczema were conflicting and the authors say that there is a possibilty that eczema is more common in those given foods under 4 months.

I think that parents are often tempted to start solids due to excitement and impatience. Of course, this is completely the wrong reason to start them and we need to follow our baby’s cues as to when she is ready.

 

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