I often get asked by parents if it is ok to move their baby into their own room before they are 6 months old because they are finding it difficult to sleep due to the snuffles, grunts and groans that their baby is making. I’m sure this is a question that resonates with all of us. Laying there in the night pondering what is causing your baby’s discomfort? And out of desperation spending and arm and leg on all the over the counter remedies – Colic Calm, Gripe Water, Infacol or taking the advice ‘just give him a teaspoon of water,’ and the self-doubt must be because I’m not burping him properly.
The truth of the matter is that your baby makes these noises 24/7 but at night it’s more obvious because it’s an environment that is dark and quiet when everyone is typically asleep! These noises are normal new-born noises. Babies have sensitive digestive systems and are nose breathers because they have large tongue that is needed for breastfeeding. Their nasal passages are narrow and even more surprisingly it is normal for new-born babies to aspirate small quantities occasionally without causing any harm (Nikki Mills ENT specialist – Symposium conference April 2018).
If sleeping your noisy baby in the same room as you is keeping you awake it’s because they’re supposed to! While you partner is (frustratingly) sound asleep and snoring away you are disturbed every couple of hours. I’m sure this is how the term ‘lucky you’re cute’ gets overused – not the partner the baby. Mother-baby synchrony is an important protective mechanism that reduces the risk of SUDI. It goes a bit like this – baby grunts, mum wakes and checks on her baby, baby goes back to sleep, baby farts, mum wakes and checks on her baby, baby goes back to sleep, baby cries, mum wakes and feeds baby, baby goes back to sleep, baby coughs, mum wakes and picks up her baby, baby immediately falls back to sleep. REPEAT.
So the answer to the original question is ‘no’ I would not recommend moving your baby out of your room before 6 months. Your baby needs to be in close proximity to you! And none of those over the counter remedies will help your baby sleep any better.
As your baby matures your baby will sleep more soundly and you will only wake to noises that alert your instincts to a genuine need from your baby and that might just be a cuddle. After 6 months the risk of SUDI dramatically reduces and is a good time to consider letting baby sleep in their own room if that is what you choose.
Noisy breathing closer to a year of age is abnormal and you should discuss this with a health professional. The Baby Sleep Practitioners was founded by myself and a nursing colleague due the concern of the unregulated baby sleep industry. The case study below highlights one example I have come across in my practice that could have ended sadly if given baby sleep advice from someone without a medical background.
Charlie is a 1 year old and mum has been using cued care. Charlie is now on a baby led routine of 2 naps per day of 1-1.5hrs durations. Charlie is eating 3 solids meals per day and feeds herself.
Mum has taken Charlie to an allergy specialist due to excessive spilling – results were NAD (Nothing Abnormal Detected). Charlie is now a specialised formula as well as Gaviscon and tolerating this well.
Charlie is waking up very often in the night but very inconsistently. The worst nights are every 20-45mins. Mum has a responsive parenting style and is beginning to question herself that she has created bad habits by rocking Charlie to sleep and is considering spaced settling.
After a one hour discussion with mum I referred her to her GP due to symptoms of noisy breathing and possible obstructive apnoea. This was a good outcome for mum and baby as Charlie was referred urgently by her GP to an ENT specialist to have her tonsils and adenoids removed. I hate to think what might have eventuated if mum have not trusted her instructs and responded and comforted her little girl or if she was advised that Charlie was ‘trying it on’ and was told it was ok to leave her to cry!
Pregnancy and birthing practices, politics and social norms have evolved as medical practitioners and mothers have become more experienced and knowledgeable with birthing methods. That being said, many societies’ rituals and customs have remained sacred throughout centuries. One such ritual that is gaining popularity is the “Lotus” birth.
The placenta is the temporary organ that feeds the foetus inside the mother’s womb. In some cultures the expelled placenta holds a spiritual significance - some bury it, some eat it and some leave it attached until the umbilical cord dries up and it falls off on its own (up to 14 days) – this is a Lotus birth.
This type of birthing practice had only been witnessed in chimpanzees until 1974 when Clair Lotus Day - pregnant and living in California - began to question the routine cutting of the umbilical cord. Her search led her to an obstetrician who was sympathetic to her wishes, and her son Trimurti was born in hospital and taken home with his cord uncut. More recently Jeannine Parvati Baker in the US and Shivam Rachana in Australia have both been strong advocates for this practice ever since.
Dr. Sarah Buckley adopted this practice with her second child in 1993, when she placed the placenta in a hand sown red velvet bag and rubbed the placenta daily with salt and lavender until it fell off after six days. She described it as having a ‘slightly meaty smell’ and that it attracted the attention of her cat.
A Lotus birth is an uncommon practice and therefore there are many unknowns but to date there is no research to support any benefits of this practice and there are warnings of associated risks such as bacterial infection. However, the spiritual meaning of it aligns with optimising mother baby synchrony after birth which is something we all aim to achieve regardless of our cultural practices.
I am uncertain as then when it became common practice to cut the umbilical cord immediately after birth but it is now more commonly known that delayed cord clamping (30-60secs) or cord milking can increase iron storage of the infant, supporting healthy brain development.
With this is mind, you can see how things can be done so differently but not necessarily wrong. Most of us try to keep ourselves informed as to what modern practices will optimise health and wellbeing of ourselves and our baby.
I have been reflecting on all that we try and do to promote good health through preconception, pregnancy and birth, and most of it boils down to achieving and maintaining a state of calm. By remaining calm we can balance hormone production and this is at the heart of our bodily processes; from our menstrual cycles to our moods and energy levels. More specifically, keeping our fight or flight hormones (adrenaline and noradrenaline) at bay so that our more healthy and helpful hormones like endorphins, oxytocin, prolactin can be produced in higher quantities.
We know that maternal stress during pregnancy does effect the developing foetus and can lead to adverse obstetric outcomes. Sadly, in the 21st century with dual working families, single parenthood, geographically dispersed families and friends, the energy demands of employment, home, parenting, family and friends it almost unavoidable. Therefore relaxation techniques during pregnancy such as massage therapy, hypnotic relaxation and breathing/tension release exercises are effective to keeping a state of calm and improving outcomes for mother and baby - demonstrating lower heart rates and blood pressure, and a lower incidence of gestational hypertension
During birth, remaining calm becomes particularly important, not only to help with labour, but also to allow your body's helpful hormones - especially oxytocin and prolactin - to make bonding and attachment and initiating and maintaining breastfeeding as easy as possible. Keeping mother and baby in hormonal synchrony (as best you can) is vital for the healthy transition into motherhood.
Becoming a mum is filled with both joy and pain - these emotions go hand and hand. The struggle with keeping that state of calm is now real. Postnatal stress and anxiety can impact on your life with your baby and effect your baby’s development negatively. So many of us today are goal focused and working towards the ideal. Getting caught up in self-blame thought processes. More often than not there is a silent competition at coffee group about whose baby is doing what first. Please do not rush your baby through developmental milestones such as self-settling, you are wasting your time and energy because they will do it when they are ready. Instead, focus your energy on keeping your state of calm and enjoying the journey. I like to compare sleep training to toilet training. You do not need to train your child to go to the toilet, just wait until they pull the nappy off themselves and refuse to wear one. Wouldn’t parenting be so much easier on our emotions if we simply just waited until they were ready! We would have a more respectful, healthier relationship with our offspring.
As you can probably appreciate from the differing of birthing practices mentioned, some of them even rather unusual, infant care practices also differ. There is not right way and there is no ideal, there is however, more than one way to skin a cat. I must still have cats on my mind!
Nathan Wallis - The developing brain
Regardless of which way you lean politically, Jacinda Ardern’s pregnancy has got a lot of people talking. Underneath the politics is a woman pregnant with her first baby in a very high pressure job that carries a lot of expectations – not just those of the people around her but her own and her partner’s as well.
Most of the headlines and opinions I have read so far are in favour and support of Jacinda Ardern’s pregnancy and baby plans. At the time of writing she has stated she will take 6 weeks’ leave with her partner after which time he’ll continue on as the primary caregiver and she’ll return to the workforce. I asked some local Auckland mum’s to find out what they thought about this move since the media have only really focussed on the job rather than the motherhood aspect.
The Question I asked was:
“What do you think about Jacinda Ardern’s decision about returning to work 6 weeks after having her baby?”
Here are a few of the responses:
‘It’s not something I feel is the right thing to do for herself and of course for the baby but I also believe it’s every mothers choice to do what she thinks is best.’
‘I personally think it’s too soon but understand her position and the horrible scrutiny she’ll be under whatever she decides to do?
‘I think it is amazing she is having a baby but not sure she realises how hard it will be to do leave her baby until she holds him/her for the first time. I think it will be incredibly hard for both her and the baby but if dad is hands on from the start, it will be easier. I couldn’t have done it. I just feel a bit sad for her.’
‘I respect her choice and I don’t think it will be detrimental to the baby because he/she will still be with a full-time primary caregiver – Clarke will be a stay at home dad’
Let me make this very clear: this blog is not an attack Jacinda Ardern and her proposed choices on how she chooses to care for her baby - mothers need to be more supported by other mothers, not judged. The issue here is that Jacinda becoming the ultimate multi-tasker is being glorified: That having a baby and getting straight back to work full time after only 6 weeks makes her superwoman! My concern is that this is this placing unfair societal pressure by role modelling – an expectation that mothers should be doing it all by juggling numerous roles including looking after a baby, running the household, paid work and being a wife. I personally don’t that think this is something to be hailed as a great thing for mothers. Feminism is about empowerment - not that woman should do everything! Let’s not sugar coat it; in line with the comments from above returning to work after 6 weeks would be extremely hard for any mother in any kind of role, not just the Prime Minister of New Zealand. And this is why…
There are many physical and hormonal changes that take place after having a baby that are important for many reasons other than the most obvious – actually meeting the biological needs of the baby. Hang on, has anyone even thought about what is in the best interests of the baby here? Perhaps we have but are all too afraid to say it out loud because might make other mothers feel guilty for choices that they have made. Many mothers do need to return to work soon after having a baby for financial reasons and nor is this an attack on them. Being a stay at home parent has become a privilege in today’s society however we do need to also acknowledge that they do an incredibly hard and very important job.
Stay at home dads totally rule and it’s great to see Clarke role modelling the importance of a father’s involvement in raising a baby. However, mother and fathers are different again for obvious biological reasons – in the simplest terms they cannot carry a baby and they do not have breasts for feeding. In the early days, weeks and even months dads tend to feel rather hopeless and it’s not their fault - mum gets a 9 month head start. She has already begun the bonding and attachment process with her baby, right from conception. After birth both mother and baby produce large amounts of oxytocin which further supports the development of that relationship. The baby spends many hours of the day in close proximity to its mother who it instinctively knows can provide food and comfort including a familiar smell and voice while it transitions and adapts to life outside the womb.
I wonder if Jacinda knows that baby brain is a real thing? From what I can see this is a major obstacle she will need to overcome. The brain in simple terms is made up of 2 sides, the right side controls feeling and emotions and the left side controls logical thinking and decision making. Babies use majority of the right side of their brain to form attachment with loved ones. Once a mother gives birth the left side of her brain becomes less active and the right side goes into overdrive to allow crucial bonding to take place. This is why new mums are very sensitive to things people do and say that would not normally bother them. Jacinda’s job involves making important left brain decisions for the wellbeing of New Zealanders so I am a little nervous for her. Now let’s add sleep deprivation to that equation. Crikey!
Surely she does know that breast is best and is probably planning to breastfeed or mix feed for a period of time – more than 6 weeks though? I am picturing Clarke driving around following Jacinda from place to place with a hungry, screaming, red faced baby yelling ‘he/she won’t take the bottle.’ Personally I would love to see some media interviews with her boob out but we probably won’t. Wouldn’t it be awesome to see her feeding her baby in public places and baby wearing? This would be some real positive role modelling! Without this type of contact pumping and bottle feeding breast milk may not be sustainable long term.
I really hope that Jacinda will be kind to herself and allow herself some more physical recovery time before returning to work for everyone’s sake – more 6 months than 6 weeks. Nobody should judge her for that. Early separation from her baby will ultimately risk her mental health as well as the baby’s and really nobody will be winning. The first 3-6mths of life with a new baby is an intensely emotional time while you spend time getting to know each other. After these first few months the transient nature of it all begins to settle and life resumes somewhat back to as it was.
But most importantly this baby will be loved by its parents and by the nation. Babies that have loving responsive parents do well. Best of luck to Jacinda and Clarke, it is going to be an incredible journey with many challenges – many common and some that are unique just to them.
What gives us happiness also comes with pain and as this is the only way we can truly appreciate the best things in life. Being a parent is the best job in the world.
Many years ago no-one talked about cued care, parents simply just looked after their baby. Families were larger and the majority of mothers were stay-at-home caregivers which meant baby care was synchronised around other siblings and a pattern of sensible responsiveness was used to meet baby’s needs. Being a stay-at-home parent is not relevant for all of these days but that in itself does not rule out cued care which is simply the intention to respond. It does not mean you should expect to drop everything to attend to your baby’s every grizzle or for your baby to be happy and contented all of the time. You are modelling cued care when you are doing your best to communicate with your baby in the blur of confusion and crying and this will mean your baby will feel protected.
The current infant care culture revolves around deliberately delaying responses and teaching your baby to ‘self-settle’ as soon as possible. The intent here is to prevent baby requiring parental assistance to get to sleep or to get back to sleep. Using this method, intervening to assist your baby to sleep can leave you worried that you are creating bad habits such as baby relying on your help to get to sleep. When teaching your baby to ‘self-settle’ fails to work, parents often seek out a pre-defined schedule to guide their parenting and entrench ‘self-settling’. Unfortunately, babies are not all programmed to follow an identical pattern because they are all unique, and by trying to follow a schedule you may end up feeling more lost than ever.
Some people are of the belief that babies do not feel pain or have emotions. I do not share this belief! Let me explain this controversial matter. Babies do suffer pain and emotion but there is a communication barrier. Cued care aims to break down that barrier by letting them know you are responding to what communication they can give. Babies have a biological drive to survive and commonly will cry because they are hungry. Feeling ‘Hangry’ is a real for them and this can be a painful and stressful experience especially if establishing breastfeeding has not been a smooth ride or if their cues have not been regularly responded to. Studies show that babies produce less of the hormone cholecystokinin (a hormone that signals satiation and satisfaction) so even if all is going well with feeding, babies just simply do not feel as contented after eating as the rest of us.
Some of you may be reading this and thinking that cued care sounds fab but seems unattainable. Well, read on because I have a couple suggestions of how to make cued care easier.
Study your baby instead of your phone:
Cell phones and internet-connected devices are a huge part of modern life with a baby and connect us with the outside world. It is rightly said that this may reduce the feeling of isolation and protects parents’ mental health. However, these devices may also be a barrier to attachment and bonding with your baby. We may be oblivious to the amount of time we spend on them accessing social media, internet and other applications, especially if those are being used to try find the cure to poor sleep! In truth, the answer is right in front of you. Be mindful about how much time we are spending on devices that could be taking your attention away from your baby and as a consequence missing your baby’s cues. Limiting screen time for parents will mean that you are more in tune with your baby and will also mean you that you can get on with parenting the way that you want to rather than listening to and reading articles that go against intuitive parenting. Balance is something many of us struggle with but is so important. When you are meeting up with a friend for a playdate – leave your phone in the car! You can return missed calls later and scroll news feeds during down time. Relax and enjoy the playdate.
Stop hurrying, hustling and stressing:
Have you ever wondered why your baby grizzles more than usual when you are in the company of others?
Being a parent today is about being everywhere and doing everything. We teach by doing and if you want to nurture calm then you need to slow down. Scale back the number of activities so you don’t need to be somewhere in particular at every moment of the day - you will find that you will have more time and energy to connect with your baby and pick up on their subtle communications. This will make you more capable of keeping your baby’s stress responses dialled down by creating an example of calmness. Babies are like sponges and they pick up on our stress and worry, likewise they will pick up on calm and relaxed behaviour. Try not to let stress and worry steal the joy of being a parent. It is worth noting though there is no need to avoid outings just because they fall around nap times. If you do rush home for nap time, your baby will be picking up on this chaotic frenzy and respond in a similar fashion.
If you are finding it challenging to look after a baby and get the housework done and dinner prepared, don’t feel ashamed to take a friend up on the offer of help or use some of the paid services that are available to accommodate our busy lives.
One of the main things parents do stress about is their baby not getting enough sleep to support their development. Average sleep requirements are just guides with a broad distribution, the truth is that sleep needs vary greatly between babies. Let this reassurance give you the permission to make the change starting today. Love grows brains and nurtures development, talk, sing and read to bubs from day one.
My hope is that one day soon no-one will talk about cued care at all, it will just be the default mode of parenting. For now we need the term to educate parents and begin to change infant care practices that have become so embedded in society. We are well educated about maternal anxiety and depression, and now acknowledge paternal depression. Childhood anxiety is on the increase and I wonder if we are overlooking infant mental health? Take me back to the days where the term cued care didn’t exist it was just what was done. This could be the answer to better mental health for the whole family.
Denaye Barahona, simplefamilies.com
Possums conference, Brisbane 2017, possums-au.breastfeedingconferences.com.au/index.php
Parents are commonly concerned when their baby does not sleep through the night, especially if the largest stretch of sleep is not when they sleep. The results of this study give us a guide of appropriate developmental expectations for infant sleep, and help determine the optimal timing for prevention and intervention of sleep problems. From a developmental perspective it reflects an understanding of infant’s physiological capabilities in self-soothing and sustained sleep, showing the large variability of this from one baby to another.
This NZ based study enrolled 75 parents of healthy, developing infants and parents completed sleep diaries for 6 days each month for 12 months. Parents recorded the time and at what state the infant was placed into the cot and then the duration of time until the infant fell asleep. Parents also recorded the time and duration of each night-awakening and the time that their baby woke in the morning. Accuracy of parent reports were assessed by using videosomnography (diagnosis by behavioural observation).
The sleep of each infant was classified based on the three criteria below:
1) 2400hrs to 0500hrs
2) 8 hours of uninterrupted sleep
3) 2200hrs to 0600hrs
The findings of the study showed that self-regulated sleep (without behavioural intervention) became apparent most rapidly in the first four months, with 50 percent of infants meeting criterion 3) at 5 months. From 4-9mths age infant sleep length tended to plateau and began to lengthen again between 10 and 12months. However at 12 months age, 32 percent of infants still did not meet criterion 3) - many babies do not sleep through the night by one year of age but are still perfectly healthy and this is not necessarily problematic.
The authors of the study recommend that criterion 3) should be used to define ‘sleeping through the night’ for babies from the age of 4 months. The reason for this is because it is harmonious with family sleep patterns, and falls within typical sleep times of the parents. Additionally, it is recommended that prevention of sleep challenges should begin before 3 months, emphasising the importance of working with infant sleep biology to determine healthy sleep habits in the long-term.
Many families aim to put their baby to sleep at 7pm but why do we place this expectation on our baby? A later bedtime may be better suited for baby’s actual sleep patterns and may also be beneficial in synchronising their sleep with their parents. It is actually possible to aid in the prevention of sleep challenges by achieving a synchronised sustained period of sleep during the night after completing day to day activities and self-care tasks. For example moving bed time routines out to a later hour can not only help with preventing sleep challenges but perhaps even more importantly, reset parents’ expectations of their baby’s developmental capabilities.
One of the main limitations of this study was that there was no data provided on the method of infant feeding (i.e. breastfeeding or formula feeding) as this does seem to impact sleep duration and quality of sleep. Many parents believe that supplementing their babies with formula feeds will encourage earlier sleeping through the night. A separate study has found that although breastfed babies do wake more frequently in the night, they often get better quality sleep as they settle back to sleep more easily.
Additional research is now needed to establish the factors that precede and predict infant sleep problems.
For full aticle please see:
Sleeping Through the Night: The Consolidation of Self-regulated Sleep Across the First Year of Life
If we were to look at cultures purely in terms of their infant care practices, norms and values, which culture would you choose to be born in to? Think carefully, as this choice can make a huge impact on how you develop as a healthy, happy baby. Because the thing is, it does not matter which culture or country an infant is born into, its biological needs are the same – but does the culture a baby is born into meet these needs? Or does it promote crying, fussing, feeding and sleeping issues?
The western culture’s predominant norms and practices around infant care often stray very far from what a baby biologically requires. In fact, when describing how both historically and cross-culturally unusual our parent-infant sleep practises are, researches have come up with this acronym to describe the worst offenders - W.E.I.R.D (western, educated, industrialised, rich and democratic), (Heinrich et al., 2010).
The western way of child rearing is one of the biggest mismatches between culture and what a baby biologically expects.
Human babies are mammal babies, more specifically secondary precocial. This is because typical brain growth cannot be completed before birth. Human babies have 25% adult brain growth at birth, compared with 50% of other primates. Humans produce mainly single infants that have well developed internal and sensory organs (can see, hear and call) but our babies have poorly coordinated neuromuscular control, so cannot follow or even cling to their caregiver. Our milk is low in fat and high in sugar, so our infants need to be fed frequently.
Every primate baby is designed to be physically attached to someone who will feed, protect and care for them. They have been adapted over millions of years to expect nothing else and humans produce unusually helpless primate babies!
When you take this into consideration and then think to some of the predominant advice around caring for a new born e.g. teach them to self-settle independently, space their feeds, do not let babies fall asleep at the breast, put babies to bed awake, carry out feed/play/sleep cycles, leave babies to cry or leave them to cry but give them verbal ‘reassurance’, do not let your baby form ‘bad habits’, don’t let your baby sleep on you, enforcing feeding and sleeping schedules or routines and never co-sleeping (for families that have no risk factors and are doing it completely safely), you can start to see what I am talking about.
The dominant western approach to infant care has evolved far faster than baby’s biological needs ever could and this is why there is such a mismatch.
So where does this ‘expert’ advice that pervades western culture come from? During the 1920’s, doctors John B Watson and Frederick Truby King advocated the ‘scientific’ approach to infant care. The focus of their approach valued independence, self-control and self-reliance. It is this focus which you can still see today in many approaches to infant care – particularly in the management of crying, fussing, feeding and sleeping challenges.
It is this approach which encourages independence, self-control and self-reliance that research clearly shows has no beneficial outcomes for infants. In fact, some variations of this approach can at times result in negative outcomes.
So, what can you do to ensure that you are doing your best to meet your baby’s biological needs, to provide them with a loving environment that helps to achieve optimum development, bonding and attachment? Quite simply – physical contact and emotionally connecting with your baby – day and night. 24/7.
Physical contact does so many amazing things for parents and their babies. It reduces maternal anxiety and promotes involvement in their infant’s care, is great for breast feeding initiation and long-term breast feeding success, reduces stress, promotes oxytocin, beta endorphins, prolactin and sleep, conserves heat and energy, can reduce pain levels, premature babies experience less agitation and have more stable vital signs.
You only need to google ‘The still face experiment’ to see the stress inducing effect that a non-responsive caregiver has on a baby – even when in very close proximity.
Rest assured, there are no rules required to meet the biological needs for babies. As mothers, we can just remind ourselves that our babies can communicate to us what they need and through our own biological changes during pregnancy and childbirth, our brains are now primed to learn how to understand our baby’s ways of communicating - to build good two-way communication and trust.
Instead of a culture based on maintaining control and pushing independence, a culture of respect and kindness towards our babies and focusing on meeting their biological will ensure that over time the gap between what dominant western approaches to infant care advocate and what babies genuinely need will continue to narrow.
Prof. Helen Ball, Possums Conference, Brisbane 2017.
Pennie Brownlee. The only person who can do a Pikler is dead: Or why isn’t it a good idea to say ‘We do Pikler at our centre’. February 2015.
Heinrich, J., Heine, S., & Norenzayan, A. (2010). The weirdest people in the world? Behavioural and Brain Sciences, 33, 61-135.
Have you ever wondered why no matter how many babies you have you never quite feel complete and ponder over the possibility of another? This is an addiction to the feel good hormone, Oxytocin. This powerful hormone has the important job of reproductive success and species survival: nature’s way of patting you on the back and telling you “Good job. Have more babies.”
Making babies, having babies and feeding babies. Oxytocin is produced during sexual activity and orgasms, its analgesic properties are helpful in labour and birth, and its release is triggered in both mother and baby when a baby suckles at the breast.
Alternatively most of us know what it feels like to experience the ‘fight of flight response’ and it’s not what you would describe as desirable – a pounding, racing heartbeat, cool sweaty skin and hyperarousal. These symptoms present through a stress response which is activated by the sympathetic nervous system with intertwined hormones adrenaline noradrenaline, such as cortisol. These responses are very much tied in with labour which can be painful and stressful. Stress hormones during childbirth can either slow down or accelerate labour depending on the stage. Historically this response was important for survival: if you were giving birth in the wild and there was a threat to your survival (such as a sabre-toothed tiger suddenly appearing!), you would have an out pouring of stress hormones and blood would be shifted away from your placenta to your vital organs. As a result labour would stop so you could run away to safety where labour could resume. However, if you were in the final stages of labour when the tiger appeared, you could not run so it makes biological sense that these hormones at this latter stage would assist with giving birth quickly, so you could scoop up your baby and run to safety.
Oxytocin in this sense is just the opposite: activating the parasympathetic nervous system encouraging relaxation and growth, a feeling of calmness safety and security which promotes bonding and attachment. After having a baby you quickly forget about the associated pain and stress and immediately begin to bond with your baby; oxytocin’s side effects present as that lovely hot flush that new mothers get and baby is wide-eyed ready to bond. Activation of the reward, pleasure and motivation centres is happening during this time. No other mammals attend antenatal classes to be told how to care for their baby so there needs to be a hormonal system in place to kick in straight after births so that mother finds contact with her baby very rewarding. Mother Nature rewards us for the dedication to caring for your baby for maximal chance of mother and baby survival and species survival. It’s not hard to see why this hormonal system has been selected for during mammalian evolution.
Breastfeeding on demand is how you can keep your baby’s sympathetic nervous system dialled down and prevent activation of the fight or flight response. This is especially important during the first 4-6 months of a baby’s life during the phase of high neurological sensitivity. Oxytocin is working its magic - mother feels an overwhelming need to protect, provide and nurture her baby making her feel good and this motivates her to keep doing what she is doing. Baby feels safe and secure and remains calm when it has all its needs have been need met, including feeling satiated with a tummy full of creamy milk and sensory nourishment through physical contact. Babies that receive plenty of physical contact with their caregiver cry less and breastfeed for a longer duration.
Many parents have a specific time frame that they think their baby should be sleeping through the night by and can find it disheartening when they continue to wake during this period. Despite eating solids well and having plenty of protein they still wake up.
But they can’t be hungry so why?
It's important to understand that babies (not just new-borns) feed for reasons other than just to satisfy their hunger and met their growth demands. Often night wakings will be for the physical contact, feelings of security, pain reduction and the calming effects of oxytocin. When we as parents have set times in our mind that baby should be sleeping and not feeding, and we stop responding to our baby’s cues, and they can become stressed. This can lead to negative effects on development as well as prolonged and unpleasant night waking, which is what we want to avoid. This can be managed by being responsive to your baby’s needs. It may not be a consistent pattern but it won’t last forever either. We have all had days and nights that have been tough and it’s amazing to think that over time our minds seem to be very clever at washing away those unhelpful feelings associated with those distant memories.
Just one more baby… it can’t be that hard right?
-Adapted from a talk given by Dr. Sarah Buckley at the Possums conference, Brisbane 2017.
Breast milk sharing is rapidly gaining popularity in NZ, and for good reason. Everyday kiwi women who are complete strangers are connecting through Facebook pages like mothersmilknz and human milk 4 human babies NZ where women can both donate and seek out breast milk for their infants.
These pages are not only a great village of support for new parents, but they also offer another option to formula where cost is no barrier. For parents that cannot provide breastmilk for their infant but feel strongly about exclusively feeding their baby breast milk, this option can feel like a blessing.
There are polarising opinions about breast milk sharing, which can sadly lead to parents seeking donor milk in secret, feeling that many people will judge them with their opinion that it’s disguising and wrong. However, not all of us feel this way and alternatively, know that breast milk is the ideal food for all babies and the biological norm.
Sharing of breast milk is not a new phenomenon. It was a standard practice in 1975 in hospitals until the rise of HIV and the introduction of formula, which resulted in the shelving of this practice. Wet nursing was also practiced and still is in some cultures where family and close friends will feed each other’s babies from the breast for convenience. Historically, wet nurses were employed by wealthy families when mothers did not want to suffer what some perceived as the indignity of breastfeeding.
The health benefits of breastmilk are of specific importance for premature infants whose mothers desperately want to provide breast milk for their infant in the NICU (Neonatal Intensive Care Unit) but physically cannot produce milk in the volumes, in the time that is demanded of them.
Donor milk is treated like gold in the NICU due to the protective components of breast milk, which includes immunoglobulins, anti-bacterial proteins as well as the many oligosaccharides which provide bioactive factors, prebiotic, immunomodulatory & antimicrobial effects.
Immunocompromised premature infants are transitioned onto milk feeds quickly to protect their vulnerable digestive system from a serious medical condition called NEC (necrotising enterocolitis) that is associated with high mortality and morbidity rates. Donor breast milk is also hugely beneficial in aiding the rapid growth for these babies which is required for their progression through the NICU and therefore earlier discharge home with their caregiver.
The first New Zealand milk bank was opened in 2014 in Canterbury to provide breastmilk for babies whose mothers are unable to provide their own and priority is given to this group of vulnerable infants. Donor milk is pasteurised to prevent transference of disease form donor to recipient by heating the milk in a water bath to 62.5 degrees for 30 minutes and then quickly chilling the milk to 4 degrees. Miraculously this time and temperature combination does not destroy the all of the immunological protective benefits of breastmilk. Due to the success of the Canterbury Milk Bank, more funding has become available and another milk bank could potentially be opening in Auckland.
Donor milk banks ensure quality control by maintaining standards during transportation and storage, formal screening and guidelines for pasteurisation of donor breastmilk. Unfortunately these standards are not met when mothers freely share breastmilk on social media. We cannot ignore the risks that are associated with feeding babies unscreened or unpasteurised donor breastmilk, and this poses similar risks as blood products.
For parents who choose to give their baby another woman’s liquid gold, safety is left to the common sense of the donor and recipient. However, below is a list of guidelines how this can be done more safely based on ADHB's recommendations:
Some questions a recipients might like to ask her donor:
If the donor agrees to provide a blood sample, below are the recommended tests:
Pasteurisation of milk at home – here is what you need to do…it's easy!
Thanks on behalf of the receipts to those generous milk donors out there that have provided or are providing for other babies, you are saving lives and making lives better. Hopefully, this information will help make it safer for babies and help reduce any stigmatisation around the art of sharing liquid gold.
If you have excess milk and think you would like to donate your milk, your efforts would be greatly appreciated, please follow the links below.
Hands up if you:
1. Find cooking separate meals for adults and children day after day a bit tedious, let alone far too time consuming
2. Have kids that eat OK, but know what they like and don’t like and some days don’t eat much at all
3. Start to feel stressed about whether your toddler is eating enough when they start waking more in the night than usual
If this is you, then what the most up to date research is telling us about how to help toddlers develop healthy eating habits and how their eating affects – or more importantly does not affect – their night time waking, is going to be a great relief to you.
We love it because it’s easy, fun, makes meals times more relaxed and enjoyable as possible!
Before we start with the top 5 tips, here is my favourite meal time stress reducer. Research shows that encouraging more solids in toddlers (6-12 months of age) that are waking frequently during the night does not affect the number of times they wake for reassurance overnight. It does reduce the amount that they need to be fed overnight, but even when feeding less, their amount of night time waking, needing reassurance, does not reduce.
This tells us that if your toddler is being regularly offered a wide variety of healthy food, is eating and drinking well, there is no need to actively encourage them to eat more in the hope of reducing night time waking.
So, now that we have taken the pressure off solid intake and night time waking, here are our Top 5 Tips to help your toddler develop healthy eating habits:
1. No toddler will starve when there is food around to be eaten
It’s quite natural for toddlers of eat cyclically, some days eating like a horse and others like a mouse. Try not to worry about this, but keep offering your toddler a wide range of healthy food, knowing that they will eat when they are hungry. If you are needing to use heavy distraction to encourage your toddler to eat e.g. TV, toys, iPad, etc., it may be that your toddler is not that hungry. Experiment to discover your toddlers natural eating rhythms, don’t worry if they don’t eat what you offer them at that time (although it can be frustrating) so that meal times are relaxed and enjoyed for what they are. This will help your toddler to learn to regulate their own intake, enjoy and appreciate food, which is important in developing healthy eating habits.
2. Offer babies a wide range of food groups between 6-12 months – before they get fussy!
After approximately 12 months of age, many toddlers get very fussing with what they will and won’t eat. This is a form of self-preservation, as they become more mobile and inquisitive this fussiness about what they will and won’t put in their mouth can save their lives, as they don’t eat those poisonous berries in the neighbours garden. Between 6-12 months of age the easiest way to help your toddler eat a wide variety of food and eat the types of food you like to eat, is to simply offer them the same meals that you prepare for the rest of your family. If you are cooking healthy food (with no added salt) and have a balanced diet, this is fine, just adapt (puree, mash, soften or leave it as it is) the food to suit the stage of eating that your baby/toddler is up to. This works if you are doing baby lead weaning or not or you are somewhere in-between.
3. Model healthy eating
Toddlers feel safe and confident eating what you are eating as most toddlers are very risk adverse when it comes to trying new foods, as per tip number 2. If you want your kids to eat their vegetables, sit down with them as they eat theirs and have your own portion too. Show them how to eat and enjoy healthy food. Better still, if you can, try to eat as a family, making meals a safe, loving and enjoyable experience – not based around the quantity of food eaten.
4. Avoid saying “Eat your vegetables and you can have some pudding!”
It’s fine to offer food as a reward for good behaviour – that will not create an unhealthy relationship with food. What can create an unhealthy relationship with food is offering food rewards for eating certain foods, for example, avoid rewarding eating vegetables with a piece of cake. All it will do is reinforce the dislike of vegetables. Interestingly researchers have also found that telling toddlers that the food is good for them to encourage eating is unhelpful.
5. Having to offer foods many, many, many times before a toddler will take an interest is perfectly natural behaviour
Again, this behaviour comes down to self-preservation, they want to be completely sure that this new food is OK. When you are in the thick of this continual rejection, do not be perturbed – it’s normal. Most parents when questioned offer a new food 3-5 times before they stop offering it, claiming their toddler does not like it. Keep persisting, while you are getting through this stage, make like you have amnesia, and keep offering a little of the foods they have not yet warmed too. Offer it up with the foods that they think are yum and just wait, one day it will make it into their mouth. Until then, you will have a thriving compost heap.
Recently the Otago Daily Times (and the NZ Herald by extension) published this article: Sleep lessons halve obesity rates in children. Eye catching isn't it? Well we took issue with the title and the reporting as well as the study itself. In response we wrote a letter to the editor which they declined to publish as they felt the criticism should be directed to the researchers.
We disagreed so have published the letter below:
Letter to the Editor
With regards to your article entitled Sleep Lessons Cut Obesity, published on Wednesday 8 March, I am concerned about both the misleading headline and quality of research promoted in the article.
I am a fully qualified senior nurse with a Masters in Health Science. I am also a co-founder of The Baby Sleep Practitioners, providing specialised advice to families about baby sleep, feeding and emotional needs.
Overall, the study the article references was poor quality and the methodology was inappropriate for the study design. Thankfully, this has been acknowledged by the investigators.
1. It was very disappointing to hear that health professionals providing advice in sleep education group discussed outdated methods, for example: putting new-born babies down to sleep while awake without using any settling techniques; feeding in a dark area and the use of extinction methods in some cases.
2. Even though the results between the 3 groups were statistically insignificant with no difference in sleep quality or duration it was still reported that the sleep intervention group had reduced obesity. This minor difference 0.4kg weight/0.7cm length could be explained as subject bias - parents are likely to record results inaccurately, either unintentionally or intentionally.
Sleep deprivation resulting in poor memory unintentionally skewing data or by recording more activity, less unhealthy food and less wake ups intentionally to make themselves feel better about their situation through their own self believe.
The investigators did acknowledge that the non-sleep intervention control group could not be isolated from external sleep advice – it would be impractical and unethical. This includes strong influential routes such as sleep consultants, social media, the internet, magazines and well-meaning friends and family.
3. Progression of developmental milestones is one of the many factors that seems to be overlooked in this study. For example a baby learning to crawl or walk would clearly have a direct effect on BMI especially given the wide range of what is accepted as developmentally appropriate.
4. I agree that obesity is becoming a problem in preschool children and that the evidence suggests that an overweight pre-schooler leads to an overweight adult. This is of concern due to the associated poor health outcomes, for example the increased risk of heart disease and type 2 diabetes. However formula fed and breastfed infants need to be treated differently without perpetuating mother blame in society around how we feed our babies. It is inappropriate to be labelling a breastfed infant as overweight. A breastfed baby cannot be overfed as any excess weight is required to sustain a baby through periods of illness when ones immune system is developing. This excess weight will be latter lost if the toddler leads an active lifestyle with a diet consisting of variation that is quantity controlled by the baby preferably through self-regulation of sleep and appetite. Therefore, a mother should never feel guilty about putting her baby to the breast for any reason.
Formula fed babies are less likely to lose excess weight gained in infancy and education should be focused on paced bottle feeding and encouragement of babies to feed themselves solid foods with the aim of slowing down the rate at which they eat. The rate and which a baby eats is an important part of developing self-regulation but also will ensure a baby still grows to its genetic potential. If this study or a similar study was to be repeated in future I would advise that the rate at which a baby eats should be an area that needs to be focused on.
There are too many weak areas in this study – before the results can better stand up to scrutiny and peer review, conclusions should not be drawn and promoted.
Amy Sherpa, RN, MHlthSc (Nursing)
The Baby Sleep Practitioners®
Specialised nurses for your baby’s feeding, sleeping and emotional needs
Amy and Elspeth