I'm finally writing down my experiences in this happy time enjoying the early days of my blooming family. It's taken me a few weeks to sit down and write (I'm writing as Thomas sleeps on me in his sling - this hot weather has been a little unsettling for him, my daughter is at nursery today after a bout of chicken pox and potty training in sequence - we've been busy!). The washing machine's on, washing up is piling but not critical, I'm listening to some relaxing music and spilling out onto the keyboard at last.
Monday 28 May 2012
Wednesday 23 May 2012
Speaking of breastmilk
After finding out that the chances of Thomas catching chicken pox off Abbie were lower as a result of me breastfeeding him, I was pretty chuffed (see chicken pox blog). It isn't to say he won't contract it. Just made me jump a little inside out of celebration for the amazingness of breastmilk! I did also wonder about what the other benefits were to the immune system - if it could do this, what else could it do?
I checked out the Cochrane review database, where tightly controlled reviews are made of all scientific research over a period of time to find out the answer to a particular question. If you ever get frustrated that one article comes out saying one thing, later another says to do completely the opposite, these reviews take all the studies together, say over a 20 year period, and deliver the most up to date answers. I found this review by Renfrew et al., (2012), where the background more than covers the benefits of breastfeeding:
"Breastfeeding has a fundamental impact on the short-, medium- and long-term health of children and has an important impact on women’s health. Good quality evidence demonstrates that in both low- and high-income settings not breastfeeding contributes to infant mortality, hospitalisation for preventable disease such as gastroenteritis and respiratory disease, increased rates of childhood diabetes and obesity...Few health behaviours have such a broad-spectrum and long-lasting impact on population health, with the potential to improve life chances, health and wellbeing...The established negative impact on a population of not breastfeeding has resulted in global and national support for encouraging the initiation and continuation of breastfeeding. The World Health Organization (WHO) recommends that, wherever possible, infants should be fed exclusively on breast milk until six months of age (WHO 2003), with breastfeeding continuing as an important part of the infant’s diet till at least two years of age." (Note: For an idea of what this means in terms of how much feeding occurs as babies grow, see bottom of this blog)
"In few settings is standard care offered by professionals with an in-depth understanding of the prevention and treatment of breastfeeding problems. To address this, UNICEF and the WHO established the global Baby Friendly Hospital Initiative (Baby Friendly Initiative in some countries) in 1991 to train health professionals and remove inappropriate routines such as supplementary feeding and restrictions on feeding times. Over 15,000 facilities in 134 countries have been accredited (UNICEF 2011), but most babies are still not born in a Baby Friendly environment"
I took in the advice of midwives, health visitors etc when my daughter was born, and some of it did conflict. It's taken time for me to learn to take their advice with a pinch of salt, to trust my own instincts on what's right, as well as to seek accurate advice from other sources. Although I am doing this now, I think that it is a concern that we cannot rely on advice from such people, at times when we could be quite vulnerable and need good advice. Being able to make informed decisions (based on the truth) about how and whether or not we breastfeed is so important, to us and most likely to the NHS itself! This is particularly the case where incorrect guidance on positioning/attachment or how to feed on demand may lead someone to incorrectly believe that they/their baby are physically unable to breastfeed when they had instead been let down by inappropriate guidance, and perhaps be put off from trying again in the future. This surely goes beyond feeding decisions too. Give us the facts and appropriate support!
Just to be clear, I am not a signed up breastfeeding mafia member (if that exists...I suspect not! What is it anyway?). I believe in what I'm doing, but understand that it may not be physically or practically possible, or a priority for everybody (the problems some have in establishing breastfeeding in particular is something I realise more now than I did in the past). Who knows, I may not manage it or want to next time around. Lives change. Although I support breastfeeding and it's benefits, I realise that it is an element of allsorts of positive contributions we can make to our children's lives. I'm sure I've got deficits in other areas (my husband says I should get out more when I talk to him about how seriously I take these subjects at times and I probably should!).
However, I would like to find a way to bring up breastfeeding without it being assumed that I am challenging anyone who hasn't breastfed their baby - the two seem linked when I wish they weren't. I do not believe that there is any debate to be had if we stick to the facts so do not have much interest in it anyway. But just bringing up the subject seems to invite the debate all over again...sigh. Despite my convictions, I also don't want to hurt anyone's feelings, and it is very difficult in general when talking about such a volatile subject as parenting. Balancing my writing sensitively is something I aim for, and always try to improve on.
In sum, the chicken pox enlightenment moment was something that I simply found pretty cool and I just wanted to share it. That's all. I hope that I can keep sharing the things that I find, just to get them out there. (For my nerves' sake I think I'll avoid mentioning it for a while, as this has been quite a challenging process).
STOP PRESS: We're at the end of the incubation period and Thomas did not contract chicken pox.
Conclusions about best way to support breastfeeding - from the review:
" All women should be offered support to breastfeed their babies to increase the duration and exclusivity of breastfeeding. Healthcare settings should provide such trained support as standard. Support is likely to be more effective in settings with high initiation rates, so efforts to increase the uptake of breastfeeding should be in place. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed. Support that is only offered when women seek help is unlikely to be effective; women should be offered ongoing visits on a scheduled basis so they can predict that support will be available. Support should be tailored to the setting and the needs of the population group."
*Frequency of feeds reduce over time!
Just in case anyone is wondering how often you feed your baby, and how this frequency changes beyond newborn time, here's what happened with me:
- As a newborn, Abbie fed sometimes every 20 mins, sometimes either side of some bigger naps/playful waking times (1/2/3 hours - even longer at night, Thomas is currently every 4/5 hours at 7 wks). This depends on things like growth spurts - where feeding becomes more frequent over a 36 hour period - and weather: breastmilk quenches thirst as well as sorting out hunger (fore/hind milk) so in hot weather, babies drink more. As their tummies get bigger they can cope with bigger feeds over longer stretches. Feeding on demand, they'll organise their feeding so sufficient, so it isn't a worry.
- By 6 months we started Abbie on solids, although at this time it's about tasting and learning about how to eat the foods, while the milk provides their nutrition, she tended to need feeding about 4 or 5 times a day.
- When I went back to work (9 months old), she had water at nursery, as I never cracked expressing, so had 3 feeds a day: at wake up, after nursery if hungry, and then before bed (around 7pm).
- By 1 year old, when cow's milk ok as replacement (although breastfeeding not purely nutritional act so not a straight swap, and weaning does take time) I adopted the "don't offer, don't refuse strategy" and usually fed her twice a day unless requested more, until she weaned herself off (about 14 months old).
Tuesday 22 May 2012
Chicken pox nuggets
I'm all for learning curves and have been wandering up a new one lately, Abbie has two spots the Sunday before last at bath time, which turned into 20 the day after and confirmed by the nurse practitioner the following Tuesday as a "classic case" of chicken pox. I've been finding out what I can from friends, health professionals and good old NHS direct health information service (understanding the exact risks - when my children are contagious, for example). I thought it was a matter of some itching and stopping her picking them over a week or so, but actually it was quite an unpleasant few days for her. Thought I'd layout what I've learnt here for future reference for any readers who've yet to be struck!
Thursday 10 May 2012
Great new baby gear
We've had some lovely cards and gifts for Thomas, here are some of them - I love them and they're definitely flagged as gift ideas for future babies!
Rainbow muslins
Bright, breezy, fun. You could also get practical, e.g., use colourful muslins for use for nappy changes/accidents and white muslins for hands/face needs. Abbie also uses them to create rainbows on the floor at the moment!
Gro-egg room thermometer
I was so unsure about if room too hot or cold, quite pleased to have the instant, colour coded reassurance. It also doubles as a night light.
Powell craft farm yard cardigan
Such an adorable, hand knitted cardigan! Powell craft products are fab, Abbie loves her rag doll from the same Cornish family firm.
Green baby vests (wrap bodysuits)
These have been great - I hate pulling vests over a wobbly newborn head and these avoid it by buttoning up at the front instead with poppers. Definitely my preference when reaching for a vest at changing time!
Bright, breezy, fun. You could also get practical, e.g., use colourful muslins for use for nappy changes/accidents and white muslins for hands/face needs. Abbie also uses them to create rainbows on the floor at the moment!
I was so unsure about if room too hot or cold, quite pleased to have the instant, colour coded reassurance. It also doubles as a night light.
Such an adorable, hand knitted cardigan! Powell craft products are fab, Abbie loves her rag doll from the same Cornish family firm.
These have been great - I hate pulling vests over a wobbly newborn head and these avoid it by buttoning up at the front instead with poppers. Definitely my preference when reaching for a vest at changing time!
Saturday 5 May 2012
This generation: Bradford, UK
I'm not very good at quickly referring interesting tv/radio and before you know it, the iplayer has stopped making it available.... one worth mentioning is an update on the Born in Bradford study that I heard on radio four last week, tracking babies from in the womb and beyond. Those children are now entering primary school. I found the study into bed sharing/co sleeping particularly interesting (as I am co sleeping and did with my first child too), although there were also sad discoveries about children's lives in more deprived parts of the city. I've tried to summarise below. There's plenty more besides too though, so worth the 30 minutes it takes to listen.
Born in Bradford
Study outline, from BBC iplayer page (click here to listen):
"Winifred Robinson tracks researchers on one of the world's largest child health studies, which has gathered statistics on 17,000 babies born in Bradford since 2007. Families have given blood samples, medical histories, details of their educational attainment, eating and parenting habits, family structures and incomes. As the first children to join the study start school, Winifred finds out how they have fared.
The research team is based at the Bradford Royal Infirmary and its work will provide solid evidence to help answer some of the great medical puzzles of our time: everything from why some people have heart disease and depression to what is driving the rises in incidence of diabetes, asthma and obesity. The findings on cot death are just about to be released, with results that will significantly modify the guidance to parents. Other studies soon to be released with assess how far a pregnant mother's diet affects her baby's health.
The city is ethnically diverse - more than half of the 6,000 babies born each year have a mother of Pakistani origin. Bradford also has the highest rate of genetic illness in Britain and this is due to genetic disorders passed on in cousin marriages. The research has demonstrated that two thirds of mothers of Pakistani origin in Bradford have husbands who are their first or second cousins - which significantly increases the risk of autosomal recessive conditions.
According to the Head of the study, Professor John Wright - an epidemiologist based at Bradford Royal Infirmary - the aim is to find out more about the causes of childhood illness in children from all cultures and classes as their lives unfold: "It's like a medical detective story really - trying to piece together the clues in people's lifestyles, their environments and their genetic make-up, as we try to determine whether someone falls sick or someone doesn't."."
I recommend finding time to yourself, cup of tea and a good listen. I've summarised some findings, and my interpretations of them, below too.
Study into bed sharing and cot death
One investigation sampled 2000 babies, half of asian origin, half of
white origin. Four babies in the study died of cot death. The deaths
were in the white families. Babies in asian families were less likely to die of cot death, even though they tended to bed share (or co-sleeping, see nice blog describing this approach). Current NHS guidelines say safest place for newborn is in your room, in a cot, advice is not to sleep with your baby - this is a strongly dealt message by health visitors too (I've received it enough already).
Bed sharing is a common practise in the Bradford Pakistani community. Pakistani mums in the study described that when you bed share, the Mum is by her baby all of the time, that there is no delay in getting to the baby or noticing they need anything, compared to if they were in a cot. The paediatrician leading the study, Dr. Moya, finds this a positive, safe behaviour, and found no need to change it. The study also found that "educated white women who were breastfeeding" also tended to bed share with their babies, and that it has a protective effect (no details on what these were). The danger arises when parents who drink/smoke fall asleep with their baby on the sofa, perhaps even in response to health advice: they are perhaps so scared of bed sharing that they move outside of the bedroom and onto the sofa, leading to them taking more dangerous actions. The study's researcher's recommend that there is a new, more sophisticated discussion surrounding cosleeping, that not all cosleeping is the same. Also, they mention the unintended consequences of warning off against cosleeping, for instance, it may put mothers off breastfeeding.
The finished paper is available here: Ball et al. (2012) Infant care practices related to sudden infant death syndrome in South Asian and White British families in the UK. Paediatric and Perinatal Epidemiology, 26 (1), 3–12.
Last paragraph: "This study identifies maternal smoking, non-breast feeding, sofa-sharing and alcohol consumption as clear targets for SIDS risk reduction among White British families. The study also shows that South Asian families prioritise close proximity, breast feeding and maternal behaviours congruent with infant health and low SIDS risk as normal cultural practice. This study therefore calls into question the unproven value of applying SIDS risk reduction advice developed for White British families to those of other ethnicities. In groups where mothers breast feed, do not drink alcohol or smoke, sleep their infants supine and in close proximity to a parent at night, SIDS rates are so low we speculate that alterations in other infant care practices are poor targets for achieving further SIDS reduction."
Study into children in poor white families known to have an educational disadvantage
The headteacher at a nursery and primary school in an area she says is known for high social, economic and emotional disadvantage summarises the pupil intake: When children come into nursery, at age 3, they may have problems with little/no speech; when children come into primary school, teachers are toilet training children either because carers find easier to put nappy on child or for medical reasons. A lack of communication between children and parents (e.g., talking to them as they spend time together) is thought to be the major reason for speech delays: parents wearing headphones, using mobiles, not facing their children in buggies, children being left for long periods watching TV / playing computer games etc. Furthermore, many children suffer from general health problems that include asthma, autism, obesity, mental health problems (emotional instability: not resilient, able to cope with change). They are working to improve children's attainment in school based on theories that gross motor skills in physical education, translate to fine motor skills (e.g., tracing a shape on paper) that are linked to literacy. They are also providing speech therapy for children whose parents unable/ unwilling to take them to speech therapy elsewhere.
The description of children entering primary school from such a disadvantaged background sends all sorts of questions into the air. The major point for me is the emotional impact the children are being pounded with. The benefit system maybe providing support for these families financially, but it cannot replace the love and attention that these children need in order to truly prosper - that is what can help social mobility, not just job availability, but employability, the capacity to be educated. Why are the parents/ carers of these children not providing the one thing that is freely available? Why is this problem specific to this particular section of society - are there lessons to be learned from the other groups in the Bradford cohort that do not show this socio-economic-emotionally disadvantaged profile, e.g., as found by comparing communities in the bed sharing study above?
Bringing children up to know that they are loved and wanted, that there will always be somebody there to support them is what is needed so that the children can enter school more psychologically equipped for education and to make the most of the world that they are growing up into. Not taking time to talk to their children, to potty train them, and more besides, must leave those children feeling lonely and ignored, to say the least.
Advances in technology too have contributed to the impeded relationships between children and their parents, (and it isn't limited to one social group, e.g. recent book by MIT Professor, Sherry Turkle, "Alone Together: Why We Expect More From Technology and Less From Each Other." US President Obama also recommended parents switch off their phones when spending time with their children at a speech last September). [She preaches... in her online blog - there are great things about technology, but only if it doesn't remove our attention from those that deserve or require our attention more].
The lower socio-economic groups are receiving the greatest impact of these negative parenting behaviours, when they need the reverse to happen. How can the culture change? What happens when the children brought up in such an emotionally-damaging environment go on to have their children? (Probably already happening now). It is perhaps not enough to look at the children once they are NEETs
or long-term unemployed, and to blame them for not going out and
getting a job - early intervention before they even enter primary
school is needed, so that children don't get institutionalised into this
unproductive, unmotivated, and unhappy way of life. I think this needs alot more discussion than what I have provided here, I hope that the Bradford Study, and those similar, will help to find interventions for these families.
Also:
For a programme summary, download one here.
For a list of publications from the research programme so far, click here.
Study outline, from BBC iplayer page (click here to listen):
"Winifred Robinson tracks researchers on one of the world's largest child health studies, which has gathered statistics on 17,000 babies born in Bradford since 2007. Families have given blood samples, medical histories, details of their educational attainment, eating and parenting habits, family structures and incomes. As the first children to join the study start school, Winifred finds out how they have fared.
The research team is based at the Bradford Royal Infirmary and its work will provide solid evidence to help answer some of the great medical puzzles of our time: everything from why some people have heart disease and depression to what is driving the rises in incidence of diabetes, asthma and obesity. The findings on cot death are just about to be released, with results that will significantly modify the guidance to parents. Other studies soon to be released with assess how far a pregnant mother's diet affects her baby's health.
The city is ethnically diverse - more than half of the 6,000 babies born each year have a mother of Pakistani origin. Bradford also has the highest rate of genetic illness in Britain and this is due to genetic disorders passed on in cousin marriages. The research has demonstrated that two thirds of mothers of Pakistani origin in Bradford have husbands who are their first or second cousins - which significantly increases the risk of autosomal recessive conditions.
According to the Head of the study, Professor John Wright - an epidemiologist based at Bradford Royal Infirmary - the aim is to find out more about the causes of childhood illness in children from all cultures and classes as their lives unfold: "It's like a medical detective story really - trying to piece together the clues in people's lifestyles, their environments and their genetic make-up, as we try to determine whether someone falls sick or someone doesn't."."
I recommend finding time to yourself, cup of tea and a good listen. I've summarised some findings, and my interpretations of them, below too.
Study into bed sharing and cot death
One investigation sampled 2000 babies, half of asian origin, half of
white origin. Four babies in the study died of cot death. The deaths
were in the white families. Babies in asian families were less likely to die of cot death, even though they tended to bed share (or co-sleeping, see nice blog describing this approach). Current NHS guidelines say safest place for newborn is in your room, in a cot, advice is not to sleep with your baby - this is a strongly dealt message by health visitors too (I've received it enough already).Bed sharing is a common practise in the Bradford Pakistani community. Pakistani mums in the study described that when you bed share, the Mum is by her baby all of the time, that there is no delay in getting to the baby or noticing they need anything, compared to if they were in a cot. The paediatrician leading the study, Dr. Moya, finds this a positive, safe behaviour, and found no need to change it. The study also found that "educated white women who were breastfeeding" also tended to bed share with their babies, and that it has a protective effect (no details on what these were). The danger arises when parents who drink/smoke fall asleep with their baby on the sofa, perhaps even in response to health advice: they are perhaps so scared of bed sharing that they move outside of the bedroom and onto the sofa, leading to them taking more dangerous actions. The study's researcher's recommend that there is a new, more sophisticated discussion surrounding cosleeping, that not all cosleeping is the same. Also, they mention the unintended consequences of warning off against cosleeping, for instance, it may put mothers off breastfeeding.
The finished paper is available here: Ball et al. (2012) Infant care practices related to sudden infant death syndrome in South Asian and White British families in the UK. Paediatric and Perinatal Epidemiology, 26 (1), 3–12.
Last paragraph: "This study identifies maternal smoking, non-breast feeding, sofa-sharing and alcohol consumption as clear targets for SIDS risk reduction among White British families. The study also shows that South Asian families prioritise close proximity, breast feeding and maternal behaviours congruent with infant health and low SIDS risk as normal cultural practice. This study therefore calls into question the unproven value of applying SIDS risk reduction advice developed for White British families to those of other ethnicities. In groups where mothers breast feed, do not drink alcohol or smoke, sleep their infants supine and in close proximity to a parent at night, SIDS rates are so low we speculate that alterations in other infant care practices are poor targets for achieving further SIDS reduction."
Study into children in poor white families known to have an educational disadvantage
The headteacher at a nursery and primary school in an area she says is known for high social, economic and emotional disadvantage summarises the pupil intake: When children come into nursery, at age 3, they may have problems with little/no speech; when children come into primary school, teachers are toilet training children either because carers find easier to put nappy on child or for medical reasons. A lack of communication between children and parents (e.g., talking to them as they spend time together) is thought to be the major reason for speech delays: parents wearing headphones, using mobiles, not facing their children in buggies, children being left for long periods watching TV / playing computer games etc. Furthermore, many children suffer from general health problems that include asthma, autism, obesity, mental health problems (emotional instability: not resilient, able to cope with change). They are working to improve children's attainment in school based on theories that gross motor skills in physical education, translate to fine motor skills (e.g., tracing a shape on paper) that are linked to literacy. They are also providing speech therapy for children whose parents unable/ unwilling to take them to speech therapy elsewhere.The description of children entering primary school from such a disadvantaged background sends all sorts of questions into the air. The major point for me is the emotional impact the children are being pounded with. The benefit system maybe providing support for these families financially, but it cannot replace the love and attention that these children need in order to truly prosper - that is what can help social mobility, not just job availability, but employability, the capacity to be educated. Why are the parents/ carers of these children not providing the one thing that is freely available? Why is this problem specific to this particular section of society - are there lessons to be learned from the other groups in the Bradford cohort that do not show this socio-economic-emotionally disadvantaged profile, e.g., as found by comparing communities in the bed sharing study above?
Bringing children up to know that they are loved and wanted, that there will always be somebody there to support them is what is needed so that the children can enter school more psychologically equipped for education and to make the most of the world that they are growing up into. Not taking time to talk to their children, to potty train them, and more besides, must leave those children feeling lonely and ignored, to say the least.
Advances in technology too have contributed to the impeded relationships between children and their parents, (and it isn't limited to one social group, e.g. recent book by MIT Professor, Sherry Turkle, "Alone Together: Why We Expect More From Technology and Less From Each Other." US President Obama also recommended parents switch off their phones when spending time with their children at a speech last September). [She preaches... in her online blog - there are great things about technology, but only if it doesn't remove our attention from those that deserve or require our attention more].
The lower socio-economic groups are receiving the greatest impact of these negative parenting behaviours, when they need the reverse to happen. How can the culture change? What happens when the children brought up in such an emotionally-damaging environment go on to have their children? (Probably already happening now). It is perhaps not enough to look at the children once they are NEETs
or long-term unemployed, and to blame them for not going out and
getting a job - early intervention before they even enter primary
school is needed, so that children don't get institutionalised into this
unproductive, unmotivated, and unhappy way of life. I think this needs alot more discussion than what I have provided here, I hope that the Bradford Study, and those similar, will help to find interventions for these families. Also:
For a programme summary, download one here.
For a list of publications from the research programme so far, click here.
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