Saturday, March 22, 2008

An Update on My Life and Health

Thought I'd better take a moment to update everyone on what's been going on for me lately. Besides watching NCAA hockey and basketball games and running around after Nicky outside, there have been some notable developments on other fronts.

First off, I got my butt to the doctor's office last week to make sure there wasn't something more sinister behind my weight loss than too little calories consumed. I had to find a new doctor since my last one moved. I really loved my last doctor so I wasn't sure I'd be as comfortable right away with a new one. Luckily, when I told the scheduler my issues over the phone (60 unintended weight loss, back pain, more illnesses than usual this winter) she took me seriously and got me in right away with another doc in the practice whom she thought I would like and said was a really good doc. So, I had to get Nicky up early last Tuesday so I could haul him with me to the doctor's office. After waiting an eternity in the waiting area and then in the exam room, I had to give my history to the medical student which was interesting because I could tell she had little experience in doing that. The interview was quite meandering and I wondered how much of the info would make its way back to the doctor. Oh well, the student was nice, though. The doctor finally came in and she also took my concerns seriously which took a load off my mind because I didn't want to come off like as a hypochondriac. I really didn't think that I had hyperthyroidism or anything worse but I needed to make sure. The doctor also didn't think I looked like I had hyperthyroidism, but the weight loss and unresolved back pain along with my high blood pressure reading and some hyperactive reflexes I showed that day, she wanted to make sure it wasn't hyperthyroidism or multiple myeloma (an incurable blood plasma cancer). She ordered some blood tests and a back x-ray for me. It had me a bit freaked out last week while I was waiting for the test results because while I really didn't think anything major was wrong with me, the big C word was in the back of my head. I kept having "what if?" thoughts.

Good news came a few days later - no hyperthyroidism or cancer. The only thing that was off was my calcium was a little low (8.7 when 9-12 is considered normal). Man, I have to be better about taking my calcium supplement and getting my high calcium foods. When I saw the doctor again this week, she said she wanted me to have a bone scan because my x-ray showed possible bone loss. So I had a DXA bone scan that day. I am currently researching how lactation affects women's bones to educate myself on the topic. Everything I've read (which is pretty interesting stuff for medical journal articles) says that during pregnancy, the body pulls the additional calcium needs for the baby from the mom's diet (that's probably why pregnant women have cravings for dairy products). However, during lactation, the body automatically pulls the calcium for the milk production from the woman's bones and this is irrespective of the amount of calcium in her diet. The body obviously does this for a reason and it doesn't seem to hurt anything because research has also shown that after the woman stops breastfeeding the body replaces the calcium back in the bones and then some. So, lactating women actually end up with stronger bones after all is said and done. Cool!!! So, this leaves me in a position where I will consider what the DXA scan results say, but still keep in mind that since I am lactating still, they really are hard to interpret. I will have to have them done again when I am done lactating for at least 6 months to really get a good idea if my bones are in good shape. For right now, since I am still breastfeeding, it is normal for my bones to be show to some decreased density since the calcium in them is going to Nicky for now. I think my doctor is concerned since I am so tall and thin and am Caucasian so those things put me at a bit of a risk for osteoporosis when I get older. While that is a risk farther down the road, I can take measures to prevent it by doing weight bearing exercise and generally getting enough calcium as well as vitamin D and magnesium so that I can absorb that calcium. I have talked to my brother, Dusty, about designing me a weight lifting routine, but now I am that much more motivated to get that in place.

The other good things for the doctor's visit this week is that my blood pressure had went down (I was probably just anxious the first time), and my weight actually went up 1 pound!! Thank you Easter. I think the multiple servings of the strawberry lemon trifle dessert I made and ate helped with that! Also, I had had the flu a few weeks ago, so I think I lost a few pounds from that and my body is now bouncing back which is good. So, I will now be making sure I always eat like a horse instead of just sometimes. I will also make sure I have calcium in my diet as well as take my calcium and magnesium supplements (better safe than sorry). The doctor had my vitamin D levels checked too, so if those are low, I will make sure to get my 15 minutes of sunshine each day and will take a supplement for that, too.

Okay, this has gotten long enough. I have more to tell you about my dissertation and things surrounding that, but I'll leave that for another post. I hope this Easter has found you all surrounded by family and in good health!

Thursday, March 13, 2008

Saturday, March 08, 2008

La Teta... dar la TeTA es dar ViDA

Translated, that means "to give the breast is to give life." Its the title of the beautiful public service announcement from Peurto Rican television below. Some might think it too "graphic," but I think it is nothing to be embarassed about. Besides, if we were more comfortable with and supportive of breastfeeding in our society, it wouldn't faze us at all to see such images. I hope others find the video as sweet and touching as I did. And Nicky likes it, too:) He always is tickled by watching other babies and toddlers breastfeeding.

Great Breastfeeding Videos

I read a breastfeeding book and took a breastfeeding class before Nicky was born, but there were still things I struggled with. I guess sometimes you need more visual demonstrations or personal examples to follow:) I wish I had known more about breastfeeding on your side in bed as well as ways to make breastfeeding in public comfortable before he was born. For example, when Nicky was a few weeks old, my in-laws were visiting and we all went to the mall. In the middle of shopping, Nicky needed to nurse while we were in JC Penney's. It took me forever to find a dressing room with a bench in it to sit down so I could nurse. Lucking, my mother-in-law helped me find a free dressing room across the store while I was waiting in line for another. Hungry babies don't like to wait! I have also nursed in restrooms before, but I absolutely hate it! They are dirty and loud and unsanitary - I would never eat in one so why should a baby? I have had my pants or shirt get wet from slipping into the toilet, those toilet seats are super uncomfortable to sit on and there is nothing to support your back or arms, and the toilets flushing freaked Nicky out to no end! I am so glad I have grown enough of a backbone to look for other places to nurse first besides bathrooms.

As far as breastfeeding on my side, positioning is key I learned. That and pillows. Lots and lots of pillows. You need them all around you (under head, between your legs, etc.) but especially behind your back to support you in the right position. If you try to go without these pillows, your back will pay for it. Not a good idea. The C-shaped pregnancy pillow I had worked well for this, too. Side-nursing is an important skill to learn ASAP, though, because it will save you sleep. You simply have to roll over to find the baby or sometimes not even that, and you can doze through the feeding, thus saving yourself some sleep. Its so much better than sitting up to nurse or having to wake up completely and tromp down the hall to feed the kiddo. These videos address these topics. Hope they help some first-time moms out there.

VideoJug: Tips For Breastfeeding In Public

VideoJug: Public Breastfeeding And The Law

Wednesday, March 05, 2008

Some articles on touch

Here are a few articles on the role of touch in human development:

Bonding with your infant: The power of touch

Caron B. Goode

From the moment a pregnant woman intuitively strokes her growing belly, a bond forms. In response to this gentle massage, the unborn child will move her arms, legs, and head. This exchange of movement and the mutual feelings it evokes initiates a bond between mother and child. Bonds, such as this, that start with touch can be one of the strongest and most influential for infants and children of all ages.

For infants, touch is their primary sense. It is how they experience and respond to their environment and their caregivers. Countless studies have proven that for infants, touch is essential to growth and well being. According to Frederick Leboyer, French obstetrician and author of Loving Hands-The Traditional Art of Baby Massage, "Being touched and caressed, massaged, is food for the infant. Food as necessary as minerals, vitamins and proteins."
The link between touch, growth, and bonding begins in the womb. In the embryo there is a layer of cells called the extoderm. These cells produce both the skin and the nervous system. This physiological connection is the foundation through which the embryo experiences life. Touch and movement provide the growing child with awareness and the innate knowledge that she is alive. This awareness will follow her through birth and into the world where touch will continue to play a key role in her development.

Developmentally, touch is crucial to brain growth and the cultivation of coping skills. The ability to cope with stress begins in infancy. Touch contributes to this by encouraging the brain to integrate nerve impulses. This helps create neurological, chemical, emotional, and cognitive patterns that reduce the harmful effects of stress. An infant experiences stress when she is hungry, wet, under/over stimulated, or in need of physical contact. When a parent answers her cries with comfort and loving touch, she learns to trust her feelings and the messages her body is sending. She also learns to trust and experience the emotional bond she shares with her caregiver. When comforting touch and a secure loving bond is combined with empathy, the child learns to accept and calm herself. This is the first step towards regulating her emotions and developing resilience.

Successful infant bonding begins with touch. Touch is soothing and a natural way of showing love. When a child is in need or disoriented due to stress, movement or action combined with touch helps her regain balance. If this action emphatically answers the child's need without imposing the parent's perception, then the child learns to trust herself. She feels safe within her body and her environment. These responses are the building blocks for how the child will connect with the world and handle adversity. Also important to infant bonding are expressions of positive emotion and love. The child who has smiling, cooing parents feels a positive connection with them. She knows and feels their love. This connection is often takes the form of intense mutual emotional engagement. Examples of this include staring into her parent's eyes or enjoying a ritual such as bath time or massage. These periods are essential to the bonding process. Likewise, breaking these connections paves the path for integrating stress. When there is a reduction in emotional arousal, such as bedtime, a child learns to trust. She learns to trust that when she needs her parents, they will be there to reconnect with her. Sarah's story illustrates the ebb and flow of connection, reconnection, and trust.

Sarah's Story After giving birth to her daughter Sarah, Helen instinctively places the child on her chest. She rubs Sarah's back and kisses her cheek. The comfort of these gestures helps calm Sarah. After a few minutes, her father, Tim, scoops her into his arms and begins stroking her legs. With gentle and loving touch, Sarah is welcomed into this world. Upon their arrival home, Sarah's parents continue to offer her comforting touch and loving looks. Her mother and father stare into her tiny face; only too happy to share the joy they feel. Their happiness is transferred to Sarah and she feels their love.

Several weeks go by, and all the while Sarah is rocked, cuddled, nursed, and fawned over. During this time, Sarah and her parents establish a sense of communication. By reading her cues, Tim and Helen are able to anticipate Sarah's needs. At eight weeks of age, Sarah is able to focus and lock eyes with her mother. Throughout the day, mother and child share quiet moments staring into each other's eyes. More often than not, Sarah is the one who breaks the connection. She signals that the moment is over by turning her head, moving her arms or kicking her legs. At this point, Helen turns her concentration elsewhere. She talks to Tim, answers the phone or attends to household chores.

From time to time, Helen and Tim become distracted and do not realize that Sarah is in need. Her cries let them know that she wants attention. These cries bring Tim and Helen back to Sarah. They intuitively use touch to calm her until her needs are met. By touching and responding with empathy, her parents give Sarah a sense of safety and security. By consistently attending to Sarah in this way, they help her establish a foundation on which her future coping skills will be built.

Getting in touch with baby
Parents turning to ancient practice of infant massage
By Anne Harding
MSNBC contributor

updated 11:42 a.m. CT, Fri., Dec. 12, 2003

Strollers are double-parked in the hall outside, and 16 moms, one dad and 17 babies have packed a playroom at the 14th Street Y in New York City on a recent afternoon. They’re about to take part in a class on one of the latest trends in baby care — the ancient practice of infant massage. Babies who get a daily rubdown sleep better, grow faster and are less fussy, research suggests. As a result, their parents tend to be more relaxed and rested, too.

As evidence mounts, the medical establishment’s acceptance of infant massage is growing. It is becoming standard care in neonatal intensive care units and increasingly being offered as part of childbirth education. State health departments and hospitals are building infant massage into early intervention programs designed to prevent child abuse and neglect.

And the number of trained infant massage instructors in the United States has soared from 2,500 to nearly 6,000 over the past five years, according to the International Association of Infant Massage.

While increased interest in baby massage is a new phenomenon in the U.S., it has been practiced for centuries in many cultures around the world, including some in India, China and South America. “We call it ‘anointing’ back where I’m from,” says Samantha Hunte, an infant massage instructor in New York City who grew up in Guyana. “It’s all about finding time to communicate with your child,” says Hunte, whose mother massaged her and taught her to massage her little sister when the time came. Recently, Hunte taught her sister to massage her own son.
Vimala McClure, author of “Infant Massage: A Handbook for Loving Parents,” is largely responsible for popularizing baby massage in the West. The U.K. native who now resides in Boulder, Colo., learned about infant massage while working in an orphanage in India. When her son was born in 1976, she began massaging him every day with a series of strokes based on Indian and Swedish techniques. Then she started teaching the routine to other parents, and then to instructors. In the mid-80s, McClure and her colleagues founded the International Association of Infant Massage, which now has chapters in 31 countries.

How it helps
The scientific case for the medical benefits of infant massage began with a landmark study of premature infants published in 1986. Preemies given a series of gentle strokes and limb manipulations gained nearly 50 percent more weight than infants who didn’t receive such therapeutic touch, Dr. Tiffany Field and her colleagues found. The massaged babies also went home from the hospital an average of six days earlier, for a savings of about $3,000 per child.

Field, the founder and director of the Touch Research Institute at the University of Miami Medical School, speculates that massage may hasten weight gain in preemies by promoting the release of insulin and other hormones that allow the babies to get more energy from food.

Field started down this research path when her own daughter was born prematurely. At 28, “she’s now taller and smarter than me, and I think that’s testimony that massage is a good thing,” Field says.

Field went on to study healthy, full-term babies, and found massage helped them sleep better and reduced their irritability. Massaged babies also performed better on infant IQ tests and were more alert and attentive.

Among other effects, she says, massage lowers levels of stress hormones and reduces both heart rate and blood pressure, resulting in a more restful state.

Time for bonding
And in today’s busy world where both working and stay-at-home parents seem more stressed than ever, a daily massage provides a quiet time for both parent and child to unwind and relax. “One of the benefits is that it forces the mothers to slow down, which a lot of mothers in our culture have trouble doing,” says Jane Kornbluh, the infant massage instructor at the Y, formally known as the Sol Goldman Y of the Educational Alliance.

By slowing down, she adds, moms — and dads — can get to know their babies better and build a foundation for communication that lasts long after infancy ends.

In one of her recent classes at the Y, Kornbluh demonstrates on a baby doll as she leads parents through a series of gentle yet firm strokes of the feet and legs, belly, chest, arms, face and back. Some babies gaze at their moms with rapt attention, returning her smiles and gurgling with pleasure. Some fuss, some wail, others just twist around to check out their surroundings.

If an infant cooperates, a massage may last upwards of 20 to 30 minutes. But the most important thing, Kornbluh tells the parents, is not to just get through a series of strokes or to finish the massage. It’s to use this time to listen to the baby and learn how to read his or her cues, how he or she says “I’m tired,” “I’m hungry,” “This feels good” or “I don’t like this.”

Experts say better understanding a baby’s needs helps cut off the vicious cycle that can occur when a baby gets upset, the parent gets upset and the family spirals out of control.

“Crying is the No. 1 thing that will tick parents off and lead to abuse, crying that cannot be relieved,” notes Dr. Ruth L. Jenkins of St. Anthony’s Medical Center in St. Louis. Jenkins runs an educational program for parents that incorporates infant massage instruction and is designed to reduce family stress.

“I think that the real potential of infant massage is that it sets up a dynamic between the parent and child that facilitates or promotes conversing and communication and encouragement,” says Dr. Steve Berman, a professor of pediatrics at the University of Colorado in Denver and past-president of the American Academy of Pediatrics.

Berman and others even argue that infant massage has the power to help cure societal ills by building such loving relationships.

Touch-deprived kids?
There’s a lot of violence and aggression in American culture, Field says, and “touch deprivation” may be partly responsible. Field and her colleagues recently conducted a study that found U.S. preschoolers and adolescents got less physical affection from their parents than French kids, and were less affectionate and more aggressive on the playground than their European peers. Infant massage, Field says, could be one way to get touch back into our culture.

On the individual level, it’s clear that parents who massage their babies have fun doing it — and their babies enjoy it too.

In her early weeks, Jai Griem’s baby daughter, Katherine, was gassy and fussy. Griem’s mother, who was visiting from India, suggested massage. Katherine, now about 4 months old, gets a massage almost every day, and Griem says it’s eased her irritability and helped her sleep better. What’s more, the Brooklyn mom says, it’s fun. “I love it because she likes it so much,” she says. “I smile at her, we have a lot of eye contact doing it. It’s nice because it’s just the two of us with no distractions.”

Dads are getting into the act as well. “It’s fun to hang out with him, it’s fun to see how happy he gets,” says Mark Zimmerman of Manhattan, who massages his 5-month-old son, Jack, every day after he gets home from work. Zimmerman says he plans to continue Jack’s rubdowns as long as he can. “There’s no reason I wouldn’t, honestly, until he says ‘Dad, I’m 15 years old, leave me alone.’”

And while massage gets tougher once a baby learns to crawl and then walk — and would probably be anathema to most teens — parents can revisit it from time to time as their children get older, says Kornbluh, perhaps when they are ill or just need some extra TLC.

Anne Harding is a New York City-based health journalist and new mom.
© 2008 MSNBC Interactive


Saturday, March 01, 2008

Increased Carrying Reduces Crying

This is a research article from 1986 about how carried babies cried less. This isn't new news and it wasn't even 20 years ago when it came out. Why, then, are parents seemingly picking up and carrying their kids less and less? Between overuse of mechanical substitutes like swings and bouncy chairs (these have their place - as in they should be used as little as realistically possible) and people's obsession with carrying their babies around in those heavy infant car seat carriers all the time, babies aren't getting carried enough. That is one reason why I love baby carriers like ring slings, pouches, mai teis, soft structured carriers, etc. My mother-in-law calls my Ergo carrier my papoose :) You can hold your baby or toddler close but still have your hands free. These carriers have been arond for forever for a reason. With all the different choices and ergonomical designs of some, you can find one that works for you no matter if you are a man or woman, small or big, short or tall, rich or poor. The choices are overwhelming, I admit, but is a great resource. I'll have to post more about babywearing some other time, in addition to sharing some research on how touch (part of the carrying thing) is such an important thing for kids' physical and emotional development - it makes their brains grow!

Me and Nicky in his Hotsling pouch at a Royals baseball game.

Increased Carrying Reduces Infant Crying: A Randomized Controlled Trial

Urs A. Hunziker, MD, and Ronald G. Barr, MDCM, FRCP(C)
From the Department of Pediatrics, The McGill University-Montreal Children's Hospital Research Institute, Montreal, Quebec, Canada.

ABSTRACT. The crying pattern of normal infants in industrialized societies is characterized by an overall increase until 6 weeks of age followed by a decline until 4 months of age with a preponderance of evening crying. We hypothesized that this "normal" crying could be reduced by supplemental carrying, that is, increased carrying throughout the day in addition to that which occurs during feeding and in response to crying. In a randomized controlled trial, 99 mother-infant pairs were assigned to an increased carrying or control group. At the time of peak crying (6 weeks of age), infants who received supplemental carrying cried and fussed 43% less (1.23 u 2.16 h/d) overall, and 51% less (0.63 u 1.28 hours) during the evening hours (4 PM to midnight). Similar but smaller decreases occurred at 4,8, and 12 weeks of age. Decreased crying and fussing were associated with increased contentment and feeding frequency but no change in feeding duration or sleep. We conclude that supplemental carrying modifies "normal" crying by reducing the duration and altering the typical pattern of crying and fussing in the first 3 months of life. The relative lack of carrying in our society may predispose to crying and colic in normal infants. Pediatrics 1986;77:641-648; crying, carrying, colic,- mother-infant interaction.

All normal infants cry. In our society, crying typically occurs in a pattern characterized by an increase in crying duration until about 6 weeks of age, followed by a gradual decrease until 4 months of age.1'4 Within the day, crying is increasingly prevalent during the late afternoon and evening hours.1'2'4'5 Although we have come to regard this crying pattern as "normal,"!'6 infants with similar crying patterns are frequently brought to pediatric clinicians as crying problems. Not uncommonly, they are labeled as having "paroxysmal fussing" or "3-month colic,"1'2'7"9 variously estimated to affect about 20% of normal newborns.2'9'10 In recent years, crying has come under increasing scrutiny, not only because of its theoretical importance in early mother-infant interaction,11'14 but also because of its clinical importance as a cause of maternal distress,12 a cause of discontinuation of breast-feeding,5 and a stimulus for child abuse.

Despite its salience for both parents and clinicians, remarkably little is known of the conditions associated with infant care-taking practices that might contribute to or modulate crying behavior. This lack of information is more striking in the light of anecdotal reports from cross-cultural studies of little or no prolonged fussiness in societies in which infant care practices differ significantly from our own.17"20 Among the many differences, infant care giving is characterized by constant close mother-infant proximity and extended carrying.17' 21 The soothing effects of carrying and rocking have long been appreciated, and short-term studies examining elements of these complex behaviors have supported the concept that they reduce crying, shift arousal to stares of increased visual and auditory alertness, and produce soothing effects which persist postintervention.22"33 In our society, picking up and holding are also the most frequently used and effective soothing behaviors"'34 but are typically elicited in response to crying. In addition, mothers have less direct contact and a greater relative distance from their infants.17'21'22 Although constant carrying is unlikely to become the typical infant care-taking practice in our society, we hypothesized that the "normal" crying pattern might be changed by supplemental carrying, that is, increased carrying throughout the day in addition to that which occurs during feeding. If so, such carrying might have anticipator.- soothing effectiveness in normal infants and therapeutic or preventative value in relation to infant "colic."


Overall Design

The study was a randomized controlled trial to assess the effectiveness of supplemental parental carrying in reducing crying/fussing behavior of normal infants between 3 and 12 weeks of age. Normal mother-infant pairs were recruited at birth and entered the trial when the baby was 3 weeks of age. After obtaining baseline data for 1 week, subjects were randomized to a supplemental carrying or control group. In the supplemented group, parents were asked to carry their baby in their arms or in a carrier for at least three hours a day. In the control group, parents were asked to situate their baby facing a mobile and an "abstract" of a face when the baby was placed in the crib. Infant behaviors, including crying and fussing, and parental activities directed toward the infant were monitored by diaries completed by the parent(s) at week 3 (baseline) and when the baby was 4, 6, 8, and 12 weeks of age. The study was approved by the Montreal Children's Hospital Committee on Medical and Dental Evaluation and all participating mothers gave written informed consent.

Between June and November 1983, 234 eligible mother-infant pairs were approached on maternity wards of two general hospitals in central Montreal. AU infants eligible for the study were breast-fed, first-born at term with a birth weight of at least 2,500 g and had uncomplicated pre-, peri-, and postnatal histories. The nature of the trial was explained and they were told that, if they participated, the form of additional stimulation (carrying or visual) they would be asked to provide would be determined randomly (by chance). Of those who were eligible, 50% (n = 117) agreed to participate at 3 weeks. By randomization, 59 babies were assigned to the supplemented group (ten subsequently dropped out); 58 were assigned to the control group (eight left the study). Reasons given for discontinuation were maternal inconvenience (n = 11), including the work of completing diaries regularly (missing 2 weeks or more), being too busy, and maternal illness; infant illness (n = 1); and miscellaneous (n = 6), including diaries lost in the mail and change of residence. Subjects who discontinued the study differed from those who remained: those who left were of lower socioeconomic status (61 o 68 by Green Index,35 unpaired t = 3.02, P < .01) and younger (26 u 29 years, unpaired t = 2.68, P < .01) but they were not different on neonatal indices (duration of gestation, birth weight, Apgar score at one and five minutes), infant characteristics (sex, race) and remaining parental characteristics (religion, language, marital status, age of father). In the remaining 49 supplemented and 50 control subjects, there were no differences on any of the above infant or parental variables (Table). Size of this study population was determined a priori on the assumption that a reduction of 25% in daily crying/fussing behavior would be a meaningful behavioral change. We used previously available data36 to determine that a sample size of 45 subjects per group would be sufficient for a decrease of this magnitude to occur by chance in only 5% of samples, whereas a true decrease would fail to be seen in 20%. For some subjects, 1 week of diary data was missing, but missing data never exceeded 10% of the total for either group for any week.

Parental Diaries

Parents recorded their baby's behaviors and their own activities in pretested continuous 24-hour diaries. One complete day was represented on each sheet by four horizontal "time" bars, each subdivided into five-minute units. The upper half of each bar was used for recording infant behaviors of sleeping, awake and content, crying, fussing, and feeding. The lower half was used for recording parental activities of carrying with body contact, moving with the baby but without body contact (ie, in a car or a pram) and care-taking activities (ie, changing, bathing, dressing the baby). The duration of each behavior was indicated by filling in these bars with a symbol assigned to each behavior. The diaries of the supplemental and control groups differed only in the name given to the symbol representing the intervention. For the baseline recording (week 3), this category was omitted for both groups.

Validation for short-term use of the parental diary was undertaken prior to the study by a direct comparison of parental diary recordings of crying and fussing with electronically recorded crying (negative vocalizations) during 24 hours in ten mother-infant pairs. Moderately strong product-moment correlations were obtained between duration of diary-recorded crying and negative vocalization (/• = .65, P < .05) and between frequency of crying/fussing episodes and clusters of negative vocalizations (r = .71, P < .05).37 If one poorly completed diary recording was eliminated, the strength of association of the recording methods for these measures improved further to .89 and .85, respectively (P < .01).

The dependent measures of infant behavior derived from the diaries were duration (hours per day) and frequency (episodes per day) of crying/fussing (crying and fussing combined), sleeping, awake and content, and feeding. The same measures were derived for parental activities of carrying with body contact, moving baby without body contact, and care taking. These measures were also derived for three periods of the day: night (midnight to 8 am), day (8 AM to 4 PM) and evening (4 PM to midnight). To monitor potential recording bias introduced by the different interventions, parents also recorded the frequency of five infant behaviors presumed not to be affected by parental carrying, specifically hiccups, bowel movements, regurgitation, vomiting, and tremors.


At the time of recruitment, eligible mothers were provided with the diary and verbal and written instructions regarding its use. At week 3, parents were contacted by telephone to determine whether they wished to be study participants. Participating parents were then asked to complete the diary for 1 week. At the end of week 3, parents were assigned by random number to the supplemented or control group, and they were then visited at their homes. Diaries were reviewed and new diaries were provided for the remainder of the study. In the supplemented group, parents were asked to carry their baby for a minimum of three hours per day and it was emphasized that carrying should occur throughout the day, not only in response to crying, in addition to carrying during feeding, and independent of whether the baby was awake or asleep. In the control group, parents were asked to expose their infant to the visual stimuli when they were placed in the crib, but they were not asked to increase time in the crib. The investigators provided infant carriers to the supplemented group and mobiles and face pictures to the control group. To minimize recording bias, the purpose of the study was described as being the study of the effect of additional amounts of common stimulation on the development of behavioral rhythms (sleep, feeding, regurgitation, etc) in normal infants. Neither the specific hypothesis nor the crying target variables (crying and fussing) were identified to the parents. During weeks 4 to 12, the parents were contacted by telephone at the beginning of each week scheduled for diary recording. Completed diaries were returned by mail after each week of recording. At the end of week 12, parents were asked about the type of current feeding (breast, formula, mixed) and whether the pacifier had been used frequently or rarely.
Data Analysis

A research assistant blind to the study hypothesis transferred the parental recordings of each diary sheet to an identical diary analogue displayed on the screen of a computer terminal. Compilation of frequencies and duration of behaviors, data reduction, and analyses were accomplished by programs developed for this study. Between-group differences were analyzed by planned comparisons using Student's one-way t test of the means of independent samples.

Fig.1: Daily duration of infant crying/fussing in re-sponse to change in parental carrying. Top: Means and SD of crying/fussing behavior in hours per day averaged over each week of parental recording for supplemented (0, - - -) and control (o, --) infants, respectively. Intervention (see text) for both groups started at begin-ning of week 4 after 1 week of baseline recording (week 3). Bottom: Means and SD of carrying in hours per day averaged over each week of parental recording for sup-plemented and control groups. Carrying during interven-tion in supplemented group is represented by method of holding in parent's arms or in infant carrier.

As expected, the mean daily duration of carrying of supplemented and control infants was similar during week 3 (3.4 y 2.7 h/d, P > .05; Fig 1, bottom). At each of weeks 4 to 12, parents in the supplemented group did significantly more carrying, the difference ranging from 2.1 h/d at week 4 to 1.5 h/ .-d at week 12 (average 1.8 h/d; all P < .001). As a result, the supplemented infants were carried an average of 4.4 h/d during the intervention period, of which 3.5 hours was in the parent's arms and 0.9 hours was in the carrier. The control infants were carried an average of 2.7 h/d throughout this intervention period.

Increased carrying changed the typical pattern of combined crying and fussing duration (crying/fussing) of infants after the intervention began (Fig 1, top). In the control group, the "normal" crying/ fussing curve started at 1.7 h/d (week 3), peaked at 2.2 h/d (week 6), and decreased to 1.3 h/d at week 12. In supplemented babies, however, the peak at week 6 was eliminated. Duration of crying/fussing was longest at week 3 (1.8 h/d) and was followed by a gradual decrease to 1.0 h/d at week 12. The differences were-significant at weeks 6, 8 (P < .001), and 12 (P < .05) and represented reductions of crying/fussing duration of 43%, 41%, and 23% respectively: If crying and fussing were considered separately, the patterns of differences between the groups were similar. Significant differences occurred at 6, 8, and 12 weeks for crying and 6 and 8 weeks for fussing (all P < .05).The changes in crying/fussing duration within the day are displayed in Fig 2.

Fig.2 Distribution of infant crying/fussing behavior within day. Mean crying/fussing behavior in minutes per hour at each hour of day for supplemented and control infants during baseline (week 3) and during weeks 4, 6, 8, and 12 of the intervention period.

The typical clustering of crying during the evening remained the same for both groups at all ages. However, although the supplemented group tended to have less crying/ fussing behavior throughout the day, these differences were particularly striking during the evening, representing a reduction of 54% and 47% at weeks 6 and 8, respectively. Significant reductions within the day occurred at week 6 during the day (0.4 u 0.6 hours, P < .005), evening (0.6 u 1.3 hours; P < .005), and night (0.2 u 0.3 hours; P < .01). At week 8, significant reductions occurred during the day (0.4 v 0.6 hours; P < .001) and evening (0.5 v 1.0 hours; P < .001). There were no significant differences within the day during weeks 4 and 12.

To determine which other behaviors may have been affected, similar analyses were performed post hoc for feeding, sleeping, and awake and content duration. There were no differences in feeding or sleeping duration at any age; however, awake and content behavior was significantly increased in the supplemented babies at weeks 4 (4.1 u 3.8 h/d), 6 (5.6 u 4.6 h/d), and 8 (6.0 u 5.0 h/d; all P < .01). It appeared, therefore, that reduced crying/fussing was replaced by increased awake and content behavior during this time.

During the intervention period, the feeding frequency calculated in mean episodes per day was higher in the supplemented compared with the control group, averaging 8.8 u 7.2 episodes per day (P < .025 at all weeks). This was in contrast to the frequency measures calculated for all other infant behaviors (crying/fussing, sleeping, feeding, awake and content) which were similar in both groups during all weeks. In addition, there were no between-group differences in frequency of hiccups, bowel movements, regurgitation, vomiting, or tremors. With respect to the retrospective question concerning pacifier use, frequent use was reported by 70% of the control parents o 47% of the parents of supplemented babies (x2 = 5.15, P < .05). Forty-five percent of supplemented and 40% of control parents reported having introduced partial or total formula feeding by the end of the study period (P > .05).


The results of the present study demonstrate that increased parental carrying was associated with a substantial reduction in crying and fussing behavior in these first-born, breast-feeding infants during the first 3 months of life. This behavioral change was particularly apparent in relation to two of the characteristics of crying of normal infants noted in our control group and in previous studies namely, elimination of the peak at 6 weeks of age and diminution of the crying and fussing that clusters during the evening. This reduction appeared to be replaced by increased awake contentment rather than changes in sleeping or feeding duration. The difference was most marked by 6 weeks of age when an increase in carrying time of two hours was associated with an overall reduction of one hour (43%) in crying and fussing behavior. Whether these findings can be generalized to bottle feeders, later parity infants, infants with younger mothers and lower socioeconomic status, or mother-infant pairs who choose not to participate in such studies cannot be determined from this study.

There are a number of reasons why the increased carrying might have been effective, related both to its content and timing. In all societies, there are a variety of everyday techniques that are used to calm a crying baby such as picking up, rocking, patting, cuddling, and swaddling. Such soothing behaviors share the characteristics of postural change, repetitiveness, constancy and/or rhythmicity, close proximity between mother and infant, and the involvement of many sensory modalities. In short-term experiments with newborns who are already crying or in whom cries have been elicited, many of the elements of these complex behaviors have been shown to soothe infants.22-24'26-29-31-33 Similarly, in naturalistic observations in the home, picking up and holding was the most frequent and most effective intervention in response to crying, with other effective interventions being swaddling, presence of a human voice, contact, and visual stimulation.11'34 These interventions all imply relatively more mother-infant proximity, which correlates inversely with incidence of crying behavior.11 Wolff34 noted that psychologically significant interventions such as the human voice (compared to nonhuman sounds) and human figures (compared to visual distraction in general) become increasingly important as effective soothing interventions after the second week of life. The supplemental carrying received by the experimental group would have effectively increased mother-infant proximity and the exposure of these infants to both physiologic and psychologic forms of these soothing behaviors throughout the intervention period.
It is possible, however, that the timing rather than the content of the supplemental carrying better explains its effectiveness. In the supplemented group, the mothers were encouraged to carry their infants throughout the day regardless of the state of the infant and not just in response to crying or fussing. Previous investigations have demonstrated the importance of environmental factors in modulating early infant behavior and have focused on the sensitivity of the care giver to infant signals and the immediacy of the care giver response.11'38 The increase in carrying could have systematically predisposed these mothers to detecting their infant's demands and to shortening the response time to infant distress, thereby facilitating a more synchronous mother-infant interaction.38 Alternatively, the increased carrying may have acted to reduce infant demands by maintaining the infant's state of quiet alertness.22'23'28'39'40 Gentle rocking of quiet newborn infants in a bassinet or a caretaker's arms has been shown to be effective in delaying or reducing later crying in short-term observations.41'42 Consequently, the supplemental carrying could have the effect of increasing parental responsivity and/or lowering the infants' arousal levels throughout the day. In this sense, the supplemental carrying "anticipates" and possibly prevents the behavioral decompensation represented by crying and fussing that would otherwise occur later in the day. The anticipatory nature of the carrying may be particularly important in relation to the clinical syndrome of infant colic, because these infants are often described as being unresponsive to carrying initiated after the crying has begun.7'8


The rather impressive change implies that this pattern of crying in the first 3 months of life is only normal in the sense of being typical for infant care-giving practices of our society. However, these findings do not demonstrate that absence of carrying is either a necessary or a sufficient cause of infant crying. It is probable that this particular pattern reflects underlying biologic changes, the behavioral manifestations of which are subject to modulation by different care-taking practices. For example, the changes in crying may represent changes in development and maturation of the nervous system facilitated by favorable interaction with the care-taking environment.1'3'14 Additionally, crying and fussing could be initiated by the stimulus of intraintestinal gas production secondary to the incomplete carbohydrate absorption which persists into the third month of life in response to typical feeding patterns.36'43 Whatever the particular constraints imposed by these biologic factors, the behavioral manifestations nevertheless remain subject in part to environmental influence. Consequently, normal crying most likely represents a culture-specific pattern reflecting the interaction between biologic factors and infant care-giving practices typical of our society.

We speculate that the potential for changing infant-carrying patterns may have important clinical consequences. Early infant crying is an adaptive behavior that acts to promote mother-infant proximity and to provide opportunities for social interaction.11'14 These opportunities usually result in elicitation of appropriate emotional-motivational reactions, care and feeding behavior, and parent-child attachment.3'11'12 The increased carrying reduces crying behavior but promotes proximity so that crying is less necessary. In addition, the associated increased awake contentment would likely be associated with a state of quite alertness and visual exploration necessary for positive social contact.25'30 If an infant's crying behavior is considered excessive, however, it may promote negative interactions12 and increase the frequency of clinical complaints. Excessive crying has been associated with the erosion of positive emotions and coping skills in mothers,44'45 parental responses that are less plentiful and of poorer quality,46 and occasionally episodes of child'16 In clinical practice, complaints of crying typically present as feeding problems or as colic. Because parents commonly perceive crying as hunger, elimination of the crying peak may remove one impetus to engage in formula changes, discontinue breast-feeding, or begin early solid food intake.5'47 Indeed, the associated increased feeding frequency noted with the carried infants might also facilitate early weight gain, prolong breast-feeding, and diminish the insufficient milk syndrome in breast-feeding infants.48'49 Finally, increased carrying, particularly anticipatory carrying throughout the day, may represent a relatively simple nonpharmacologic therapeutic intervention for colic, because there is a close similarity between the patterns of crying seen in normal babies and infants with colic, as well as lack of evidence of pathology in colicky infants.2'7'9 Alternatively, increased carrying may have significance as part of pediatric anticipatory guidance. Overall, supplemental carrying may be a more effective approach to feeding and crying problems than the more traditional supplemental bottle.


This study was supported, in part, by grants from the McGill University-Montreal Children's Hospital Research Institute and the W. T. Grant Foundation.Dr Hunziker is a recipient of an investigator award from the "Kredit zur Förderung des akademischen Nachwachses der Erziehungsdirektion des Kantons Zurich". Dr Barr is a W. T. Grant Faculty Scholar.The authors thank Heinz Spiess of the Departement d'information et de recherche operationnelle de 1'Université de Montréal for design of computer software programs and data analysis, James Hanley, PhD, for statistical advice, Christa Hunziker and Donna Steinberg for subject recruitment and follow-up, Anne O'Donnell for technical help, and Maria Szasz and Madeleine Ranger for secretarial assistance. We thank Drs Philip Zelazo, Barry Zuckerman, Terence Nolan, and Howard Foye for helpful critical reviews of the manuscript.


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2. Wessel MA, Cobb JC, Jackson ES, et al: Paroxysmal fussing in infancy. Pediatrics 1954:14:421-434 -—
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Copyright 1986 by the American Academy of Pediatrics - Published in PEDIATRICS Vol.77, pages 641-648, No.5 May 1986 Pubblicato su con il gentile permesso dell'autore Dott. Urs A.Hunziker, agosto 2002

Just a Mom? I Think Not!

This was orginally an email forward passed on by a friend in my parenting group. Thanks, Marcela! Comments to follow in another post:)

Just a Mom? I think not!

A woman, renewing her driver's license at the County Clerk 's office, was asked by the woman recorder to state her occupation. She hesitated, uncertain how to classify herself. "What I mean is," explained the recorder, "do you have a job or are you just a ...?"

"Of course I have a job," snapped the woman. "I'm a Mom."

"We don't list 'Mom' as an occupation, 'housewife' covers it," said the recorder emphatically.

I forgot all about her story until one day I found myself in the same situation, this time at our own Town Hall. The Clerk was obviously a career woman, poised, efficient, and possessed of a high sounding title like, "Official Interrogator" or "Town Registrar." "What is your occupation?" she probed. What made me say it? I do not know. The words simply popped out.

"I'm a Research Associate in the field of Child Development and Human Relations." The clerk paused, ball-point pen frozen in mid air and looked up as though she had not heard right. I repeated the title slowly emphasizing the most significant words. Then I stared with wonder as my pronouncement was written, in bold, black ink on the official questionnaire .

"Might I ask," said the clerk with new interest, "just what you do in your field?"

Coolly, without any trace of fluster in my voice, I heard myself reply, "I have a continuing program of research, (what mother doesn't) in the laboratory and in the field, (normally I would have said indoors and out). I'm working for my Masters, (first the Lord and then the whole family) and already have four credits (all daughters). Of course, the job is one of the most demanding in the humanities, (any mother care to disagree?) and I often work 14 hours a day, (24 is more like it). But the job is more challenging than most run-of-the-mill careers and the rewards are more of a satisfaction rather than just money."

There was an increasing note of respect in the clerk's voice as she completed the form, stood up, and personally ushered me to the door. As I drove into our driveway, buoyed up by my glamorous new career, I was greeted by my lab assistants -- ages 13, 7, and 3.5. Upstairs I could hear our new experimental model, (a 6 month old baby) in the child development program, testing out a new vocal pattern. I felt I had scored a beat on bureaucracy! And I had gone on the official records as someone more distinguished and indispensable to mankind than "just another Mom."

Motherhood! What a glorious career! Especially when there's a title on the door.

Does this make Grandmothers "Senior Research Associates in the field of Child Development and Human Relations" And Great Grandmothers "Executive Senior Research Associates?" I think so!!! I also think it makes Aunts "Associate Research Assistants"

Please pass this on to another Mom, Grandmother, Aunt, And other friends you know. The most important things in life are your friends, family, health, good humor and a positive attitude towards life. If you have these then you have everything!