Category Archives: Dummies and Pacifiers

How to Cope When Your Baby Has Separation Anxiety (AKA The Clingy Baby!)

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I remember it well. Just as you come out of the new parent fog, your baby sleeps a little more at night, you begin to think that ‘at last I might have this parenting thing sussed’, perhaps you’re about to go back to work, or consider leaving your baby for your first post baby night away…….and then it happens, all of a sudden your baby regresses back to newborn behaviour, your smiling, ‘happy to go to anybody’ little bundle is only happy in your arms. You can no longer even have a wee alone, the second you leave the room you hear your little one wail, if they’re mobile they crawl into the bathroom after you, clinging at your legs desperate for you to pick them up.

cryingWhat went wrong?

What did you do to create such a clingy baby?

Why is your little one so lacking in confidence that they need to be glued to you 24/7?

Why do they cry so much unless they are close to you?

It’s your fault……you must have done something wrong surely?

Only you didn’t, in fact you did everything right! Separation anxiety (AKA the baby who screams unless superglued to you) is a GOOD sign, yes I did say that, no I’m not insane – it’s a sign you’ve done a great job! In fact it’s one of the best signs you can see to show that you have raised a psychologically healthy, completely normal infant.

So why is it a good thing? To put it briefly when your baby is born they have no idea that they are a separate entity to you, as far as your baby is concerned you and he are one , in fact you may as well be your baby’s arm or leg, he sees you as such an integral part of your being. It takes quite a while for your little one to work out that you aren’t joined at the hip, that he is a separate being to you. This knowledge happens at around 6 to 18 months, peaking at around the 9 to 10 month stage.  It shows your baby is clever, intelligent and totally, totally normal and it shows you have done a great job as a mother, you see it is an indication that your little one has formed a secure attachment to you.

Last century several prominent psychologists spent a long term researching attachment theory, I’m going to be a bit lazy here and fill you in via YouTube

THIS is also a wonderful (in depth) summary of the origins of ‘Attachment Theory’ – in short the significantly important work of these researchers led us to the understanding we have today – that the beginnings of true independence and confidence in children stem from a secure attachment to the mother (or substitute mother figure) in infancy.

One of the best measures of ‘secure attachment’ is a very young child who is comfortable (to explore the world) in the presence of her mother and very upset when her mother leaves – the only problem is in our detachment parenting culture this is not seen as normal, it is seen as undesirable and ‘clingy’ behaviour, in many cases it is seen as a failing – a failing for the parents to ‘detach’ and grow a confident child. This couldn’t be further from the truth, just as the incorrect assumption made by society that “in order to create a confident independent child we must push them out into the world so they can learn we are not always there” is grossly incorrect too. True independence is not learnt through rewards, punishments and force, true independence stems from a loving, secure relationship with caregivers at a young age.

So then, back to your clingy 9 month old. Rather than being a cause for concern that you’ve done something wrong and will have a shy, clingy child living with you until their 30s, actually what his ‘clingy’ behaviour could be interpreted as is a way of him congratulating you “you did good mum!”. All of that considered I appreciate it would be nice to have a wee by yourself once in a while, so here’s a few ideas to help you to cope during the peak separation anxiety period whilst fostering the all important attachment your little one has created and allowing detachment at his or her pace.

hugsad1. Empathy – Understand what your baby is going through, understand that this is a normal phase of development, albeit a scary one, for them to pass through, they are not trying to manipulate you or “wind you around their finger”, if you parent with empathy during separation anxiety not only will your child be more empathic and confident themselves when they are grown, ultimately parenting will be easier and more rewarding for you too.

2. Understanding – Not just from you, but from those close to you. Despite research into attachment theory being prevalent in the 50s and 60s (the era our parents were most often born) the results of this research didn’t really filter down into mainstream parenting, thus our parents probably parented in an entirely different way that involved us “needing to learn to be independent”. It’s hard parenting in a way different to your own parents, particularly when they (and health visitors of a similar age) offer us advice along the likes of “Just leave him to cry a little bit, it won’t kill him, he has to learn he can’t have everything his own way all of the time.”

3. Consider the timing for your return to work – Many mothers book their return to work at around 7 to 10 months, thinking that their babies won’t be tiny any more, will probably be weaned onto solids and thus not so needy of the mother, in fact this is probably one of the worst times a mum can return to work, but it is so common! Consider the possibility of pushing back your return to work by a month or two if possible.

4. If you do have to return to work, consider the impact of attachment on your child, it has long been suggested that one on one care in a home setting from a nanny or childminder is psychologically more healthy  for a baby, it allows the child and caregiver to foster a good bond and to help the baby to cope with separation anxiety in a way that will lead them to be more confident as a child.  Attachment Childcare UK is a wonderful organisation that offers a free listing of childcare professionals who subscribe to the principles of attachment theory.

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Consider postponing a move to the nursery or out of the parental bed. We all know 6 months is the recommended minimum to keep our babies in our bedroom in order to reduce SIDS risks, keeping your baby in with you for a little longer can also help them to cope with separation anxiety too.

6. Build secure attachments with other people – Pretty much covered in point 4 above, but the secure attachment doesn’t just have to be with mum, it can be with dad, granny, grandad, babysitter, nanny or childminder! You just need to build the secure attachment before separation anxiety exists

7. Help your child to feel as ‘close’ to you as possible, some parents give their child an item of their clothing to hug, a muslin spritzed with their perfume or even a photograph of themselves to carry around. Some even record their voices, talking to their little one or singing a lullaby.

8. Donald Winnicott spoke widely about ‘transitional objects’, or what you and I would know as ‘comfort objects’. Teddy bears, dummies, blankets, ‘lovies’ or any other object which a child can use to transition from complete dependence to relative independence from you.  First Mummy or Daddy sleeps with the comforter to transfer all their comforting scents onto the comforter. When introduced to your baby/toddler,the comforter helps to create a cosy safe environment for your little one to drift off to sleep whilst still feeling the closeness of you. Just make sure you have more than one in case one gets lost!

 

9. Try to keep the rest of your life as constant as possible, nine months is not the greatest time to go on holiday for instance, or start a trial session at nursery or the gym crèche.

10. Be kind on yourself whilst your baby is experiencing separation anxiety. This is the real key, the key to surviving this period is you.  You can’t do much to speed your baby through this stage, nor can you stop them from feeling totally normal feelings, but what you can do is change how you respond. In order to respond with compassion for your baby you need to nurture yourself. Sleep when you can, enlist help from people your baby already has a secure attachment with, even if it is just for them to sit cuddling your baby for an hour whilst you soak in the bath, ask people to prepare meals for you, consider temporarily employing a cleaner or somebody to do your washing and ironing for you (using our local laundarettes service wash was a Godsend for me during this phase with my children!). Find something that helps you to mentally relax – yoga, relaxation CDs, running, reading a good book and know that “this too will pass”.

The easiest way to survive separation anxiety is with the help of your family and friends, this is the key – as summed up so well by the father of attachment theory – Bowlby – himself:

“Just as children are absolutely dependent on their parents for sustenance, so in all but the most primitive communities, are parents, especially their mothers, dependent on a greater society for economic provision. If a community values its children it must cherish their parents.” (John Bowlby, 1951)

Sarah (Mum to Four, Parenting Author and Founder of BabyCalm Ltd)

You can read more of Sarah’s articles HERE.

Are you a Dummy Mummy?

Dummy = pacifier to my overseas readers!

I’ve been asked twice this week if I know of any evidence on the pros and cons of dummy use, naturally being the science geek that I  am, I do indeed know of an embarrassingly large collection of trials for both camps of the debate. I thought it might be handy to pop a quick post together to summarise the evidence.

One thing is for sure and that’s dummy use is highly prevalent in the UK.  The Avon Longitudinal Study found that nearly 60% of the 10,950 babies in the sample had used a dummy by four weeks of age!

Dummy Positives:

1) Dummy use may reduce SIDs risk

dummyMitchell, Blair and L’Hoir at the University of Auckland, New Zealand carried out a trial in 2006 which found “a remarkably consistent reduction of SIDS with pacifier use. The mechanism by which pacifiers might reduce the risk of SIDS is unknown, but several mechanisms have been postulated. ” Ditto researchers Moon, Tanabe, Yan, Young and Hauck at the Goldberg Center for Community Pediatric Health recently conducted a population based case-control study of 260 SIDS deaths and 260 matched living controls. Finding that dummy use decreased SIDs risks and that “pacifier use decreased SIDS risk more when mothers were ≥20 years of age, married, nonsmokers, had adequate prenatal care, and if the infant was ever breastfed. Pacifier use also decreased the risk of SIDS more when the infant was sleeping in the prone/side position, bedsharing*, and when soft bedding was present.”  A further study published in the BMJ in 2006 and conducted at Kaiser Permanente Northern California also found once again that dummy use “was associated with a reduction in risk in every category of sociodemographic characteristics and risk factors examined”.

It has been postulated that dummy use helps to keep infants in a back lying position and that this is what contributes to reduced SIDs levels although follow up research did not find this to be the case.

This research has led to the American Academy of Pediatrics & FSIDs recommending using a dummy at every sleep to reduce the risk of SIDS (and waiting  until 1mth in the case of introducing a dummy to  breastfed babies so that breastfeeding can become established).

*note I cannot find any information on whether this was all bedsharing lumped together or co-sleeping following safety guidelines.

2) Dummies can help to calm a fractious baby

dummy3Suckling is nature’s best comforter, if the mum is breastfeeding she has all she needs – although many choose to use dummies to help partners calm the baby or when she needs time alone, but bottle feeding mums are often helped greatly by the addition of a dummy which gives their baby a chance to suck when they are not being fed. Interestingly, there are marked differences in dummy use around the world – as I’ve already mentioned above the Avon Longitudinal study found 60% of British babies used dummies, whereas in their study “Soothing methods used to calm a baby in an Arab country” by Abdulrazzaq, Al Kendi and Nagelkerke which analysed data from  702 mothers from the UAE nationality, other Arabs, other Muslims, Indians and Philippinos in 2009 found that whilst 99.1% used breastfeeding as a soothing method, less than 10% used dummies to soothe their babies!

3) Dummies may help cranial bones re-align.

During labour the baby’s cranial bones move and overlap (think of a cone headed newborn!), this is normal and the bones usually return to their normal position over a few days after the birth, mostly via the process of the baby sucking (and the movement of the upper and lower jaw) which stimulates the base of the skull via the palate. Sometimes however things don’t return to normal and often abnormal skull compression becomes noticeable via the baby’s feeding habits and need to suck much more than usual. If the baby’s vagus nerve (the nerve directly linked to digestion) is compressed this can also have noticeable effects on a baby’s digestive system causing pain. All of this is more likely to happen if the labour is long, the baby is malpresented, I often notice babies who laid in an asynclitic presentation during labour are more sucky. For bottle fed babies in particular dummies can be very useful for a baby who needs to suck a lot. Sadly I cannot find evidence to support (or refute!) these claims although anecdotally many chiropractors and cranial osteopaths around the world agree and a recent literature review of “The chiropractic care of infants with colic” by Alcantara in June 2011 published in the International Chiropractic Pediatric Association reported that  “Our findings reveal that chiropractic care is a viable alternative to the care of infantile colic and congruent with evidence-based practice, particularly when one considers that medical care options are no better than placebo or have associated adverse events.”

Dummy Negatives

1) Dummy use increases the risk of Otitis Media (ear infections)

dummy2Science suggests there is a definite link between dummy use and paediatric ear infections. A Finnish study by Niemala, Pihakari, Pokka and Uhari published in Pediatrics  in 2000 found the occurrence of Acute Otitis Media  (AOM) was 29% lower amongst children whose parents had been told to limit dummy use. A Dutch cohort study published in Family Practice in 2008 by Rovers et al found once again that dummy use was a risk factor for ear infections. In their study of the 216 children that used a dummy 35% developed at least one episode of AOM, and of the 260 children that did not use a dummy a smaller percentage of 32% developed at least one AOM episode and for recurrent AOM, these figures were 16% versus 11% respectively.

2) Dummy use causes orthodontic damage

Research suggests that dummy use can cause orthodontic changes, however the research seems to suggest that this happens with long term (2yrs+) dummy use only *. A 1994 study by Ogaard B, Larsson E & Lindsten R entitle “The effect of sucking habits, cohort, sex, intercanine arch widths and breast or bottle feeding on posterior crossbite in Norwegian and Swedish 3-year old children” found that ther was a high prevalence of posterior crossbite in dummy users, however their analyses of covariance revealed that at least 2 years of dummy use was necessary to produce a significant effect in the upper jaw and 3 years in the lower jaw.

* note – I am unable to discover whether the research looked at regular  or orthondic type dummies.

Dummy use has an adverse effect on breastfeeding

breastisbestor1A study published last month by Gerd, Bergman, Dahlgren, Roswall and Alm entitled “Factors associated with discontinuation of breastfeeding before 1 month of age.” found that there was a negative correlation between breastfeeding and use of a dummy, however the famous 2011 Cochrane review into “pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding”  found that dummy use in healthy term breastfeeding infants, started from birth or after lactation is established, did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. However, evidence to assess the short-term breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants’ health is lacking.
I wonder if you’re now feeling like me? non the wiser! non of this research seems particularly compelling to me and could be used to support either “pro” or “anti” dummy use (and indeed it is!). For the record I don’t really have a position on dummies, I think they work for some families/babies and not for others – I’ve suggested them to some of the parents I’ve worked with and have suggested to others they might want to stop using them. One thing is for sure though there are a few basic guidelines to follow when using dummies:
  • wait until breastfeeding is well established (FSID suggest breastfeeding mums don’t use a dummy for the first 4wks).
  • only give your baby a dummy when they really need it (i.e: to calm crying, or help a fractious baby sleep) but take the dummy away when the baby is calm to prevent the dummy use becoming habitual.
  • try to get rid of the dummy by 6 months, by this time the benefits have pretty much served their purpose – longer use can take you more into the negative camp.
  • Always be led by your baby! if your baby won’t take a dummy – don’t persevere, listen to them!