Thursday, March 18, 2010

Schedules are for busses, training is for athletes and routines are for dancers...Not babies

Note: To be as clear and specific as possible, in this article the word "Infant/Baby" is defined as a human being up until it's first year of life

Lately in Aruba, Babywise trends have started to pop up. I mean, the idea of scheduled feedings/sleep training isn't new, rather, it's taking on a new name and face. As part of Fundacion Pro Lechi Mama Aruba, being a Certified Childbirth Educator and Certified Lactation Consultant in training, I feel compelled to dispel these wrong notions because, to be honest, they are harmful and can cause serious injury to any given baby.

Misconception # 1

Babies who are fed using the Parent Directed Feeding method (PDF or Ezzo method) get more full-feedings and are less fussy and willingly sleep longer at night

This is decidedly not true. To establish and keep up a good supply, demand feeding is key. What is demand feeding? Put simply it is when a mother let's her baby guide her with silent hunger cues as to when she is hungry. These silent hunger cues are namely; sucking of the hands and rooting for the nipple, etc.
Crying is a late hunger cue. With PDF, a mother is in charge of "assessing" whether the baby is truly hungry. This assessment is done first of all, by means of the clock. Many Babywise advocates will contend that PDF is not clock feeding, but after looking carefully, it truly is. For example : say that a 2-month-old nursed at 8:00 am. She nursed for 30 minutes on both sides in total and got a "full-feeding" (according to Gary Ezzo). At 9:30 am, the baby is rooting and sucking enthusiastically on its hands. The baby is not cluster feeding or in a growth spurt. Now, purported by Ezzo, such a baby cannot possibly be hungry and should thus be given a pacifier or left to root until he cries, and until the mother assesses that he is rightfully hungry. This method is easy in the sense that all a mom has to do is feed. Her day can be well-planned out because she knows exactly when it's time to feed. Of course, the one who doesn't stand to benefit from this method and who always ends up getting the short end of the stick is, the baby. PDF babies are not better behaved and less fussy babies. They do fuss (fussing and crying a.k.a. colicky babies/high needs babies will fuss not because of feeding method but because that's their genetic predisposition) and cry but the only reason these babies stop a lot quicker with fussing and crying is because they know their caregivers, their mothers, won't respond to them or give them the necessary comfort anyway. Wow. What a nice way to instill good behavior.

Touching on the terms "full-feeding" that I keep hearing from this book, let me explain why this is non-sense. Do you know what a "full-feeding" means for a 3 day old baby? 22-27 ml of breast milk... Yes, that baby can only guzzle down 1 whole ounce of milk.(1) I mean.. you could try and 'fill-em up really good', but you'll just end up smelling like curdled milk. Spare yourself the clean up.

This whole notion of "full-feeding" makes me feel as if the mothers scorn the fact that the baby is constantly on the breast (in the first few weeks, it certainly feels that way). But when we look at gastric processes, taking into account their very small stomachs and how easily digested breast milk is, we can understand why they need to feed so often. It's not weird.. it's actually very normal. Of course, you cannot compare it to formula. Artificial baby-milk is thick, cumbersome and difficult to digest, so naturally it will take longer. This means they feed less often. Because of our formula feeding society, this has become the norm. So it's not difficult to understand the whole routine-schedule mumbo jumbo. You have more leeway with a formula fed infant. We are so accustomed to this that when we or anyone around us actually does breastfeed and mentions how many times they nurse, our knee-jerk reaction is what I like to call the "Diagnose and Repair" mentality. You talk about how often you're nursing your baby day and night (not necessarily in a complaining fashion) and your listener's "Diagnose and Repair" button was clicked. It is as if your listener was specifically asked to find a solution for a "problem" you didn't even know you had...

Moving on...

Misconception # 2

Putting your baby on a schedule and predictable routine will make them willingly sleep through the night quicker and easier. Infants who sleep at night enjoy better health than their frequent nighttime waking counterparts

Interestingly enough, Dr. James Mckenna, Director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame, conducted many tests and studies on mother-infant pairs where solitary and shared sleep is concerned, and how this affects sleep cycles and the phenomenon of SIDS. The leading theory of how frequent nightwaking in infants, especially those crucial first months, shows that nighttime waking is normal and even important. As we all have seen for ourselves, when our infants are born, they experience short periods of breathing cessation. How do they snap out of it, so to speak? By waking up. A baby who is forced or left alone to sleep for longer periods before he is developmentally ready for such, is at an increased rate for SIDS. Why? Because, mutual regulation, or in this case, sleep regulation is something that is somewhat learned. It has been proven that when a mother and an infant sleep close to eachother, they go through the same sleep cycles, such a Non-rem, Rem, light and deep sleep, at the same times. This is not coincidence. So, if a baby sleeping next to its mother, has a breathign crisis and stops breathing, this will almost automatically wake the mother which will in turn wake the baby. Strictly speaking on this point of view, frequent nighttime waking on behalf of the infant is not a bad habit or hindrance, it's a protection. (2)

Another reason for not forcing sleep on a very young baby who just isn't ready is the matter of nighttime feedings. Nighttime feedings can really sap a mother of her energy, especially if baby is all the way in another room. Nursing at night, however, is an important element, not just for the baby, but also for the mother's production. I have yet to meet a mother who hasn't at one point, worried about her milk production, or who wanted to make just a bit more milk. Nursing at night does this for the mother. Prolactin levels, which is the hormones that makes milk,follow a circadian rythm and is at its highest between 2-5 am.(3) Naturally, if baby has unrestricted access to the breasts during the night, especially during these hours, the breasts are stimulated and the mom can enjoy a copious and abundant milk supply. Nighttime nursings are also a wonderful way to reconnect with your baby if the two of you have been apart during the day because of work or what not.

Misconception # 3

Non-nutritive suckling at the breast is unnecessary and creates a bad habit


Sheilla Kipley wrote a stunning and extensive book entitled "The Seven Standards of Ecological Breastfeeding".(4) It explains not just the LAM method, but also delves into the fact that breasts are designed, not just for nutrition, but for comfort suckling. This is further proven by the fact that pacifiers,dummies,soothers, and binkies exist. A newborn and older baby has sucking needs. That is why so many babies will suck suck and suck away at a pacifier and be contented. But what was a pacifier designed after? A Nipple. A female nipple. Look back a few hundreds and thousands of years ago and you'll learn that a baby's need to suck has always been met at a woman's breast and not an artificial teat. A pacifier is actually an artificial intervention. Comfort sucking or non-nutritive sucking is not a bad habit,  it's a normal physiological necessity. Babies suck for comfort. This is not wrong. This is its intended purpose.

Misconception # 4

Co-sleeping, bedsharing, nightwaking infants are bad for a marriage

You can pick and choose anything under this sun that is potentially bad for a marriage. People do not experience marital tension or stress because the baby is physically in the bed. Often times it is an underlying factor that had not been addressed long before the baby's coming into the bed. I can give you numerous examples of babies who slept in nurseries, and their parents still experienced severe marital discord because of it. Why? Because it is left up to the mother alone to come and go as the hours pass, to feed and rock the baby. Bedsharing and co-sleeping can never be used as a scapegoat for a hidden agenda

Misconception # 5 

Demand feeding is burdensome, time-consuming and wreaks havoc on your household, marriage and friendships

I can't just say that demand feeding is easy. It's not. But then again, labor is not easy. Unexpected natural labor is not easy. A big problem some parents experience is trying to micromanage their new life with their newborn. It ain't gonna happen. I'll tell you what's even more frustrating, is trying to schedule your whole life, and having a baby that simply refuses to be scheduled into anything. If we let go of what western society has taught us in the recent 100 years+ , and we lower our expectations, the needs of everyone in the family can be met with understanding and compassion. Marriage partners have to be extremely flexible and adaptible with eachother because both are navigating through a new life with new experiences as a resort of having a child(ren). We are bringing our own thoughts on parenting, we are bringing our own childhoods, and no two people are alike. So, while demand-feeding takes a bit more effort in the first postpartum weeks, compassion on behalf of the husband will get the marriage through.

It is unreasonable and foolish to assume that when you have a baby, you can still enjoy certain, let's call them privileges in a marriage. Your lives will change, and depending on your personality and how you handle the new situation, it can either put stress on a marriage or it can fortify your union.

Misconception # 6

God blesses us with children, but with the blessings comes along the parental duty to guide and teach our children, this can never be done with demand-feeding

Since Ezzo's religious affiliation is so well-known (bad fame is still fame right?) it is hardly difficult to notice his false-religious notions he sets forth in his book, albeit well-disguised. Since some staunch Babywise advocates tend to play the God-card in justifying their questionable parenting methods let's also show the truth in what parenting involves where the Bible is concerned. Here are some principles we can work with off the top of my head

Ephesians 6:4 And you, fathers, do not be irritating your children ( this counts for mothers as well of course)
Now.. wouldn't you say, keeping a poor defenseless baby on a schedule and routine (even a newborn baby mind you) of which many babies will simply and outrightly refuse, as something that is irritating (to say the least) to your baby?

1 Corinthians 13:4-7 Love is long-suffering and kind. Love is not jealous, it does not brag, does not get puffed up,  does not behave indecently, does not look for its own interests, does not become provoked. It does not keep account of the injury.  It does not rejoice over unrighteousness, but rejoices with the truth.  It bears all things, believes all things, hopes all things, endures all things. 
Certainly, frequent nighttime waking is an inconvenience so say the least, but how long will it last? Everyone remarks how the baby-stage passes by so quickly. The nighttime waking stage also passes by. Sometimes it feels like it's lasting forever, but really, in the grand-scheme of things, it just plays a small piece of your child's whole life. Sometimes you got to repeat for emphasis "This too shall pass".... because, honestly, it will.

Realistic expectations of children: One study revealed that many abusive mothers expect infants to know right from wrong by the time the child is one year of age. A third of those surveyed specified six months.
The Bible shows that everybody is born imperfect. (Psalm 51:5; Romans 5:12) It does not claim that discernment is acquired at birth. Rather, it says that “through use” a person’s perceptive powers are “trained to distinguish both right and wrong.” (Hebrews 5:14) Further, the Bible speaks of “the traits of a babe,” the “foolishness” of boyhood, and the “vanity” of adolescence. (1 Corinthians 13:11; Proverbs 22:15; Ecclesiastes 11:10) Parents must understand these limitations, not expecting more than is appropriate to the child’s age and ability

The Bible urges fathers to avoid exasperating their children, “that they do not become downhearted.” (Colossians 3:21)

In view of these Bible principles, ask yourself: ‘Does my discipline teach, or does it simply control by hurting? Does my discipline instill right principles or just fear?’

As we know, sleep is a milestone, one that may be reached at an early age, or at a later age. It is not a matter of discipline. 

Feeding is also a child's right. A child has a right to be fed when he/she is hungry. Does PDF take this into account? Hardly, for it is the parents who decide based on their "assessment" if the baby is hungry or not. Didn't God intend for babies to feed frequently because of the easy digestion of breast milk coupled with the small capacity of their stomachs? The answer is a loud YES!

Misconception #7 

Using the breast for comfort and "shoving the breast inside the baby's mouth as soon as it fusses" is bad and will teach the child that all problems are solved with food

I'm trying to understand what exactly Ezzo takes issue with. Is he stigmatizing the use of the breast for comfort suckling? It must be so because he doesn't see anything wrong with shoving a pacifier in a baby's mouth as soon as it fusses. Or wait, Ezzo doesn't want you to comfort your child beyond the realms of diaper changes and deserved feedings. To tell you the truth, I don't know anymore what Ezzo's beef is...

But let's address this misconception. As was mentioned above, comfort suckling or non-nutritive sucking (where the baby is just 'having fun with you' and not actively nursing) is not a bad habit. It's a normal one. Some babies have a bigger need to suck on a breast, pacifier, bottle, thumb, SOMETHING, than others may have. The fact of the matter is, is that if you resort or encourage use of a pacifier as a means of soothing your baby, you may just want to try the breast instead. I can tell you what's a real nasty and difficult habit to break, and that's the use of a pacifier. So it comes down to, which do you rather use as a comfort method?

Other questions and observations about PDF:

Babywise permits (and after reading between the lines, encourages) the use of a pacifier, because, non-nutritive suckling (comfort sucking/sucking but not actively nursing) is discouraged and seen as a bad habit that must mothers avoid like the plague lest they become permissive parents. Use of a pacifier is almost universally known to cause nipple confusion in the first 4-6 weeks. Mother's who see pacifiers in a favorable light tend to breastfeed for shorter periods. Pacifiers are best left where they are, in the store....


(1) SilvermanWA, ed.  Dunham's Premature Infants, 3rd edition.New York: Hoeber, Inc., Medical Division of Harper and Brothers, 1961, p. 143-144.

(3) Riordan (2005, p. 76):

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