Breastfeeding Benefits Mother and Child

June 11th, 2013

by: David E. Bratt MD

I had intended writing something on gas—the intestinal kind, the one that we are full of these days, not the one that comes out of the ground, so responsible for many of the misfortunes we daily face—when two remarkable articles on breastfeeding, one in the morning on baby’s brains and the other late in the evening on women’s health, came rolling over my desk and, despite the anguished cries of my three or four friends desperate for something to laugh at in the Trinidad of today, they are too important to ignore. We’ll laugh another day, fellows.

The first benefits babies and is about babies’ brains and MRI machines. Some guys at the Advanced Baby Imaging Lab at Brown University in Providence, Rhode Island looked at the brain growth of 133 babies ranging in age from ten months to four years using specialised, “baby-friendly” magnetic resonance imaging (MRI) or “quiet” MRI machines—and if you have ever been inside a MRI machine, or tried very hard not to wake up a sleeping baby, you will understand the relevance of that term “quiet MRI”! The babies were split into three groups: those exclusively breastfed for at least the first three months of life, a group fed a combination of breastmilk and formula, and those fed formula alone. Brain MRIs were consecutively done on all babies over the years that the study lasted.

By age two, the babies breastfed exclusively for at least three months had enhanced development in key parts of the brain, in the order of 20 to 30 per cent, compared to the other two groups.
The MRIs specifically looked at the brain’s white matter, the tissue that contains long nerve fibres and helps different parts of the brain communicate with each other and is responsible for the billions of connections among brain cells. The MRIs look for amounts of myelin, a fatty material that insulates nerve fibres and speeds electrical signals as they zip around the brain and produce faster processing time. The extra growth in myelin was most pronounced in the parts of the brain associated with language, emotional function and cognition.

As expected, the combined feeding group came second and the formula-fed babies last. There were three other points that came out of the study. The differences were apparent almost from the very first MRIs. So my mother-in-law’s encouraging words for our first baby, to “give her a little bit, nuh, just a little bit,” was true. Even a little breastfeeding seems worthwhile. The differences were directly related to the length of breastfeeding. Unfortunately the authors were not able to look at babies who breastfed for more than one year so we have no idea if the differences become greater the longer the baby breastfeeds. The team then backed up their imaging studies with a set of cognitive tests on the older children and found increased language performance, visual reception and motor control performance in the breastfed babies.

There have been many reports of enhanced brain function in breastfed children but this is the first to actually document physical changes in the brains of breastfed babies. Further studies on other organs are planned. The second study, enthusiastically entitled Cost Analysis of Maternal Disease Associated With Suboptimal Breastfeeding, came out last week too, in the Journal of the American College of Obstetricians and Gynecologists, Obstetrics and Gynecology and I urge the doctors in the Government to read it. Only medical researchers, by the way, could come up with a title like that. It should have been called Women Who Don’t Breastfeed Get Sicker. They wanted “to estimate the US maternal health burden from current breastfeeding rates both in terms of premature death as well as economic costs.” So they took all the information that is known about the health benefits that accrue to women who breastfeed—less breast cancer, less ovarian cancer, less hypertension, less type 2 diabetes mellitus and myocardial infarction.

Through computer analysis, they modelled the health outcomes and costs expected for a US cohort of 15-year-old females followed to age 70 and compared the outcomes expected if 90 per cent of mothers were able to breastfeed for at least a year after each birth with outcomes under the current one-year breastfeeding rate of 23 per cent. The results were eye-opening. Current breastfeeding rates result in 4,981 excess cases of breast cancer, 53,847 cases of hypertension, and 13,946 cases of myocardial infarction compared with a cohort of 1.88 million US women who optimally breastfed. They also looked at direct costs, indirect costs, and cost of premature death (before age 70) expressed in 2011 dollars. Suboptimal breastfeeding incurs a total of US$17.4 billion in cost to society resulting from premature death, US$733.7 million in direct costs, and US$126.1 million in indirect morbidity costs. However, they found only a minor difference in number of deaths before age 70 under current breastfeeding rates. If applied to the smaller population of T&T, the results would be much less dramatic. Unless, of course, you are the one with the cancer, high blood pressure, diabetes or heart attack.

Why Mothers Kiss Their Babies

June 10th, 2013

by: David E. Bratt MD

Next Sunday is “Mother’s Day”, another of these “days” and “months” we now have to endure. I suspect, like many people, that there is more than just a mild commercial interest behind them. Do we need a special day to honour someone who we should honour and love every day of our lives? Maybe the person who came up with the idea didn’t feel that way about his mother. There are many people who are not close to their mothers. After 25 years of seeing the way some mothers treat their children, I don’t blame them in the least. Which is not to say that the medical or nursing profession should not take some of the blame for the lack of affection that some mothers feel for their offspring. Some mothers do not instinctively love their children and have difficulty with their emotions after the birth. Such a mother will seldom make her real feelings known since everyone expects her to go gaga over the newborn. This is a great hidden secret of motherhood and it is not abnormal. Most of these mothers grow to love their children dearly, much more than their children ever love them. But some never do.

What is abnormal is when doctors and nurses place obstructions in the way of mothers attaching to their babies. The classic example is removing the baby from the mother as soon as she births. Or isolating the the baby in a nursery. Why shouldn’t the baby be left with the mother (and father) so that the baby can be touched and kissed?

Why do mother’s kiss their babies? After a baby is born, it is a natural thing to see the mother kissing the baby. One would think that this is simply because of the emotional bond that has formed or is forming between mother and child. While this is the case, there are also some other very compelling biochemical reasons as to why this occurs.

Those of you who have seen an animal give birth to its young, or watch the Animal Channel, will have seen that just after the birth, the mother spends a lot of time licking it’s child. Licking exposes its five senses to the young, so that the mother knows the taste, smell, feel, sound, and sight of her new baby. In this way, the mother claims the child as her own.

When a human mother gives birth to a baby in an environment which allows her immediate and free access to her child, you will notice that over a period of time the mother performs similar behaviors, called claiming behaviors. She will caress the child, exploring the softness of the baby’s skin and counting and fondling the fingers and toes. She will marvel visually over how much the baby looks like her or her husband or another family member, the color of the hair and eyes, and other physical features. She hears the baby’s cries and learns to distinguish her baby’s cry from all others. As she leans down to kiss the child, she smells the scent of her new baby, and through the act of kissing the baby, she actually learns to know his taste. She has exposed her five senses to the baby so that she attaches to the baby, feeling that the baby is now her own. It is not unusual to note that women who are deprived of the privacy and opportunity for bonding immediately after birth often state that there is an emotional distance between them and their babies, that they are never really sure that the baby is theirs. Claiming behaviors such as kissing the baby provide not only emotional but biological attachment.

There is also a very real health benefit for the baby in terms of kissing. When a mother kisses her baby, she ‘samples’ those pathogens that are on the baby’s body and face, the very ones that the baby is about to swallow. These samples are taken up by the mother’s lympoid organs like the tonsils, and white blood cells called memory B cells, specific for those pathogens sampled, are stimulated and re-stimulated with each kiss. These B cells then migrate to the mother’s breasts where they produce just those antibodies that the baby needs. We talk a lot about breastmilk, and about how it conveys antibodies to the infant and helps to prevent illness. However, the antibodies that the mother has made to the germs around her while pregnant convey little immediate help to the infant. It is the germs in the infant’s environment at present, the ones he is in contact with right now which he needs protection from. Kissing the baby is a very important biological activity beyond it’s obvious pleasurable and attachment-promoting value.

So mothers, kiss away on those babies and may you and your children have many, many more days to call your own.

Feeding Babies

June 10th, 2013

by: David E. Bratt MD

Feeding babies is easy: mother’s milk exclusively for the first six months and then at least for 18 months more. At six months, gradual introduction of easy-to-digest solids like fig, mango, pumpkin, ochro, eddoes and rice and peas, followed by food that is a little harder to digest, like callalloo and fish and egg. By one year the child should be eating from the family pot. Apart from the nutritional and economic advantages of this simple system, there is another advantage. The family that eats together stays together. One of the joys of fatherhood is introducing food from your plate to your daughter or son and seeing them mash it down.

So why is there still some confusion? What makes feeding babies difficult are the misleading advertisements from so called “baby food”companies. There’s no such thing as “baby food”. The concept of “baby food”, to be given to babies in a bottle, is an advertising ploy worked out by clever psychologists at giant international corporations so that they can sell their particular brand of flavoured mush. This plan has worked so well in the master countries of Europe and North America that culturally dependent countries have come to believe that special foods are needed for infants. The idea of special foods for normal infants is a commercial one not a medical one. It’s “rum and roti” medicine.

There is little need for special cow or soy milks or “formulas” for babies. As if formula milks were something specially created in a lab by a mysterious scientist and designed specifically for your baby. Formula is ordinary cow’s milk with some vitamins and minerals added and a hyped up advertising campaign to convince you that your baby needs it. Some of the formulas are said to be for babies under six months. Others for over six months. And the latest are the ones “specially designed” for children from one to three years.

This is all nonsense. They are all based on ordinary cow’s milk and are all the same with very minor modifications. There is no medical information on the superiority of these milks. No research has ever been done to substantiate the claims that these milks are needed for children, far less the impression being given that they will help your child be healthier. The story that you need to drink milk from a cow for the calcium is rubbish. You can easily get calcium from other foods. Most children in the world do. All the evidence to date, and it is plenty, is that cow’s milk, whether plain or as a formula, should be considered a risk factor for a number of diseases like crib death, diabetes, asthma, certain types of cancer and high blood pressure, to name a few.

The idea is to get you hooked on milk from early o’clock so that you help these countries get rid of the surplus milk they produce whilst enriching their people and contribute to our country’s external debt. The only other thing milk does for you is make you pass gas. Quite appropiate.

Then there are the little bottles of artificial “baby food”. These seem to be specially designed to make your baby regurgitate or become constipated. The last time I looked most of them were based on sweet potato into which a little carrot or peas or chicken etc., had been added. You can always tell babies who are being fed lots of bottled food. Their skin has a sickly yellowish colour from the excessive amount of the yellow pigment, carotene, which is in sweet potato.

These bottle foods have no advantage over real food. They are artificial, expensive and tasteless. They produce bland, overweight babies, children and adults. They serve as an introduction to fast food, of the American sort. Like fast foods they are convenient and can be used occasionally. They are no substitute for a home-cooked meal, shared by the entire family. Everything goes back to the family. If we want our children to grow up and become reasonable decent, successful adults we need to go back to the basics. There is nothing more basic than how you feed your child.

Breastmilk and Breastfeeding

June 10th, 2013

by: David E. Bratt MD

Suppose someone had invented a tonic that had all the vitamins and minerals and proteins in it that a baby needed to grow properly. It contained hormones that helped develop the baby’s heart, lungs, liver and intestine. In addition it prevented the baby from getting sick with infections, especially serious ones. And it helped prevent the baby from getting a whole host of illnesses later on in life, like diabetes, heart attacks, high blood pressure, asthma, some types of cancer and obesity. Finally, to top it off, it had something in it that seemed to make the baby smarter. Giving it to the baby also guaranteed less visits to the doctor, less use of prescription drugs and savings of some US$ 1000 a year to the parents.

Well, this drug would become breaking news on CNN, the BBC, all the health networks and the businness magazines. We would be inundated with lenghty articles by eminent medical researchers and smart businessmen eager to get onto the bandwagon and make some money. We would be bombarded with radio, newspaper and TV ads urging us to give this drug to our babies as a guaranteed way to stay healthy. The company fortunate enough to develop this drug would make more money in one year than they did with Viagra.

Well this tonic exists. It’s called breastmilk. And you seldom hear it described in these terms.

Go around a room filled with pregnant mothers and their partners and ask them to list the advantages of breast-feeding and a number of them will mention bonding with baby and something about gastro. The occasional man will mumble something about “is de best way.”

Worse, ask a group of doctors why babies should drink their mother’s milk and most of the time, except from the ones whose wives breastfed or who themselves breastfed, all you get is an embarrased silence, or some platitude about “breast is best”, occasionally said with a snicker or a furtive glance at the most prominent pair of mammary glands present.

Why more women do not breastfeed remains somewhat of a mystery. The reasons behind this are complex and involve a mixture of Hollywood culture, medical ineptitude, woefully inadequate public education and some fancy footwork from the companies that sell milk for babies.

We live in a culture that paradoxically considers milk from an animal to be the “perfect” food but milk from a human to be an expression of sexual behaviour. The sexualization of women’s breasts is now so complete that in some countries laws have had to be passed to protect women who choose to breastfeed their babies in public, from being arrested and taken to jail. In some universities young women react with repugnance when told about feeding a baby with their breasts. They’ve been brought up to believe that their breasts are sexual symbols, to be used by men for their mutual pleasure. The image of a cow and a bottle are what people think of whenever you mention feeding a baby. What makes all this even more complicated is some interesting work being done that suggests that some women who are unable to breastfeed their children have been sexually abused as children.

The medical profession today remains as ignorant of the composition and medically proven benefits of breastmilk as they were in the 50’s and 60’s when they used to tell parents that formula is “as good as breastmilk”. Mention any of the various growth factors, cytokines and antiinflammatory factors responsible for the improved immune function of breastfed babies and and all you get from them is that glazed look in their eyes that reminds you of dead fish. There is evidence that doctors whose wives choose not to breastfeed are not as supportive of breastfeeding mothers as they should be. More evidence, if more were needed, that people will conveniently avoid the facts, even if scientifically proven, whenever it pleases them.

Hence the failure of public health programs that do not take the culture into consideration. The knowledge that Princess Diana breastfed the future king of England probably did more for breastfeeding rates in Trinidad & Tobago than any boring feature by the Ministry of Health on local TV. Not that the Ministry of Health has been supportive of its breastfeeding program, beyond the usual mouthing of phrases and endless committee meetings. Ironically, the most progressive educational move in T &T has been the mainstreaming of breastfeeding into some TV shows and movies on American cable. A sign of things to come?

The official policy of formula companies of course is that they are in favour of babies breastfeeding. As has been pointed out by others, that is like putting a wolf to guard the sheep. The formula companies are masters of psychological deception and there are numerous instances of them recommending certain breastfeeding practices which are certain to inhibit breastfeeding. Like the one they used to have, recommending mothers to clean their breasts with soap and water, before nursing. This continued the idea that the breast was somehow unclean and at the same time made a chore out of a simple, natural process.

The bottom line is that mothers need to have all the facts before them; facts about the dangers of feeding cows milk or formula to their babies and facts about the benefits of breastmilk. Then the choice is theirs. But the choice must be an informed one. This is not the case now. Much more education needs to be done. By everyone. Doctors, nurses, the Ministry, the media, teachers, and especially, the mothers and grandmothers who have nursed their babies. Breastfeeding is too important to be left to doctors alone.

Touching

June 10th, 2013

by: David E. Bratt MD

I see where the police are proposing to start talking about “Good Touch Bad Touch” to children. This is good. About twenty years too late but better late than never, the claim of third rate societies. If this is another manifestation of the Commissioner of Police’s 21st Century Policing Initiative, then I am all for it. It would be good to see some 21st Century trade union thinking from the Police Service Social and Welfare Association. We are all tired of this senseless resistance for resistance’s sake or to look good in the evening News. As Atillah Springer says, that’s one of the few times we can see ourselves portrayed on local TV and folks, we do not look good, especially when we are trying to defend a TV interviewer who thrives on publicity and who sees nothing wrong in showing a video of a young girl being raped or the body of a dead two year old who died while being abused, because “dey ketch dem!” So the end justifies the means?

This is the equivalent of holding literature readings for children at a fast food outlet. Feed the minds and fatten their little bodies. We may just end up with wonderfully talented obese writers who die young of heart attacks or strokes.

Good Touch Bad Touch is an incredibly complex American program, started in the mid 1980’s,that helps children from preschool through primary school, to recognize and report the signs of sexual abuse and bullying. It may have important implications for us.

Teaching Good Touch Bad Touch is difficult and is not for the uninitiated. Showing pictures of an adult hugging a child as a bad touch can give the wrong message regarding situations where a hug is appropriate, such as when a parent hugs a child. The main concept to get across is that deciding whether a touch is good or bad, depends on who is doing the touching and how that person is touching another. Anyone who is touching another person on private areas such as breasts, penis, or pelvic area, or who tries to kiss another person without that person’s consent is performing a bad touch.

When children get good touches such as hugs and kisses from their parents that should makes them feel happy. When people they do not know hug and kiss them, that should make them feel sad or unhappy. This is how you know what is a bad touch. Good touch and bad touch both give children feelings. The difference is that one is not harmful to the person and the other one is. The next step, teaching children to speak up about bad touches is another problem.

The point is that humans, from tiny babies to old hard back men, instinctively know the difference between a touch that feels good and one that does not. We all are very sensitive to touch. To teach such a program however is not simply a matter of saying “it nice”. It is a program and needs to be done in the proper way. I love that word proper. It brings back memories of little girls in organdy dresses and short-heeled white shoes with white socks going to church on a Sunday morning. Proper!

Proper calming of small babies used to mean either letting them cry themselves to sleep regardless of whether they were in pain or not or giving them medication, usually “colic medicine” or sugar water. Both work occasionally but not well and not all the time. There have now been two studies that clearly demonstrate that touching the baby works better, something that astute mothers have known about for some time.

Since it’s done by Americans, it has a special name, like “Good Touch Bad Touch” or that implied oxymoron “quality time”. It’s called the ‘5 S’s” but it basically means hold your baby close to you when he cries. Anyway these guys have made the considerable scientific discovery that if a baby is being given a needle at the two-month visit, as in vaccination time, babies who are held close by their mothers, as in breast feeding or as in simply holding close, cry less than babies whose mothers either did not hold them or gave them sugar water to drink just before the shot.

The five S’s refer to: swaddling, holding the baby in a stomach position, shushing sounds (in the West Indies we would change that to singing), swinging and sucking.

If babies were doing four out of five of these “5 S’s” they would usually stop crying within 45 seconds of the shot.

There were two other remarkable things about the babies and their parents. The authors of the studies thought that the combination of sugar water and the “5 S’s” would give superior results to the “5 S’s” alone and were surprised to find that the touching program alone gave better results.

The authors tested their hypothesis on more 2-month olds than 4-month olds. They had planned to repeat the study on the same babies at four months but were unable because most of the parents were using it themselves.

Bringing Up Children

June 10th, 2013

by: David E. Bratt MD

A question often asked is: “What’s the best way to bring up a child? What are some of the things I should do to make sure my son grows up healthy? How can I be sure my daughter will grow up to be reasonable happy?”
 
Well, it’s clear that there can be no definite answers to such ponderous philosophical questions. A lot depends on what you want your child to be. Rich? Successful? Happy? Moral? Law maker? Law breaker? Law abider? Kind? Compassionate? Caring? Selfish? Anything at all? At a minimum one would want their child to be happy and healthy but children and people are far too complex and live in such intricate and weighty situations that detailed and specific answers are all but impossible to answer without comprehensive understanding of a specific situation and all its ramifications. Even then woe to the man or woman who dares to give an opinion without considering an exit strategy. What works with one child may not work with another.
 
However there’s been enough research and practical experience for some generalities to be offered as advice. Most of the recent published research that I am familiar with, comes from the Department of Psychology at the University of Notre Dame, from the labs of Dr. Darcia Narvaez. A lot of it may be surprising and of course there will always be the know-it-alls, and there are many of them in T&T, who will turn up their noses and whinge. They were probably brought up the wrong way.
 
Dr. Narvaez has been able to show “a relationship between child rearing practices common in foraging hunter-gatherer societies (how we humans have spent about 99 percent of our history) and better mental health, greater empathy and conscience development, and higher intelligence in children.”
 
First of all, it begins in the first days of life. None of this ‘we’ll start teaching you how to behave when you start big school’ business. Small babies have been shown to have a very good sense and understanding of social interactions and respond dramatically to negative or positive influences.
Dr. Narvaez describes six characteristics of child rearing that were common to our distant ancestors and are advisable today in order to rear a child to be a happy, healthy adult.
 
It starts of with natural childbirth which provides mothers with the hormone boosts that give them the energy to care for a newborn. It just seems that all of that pushing and moaning is needed if you want oxytocin to be immediately secreted in the amounts necessary to deal with a baby.
 
A second key characteristic is prompt response to the baby’s fusses and cries. You can’t “spoil” a baby. This means meeting a child’s needs before they get upset and the brain is flooded with toxic chemicals. “Warm, responsive caregiving like this keeps the infant’s brain calm in the years it is forming its personality and response to the world,” Narvaez says. The corollary of this is never be afraid to pick up the baby and soothe it. Trust is thus formed in the child’s emotional makeup. There’s far too much nonsense being advised in T&T today with young mothers being told to let the baby “cry it out.”
 
How much harm this advice is doing to children and to their mothers remains to be seen but the suggestion is that we are creating a group of uncaring, undisciplined, self-centered monsters who have no empathy for any one or anything.
 
The follow up to this, is the third recommendation: touch, touch, touch the baby with nearly constant carrying, cuddling and holding.
 
The easiest way to do this is to breastfeeding, ideally for 2 to 5 years. A child’s immune system isn’t fully formed until age 6 and breast milk provides its building blocks as well as immunity to any disease that the mother has had.
 
A surprising finding to many but a welcome one is the fifth recommendation. A child should have, after the first months, several adult caregivers, people beyond the parents who also love and care for the child. Trust then moves from the home to outside. Of course this is exactly what used to happen in the “old days” when, not only aunties and uncles and grannies and cousins used to be around the growing child, but the very people in the street where the child lived would take an interest in what was going on.

Finally, the importance of play, and not organized play, but free play with different aged playmates. Free play is what we grew up on, roaming the streets and parks of Woodbrook, from sunrise to sunset, inventing things to do. Children who don’t play enough are more likely to become depressed, anxious, have phobias, become aggressive and suffer more from ADHD.
 
So if you want your child to grow up to be like some of my colleagues, happy, intelligent and with naturally curly hair or even no hair at all, you now know what you have to do and can’t say you were not warned.

Mammy

June 10th, 2013

by: David E. Bratt MD

Simple intuition as well as personal experience informs us that good parenting is key for the development of mature, reasonable, adaptive human beings. Just how important a mother’s love is in this process as well as just how harmful lack of parenting can be, has become more obvious as the issue is further studied and it is becoming apparent that people need to pay more attention to parents’ nurturing, if we want to ever live in some degree of social comfort. Nuturing has a very, very big impact on later development and criminal behaviour. Some of the latest research findings are simply staggering.

I do not include government in this conundrum. Reluctantly, I have to agree with Mr. Duprey when he says, “West Indian politicians are the laughing pirates of the Caribbean……….who get up in the morning and say, ‘Lord, keep these people ignorant.’” If it has taken WHO to push the Minister of Health into an appreciation that adult lifestyle diseases are directly related to children’s obesity and food and exercise issues, do not expect any politician will ever realize on their own that lifestyle is also about how much you nuture or love up your children.

Research by child psychiatrists and neuroscientists in the last two years show that mentally healthy children who have loving, caring mothers have a larger hippocampus than depressed children with non-nuturing mothers. When the body stresses, the brain activates a part of the nervous system that controls the release of stress hormones. Those hormones help cope with stress by increasing the heart rate and blood pressure thus helping the body adapt. The hippocampus is the main brain structure involved in that response.

Brain scans done on 92 children who were either mentally healthy or had symptoms of depression as preschoolers, revealed that children without depression who had been nurtured had a hippocampus almost 10 percent larger than depressed children whose mothers were not as nurturing.

This study was the first that actually shows an anatomical change in the brain, which really provides validation for the very large body of early childhood development literature highlighting the importance of early parenting and nurturing.

The effects of nurturing on the brain are likely to be the same for any primary caregiver, whether they are fathers, uncles, tanties, grandparents or adoptive parents, a finding which is supportive of the local belief that children will turn out well as long as there is someone around to love them up. That statement does not mean “spoiling” the children.

Last year further evidence of the chilling effect of lack of maternal love was again demonstrated. Neuroscientist scanned the brains of two groups of three year olds, one normal and the other, victims of child abuse. They found that the brains of the normal children were one and a half times larger than the brains of the abused kids. The only difference between the groups was the way the children had been treated by their mothers.

The available evidence suggests that, unless helped, the abused babies with the shrunken brains are more likely to become addicted to drugs, be involved in violent crimes, be unemployed and dependent on government handouts in the future.

This month comes the news that maternal love can soften the blows of harsh physical discipline. Researchers in Arizona, in a study of nearly 200 Mexican-American teenagers, found that the psychological pain of physical discipline was limited by a mother’s maternal warmth toward her children. Even if their mothers beat or berated them occasionally, children in the study did not act out as long as they felt loved.

Results showed that “their perception of maternal love kept the teenagers from externalizing problems and acting aggressively if they were harshly disciplined. Teenagers who felt more loved by their mothers showed no correlation between harsh discipline and antisocial behavior, while those who felt less maternal love tended to show a stronger correlation between harsh discipline and later antisocial behavior.”

This suggests that, “if children know they’re loved, and that physical discipline is backed by good intentions, being hit or verbally berated is unlikely to lead to externalizing aggression.” This perspective comes from attachment theory. Attachment theory suggests that “warm, responsive parenting is the critical factor in producing securely attached children who, in turn, develop positive secure internal working models of their parents.”

The authors concluded that, “Even if parents occasionally hit their children to discipline them, or otherwise use harsh verbal or physical methods, the children are unlikely to perceive their parents’ behavior as rejection if they feel emotionally supported and have a firm belief that they are loved.”

This of course is what happens in the Caribbean and may explain why so many of us who were severely disciplined as children still believe that the “licks” did us good. It may very well have, as long as we knew that we were loved. That may have worked out well for many of us but what of the child who knows that the blows come with a lack of feeling or even with dislike? And who knows what might have become of us, if we had not been abused?

The 18 months of Pregnancy

June 10th, 2013

by: David E. Bratt MD

“Pregnancy is a key time for women and their partners to take control of their own health and a unique opportunity to give the next generation the healthiest start. As a pediatrician, I believe that all parents-to-be deserve to be taught about what matters, to have the best pregnancy experience possible.” Alan Greene, pediatrician

Nice quote. I would change “to be taught”, to “to learn”. It’s a change of emphasis from the passive to the active, from “being taught” to “learning”, from being given information to finding it on your own, the only way to really ever learn anything.

The start of pregnancy is a key opportunity for parents to make a new start; to decide what they want to do with their health, whilst giving their baby the best possible start in life. Whilst doing this, a mother or father-to-be can literally take decisions that will affect his or her longevity. For certain people, the idea of having a baby can concentrate the mind wonderfully. In others it makes them more aware of the greenery on the other side of the street or country or sea.

This May has been designated Pregnancy Awareness Month and advocates are encouraging women to ask questions about their pregnancy, to actively participate in the creation of their baby’s birth plan, and, as a follow-up, to interview pediatricians to find the correct fit for themselves and their babies. Among many other things, it is critically important for pregnant women to educate themselves about the role toxins play in the health of babies.

Questions that need to be answered are: How does the environment impact your health and that of your precious baby? Alcohol? Cigarettes? Mercury? Bisphenol A? Lead? Insecticides? What are the ingredients used to manufacture swaddling blankets, bath towels, toys, baby gear, diapers? As parents you have the responsibility to constantly seek the answers, not only from the health professionals but from other sources. Parents-to-be need to challenge themselves to look at all decisions from all angles and possibilities; to question. Every week of the pregnancy should demand a question? That is the challenge.

Why are paediatricians so interested in something called Pregnancy Awareness Month?

Apart from being the most open minded and educationally oriented of the medical specialties, and indeed, having a vested interest in a successful pregnancy outcome for mother, child and father, I should remind you that pregnancy lasts 18 months.

This because the fetus and infant present a continuum in terms of John Bowlby’s attachment theory. Bowlby was an English child psychiatrist, who together with Canadian psychologist Mary Ainsworth, after studying homeless and orphaned children after World War II, developed the idea that an infant needs to develop a relationship with at least one primary caregiver, usually the mother, for social and emotional development to occur normally in the long term. Infants become attached to adults who are sensitive and responsive with them, and who remain as consistent caregivers for the first months of extra uterine life.

In pregnancy, the first nine months are spent inside the mother (in utero) and the second nine outside the womb (extra utero) or, within the embrace of the mother and at her breast. The only reason the child is born after nine months pregnancy is because of the size of the brain. Any further growth of the head and all babies would die inside the womb, with their mothers. A newborn infant is hopelessly immature and really comes out too early. At birth, they are still foetuses and for the next three months they want little more than to be carried, cuddled, and made to feel like they are still in the womb. The difference between a newborn baby and a three month old is astounding. Even more so is the difference between a three month old and an active sitting, standing, talking nine month old.

In the womb the child is attached to the mother through the placenta and umbilical cord and this is the way the child is nourished, oxygen and food, waste products are eliminated and the child is protected from infection and harm.

In the same way, with the exception of breathing and excretion, the mother can be considered the womb, the breast an external placenta, the nipple a truncated cord.

The breast continues the job of feeding and protecting the child and it can do this all by itself for at least six months and in many cases up to nine months.

The other reason to consider that pregnancy lasts eighteen months is psychological. During this period the child does not know that it is a separate individual from the mother. It has no sense of personal identity. He is one with his mother. She is his extension.

The roots of personal identity date from about 8 to 9 months and reach a hurtful detaching peak around 2 to 3 years, as anyone who has had to leave a two year old in a Day Care for the first time will confirm.

Breastfeeding Fights Obesity

June 10th, 2013

by: Dr. David Bratt

We have an epidemic of overweight people, adults and children in T&T. Lifestyle changes, i.e. less exercise, more time spent in front of the TV and computer, and poor feeding habits are the reason for this. Poor feeding starts during pregnancy when many women gorge themselves and put on excessive amounts of weight resulting in fat babies. At birth some women choose not to breastfeed and choose formula which is associated with fatness. Early on in their life babies then begin to be stuffed with high caloric feeds, disguised as “baby food” and continue on with a diet high in “fast food” and empty calories. The result: significant numbers of children younger than 6 years of age are grossly overweight, i.e. obese and the number continues to increase. Without help, these children will enter their teens having already suffered from over a decade of poor health. They will face chronic problems that, until recently, were seen only in adults, such as weight-related diabetes and joint problems, high blood pressure, and high cholesterol and later on in life, heart attacks and strokes, all because they are overweight.

Treating overweight people, children included, is almost impossible. Weight control programs show little success among children, and as the years go by, these children are more and more likely to grow up to be obese adults. To stem the epidemic of childhood overweight, prevention needs to begin long before children enter school or even preschool. If not possible during pregnancy, prevention should begin the day an infant is born. This is where breastfeeding comes in because breastfeeding reduces the risk of children becoming overweight.

Breastfeeding has long been recognized as a proven disease prevention strategy for a multitude of illnesses in children: gastro; pneumonia; asthma; eczema; child abuse etc. etc, as well as breast cancer, ovarian cancer, osteoporosis and post natal depression in women. Now that many of these childhod communicable diseases are under some form of control, the breastfeeding paradigm has shifted to the prevention of the non-communicable diseases: obesity; diabetes and cardiovascular.

Among its other well- documented effects, breastfeeding also has recently been found to play a foundational role in preventing children from becoming overweight. A key analysis, which included 61 studies and nearly 300,000 participants, showed that breastfeeding consistently reduced risks for overweight and obesity. The greatest protection is seen when breastfeeding is exclusive (no formula or solid foods) and continues for more than 4 months.

This breastfeeding-obesity link is now recognized by various key government agencies and professional groups, including WHO, the U.S. Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP). Experts at the CDC in Atlanta estimate that 15% to 20% of obesity could be prevented through breastfeeding. The AAP recommends exclusive breastfeeding for the first 6 months and continued breastfeeding with the addition of appropriate foods up to at least 1 year of age. WHO goes even farther and recommends breastfeeding for up to at least two years. Everyone recommends exclusive breastfeeding for the first six months, where possible.

Several possible reasons have been identified for the protective effect of breastfeeding against obesity.

• Breastfeeding is baby-centered and guided. Babies, not mothers or aunties, decide how much they need to eat. You can trust the baby to eat just exactly how much it needs to grow and develop. This is an amazing find. Breastfed infants are better at self-regulating their intake. In addition, mothers cannot see how much milk their child is drinking, so they must rely on their infant’s behavior, not an empty bottle, to signal when their infant is full. Thus, breastfed babies eat only as much as they need.

• Breastfed infants are more likely than formula-fed infants to try and accept new foods. Acceptance of new foods is important because a healthy diet should include a wide variety of foods, especially fruits and vegetables. Because breast milk contains flavors from foods eaten by mothers, breastfed infants are exposed to a variety of tastes early in life. In contrast, artificial baby milk (formula) always tastes the same.

• Breastfeeding has different effects than formula feeding on infant’s metabolism and hormones such as insulin, which tells the body to store fat. Breastfed babies already have lower sugar levels and lower insulin levels by age 4 months. In addition. formula- fed infants tend to be fatter than breastfed infants at 12 months of age.

The major factor mitigating against using breastfeeding in the fight to prevent children and adults from becoming overweight, is maternity leave. If governments are indeed serious about doing something about non-communicable diseases and the tremendous illness impact and economic cost that they cause society, a key factor is going to be extended maternity leave. In this scenario, the prohibition of junk advertising in favour of fast food and the provision of green spaces where children can play safely, while important, become secondary factors. The recent UNDP Report indicating that local companies have not fully integrated Corporate Social Responsibility policies into their operations adds significance to this problem.

Breastfeeding: Is It Right For You?

June 8th, 2013

By Marilyn Stollmeyer
Childbirth Educator/Lactation Consultant

So you’re having a baby and you think you would like to breastfeed because everyone says that breast milk is best for your baby. At the same time, you’ve heard many troubling stories about breastfeeding and you have numerous questions.

Is it painful? Will I have enough milk for my baby? How will my body be affected?
Much of the anxiety that surrounds the topic stems from a lack of proper information. As it is with every other element of pregnancy, getting the right information and having good support is key to conquering its potential challenges.

Let’s Cover the Basics

Once a woman is pregnant, her body assumes that she is going to breastfeed and, right from the start, sets everything up for her and her unborn baby. Your breasts will become bigger because of the increased activity in them, particularly the production of colostrum, which generally begins around the middle of pregnancy. Called liquid gold, colostrum is an important fluid, made especially to meet all your baby’s nutritional needs. With colostrum, your baby doesn’t need any other liquids or food. As a result, breastfed infants grow exactly the way they should. They tend to gain less unnecessary weight and to be leaner. In fact, studies show that premature babies do better when breastfed compared to premature babies who are fed formula.

Colostrum is also high in antibodies. This is your baby’s first immunisation, which protects him against infectious diseases. Colostrum is rich in growth factors and is also a laxative that helps your baby to pass meconium (the first stool). This prevents jaundice.

Baby Rules!

Breastfeeding is baby led.

At birth, your baby’s stomach is about the size of a walnut and so colostrum comes in small quantities, about a teaspoon at a time to start with. Your breasts continue to produce colostrum, as your baby demands it. The more your baby feeds, the more milk there is.

If your baby does not suckle or is separated from you and is given a bottle (e.g. in a medical situation), unless you express the colostrum, there is no message sent to the breasts to make milk.
As breast milk is digested easily and quickly, breastfed babies feed very frequently, every two to three hours or so, in the early months.

One of the truly remarkable things about breast milk is that it changes in composition from feed to feed, day to day, month to month, to satisfy the needs of your growing baby. In this way, baby rules!

The Effects on Mommy

Baby isn’t the only one who benefits from breastfeeding. Mommy does too!

Apart from the fact that breast milk is free and so saves you money, nursing also uses up extra calories, making it easier to lose the pounds gained from pregnancy. Breastfeeding helps the uterus to get back to its original size more quickly and lessens any bleeding a woman may have after giving birth. Breastfeeding may also lower the risk of osteoporosis and breast and ovarian cancers.

Almost all women can breastfeed; they just need to learn how to do it right. There are many options for this, including research, which is widely and readily available online. It’s also important for you and your partner to consider joining a childbirth education class to learn about pregnancy, giving birth and postnatal issues such as breastfeeding. These will help you become more confident about being a parent. You can also join a breastfeeding mother support group, where you can interact with other pregnant and new breastfeeding mothers.

The Emotional Connection

The emotional connection breastfeeding establishes between mother and child cannot be emphasised enough. Breastfeeding brings you closer to your baby, creating a powerful bond. Physical contact is also important to your baby and can help him feel more secure, warm and comforted.

When you breastfeed, oxytocin, called the hormone of love, is released, causing tiny muscle cells around your milk glands to squeeze milk out of the glands and into the milk ducts. This is called the let-down reflex or milk ejection reflex. All the effects of this hormone are directed towards the baby and in a beautiful way, the baby becomes the object of love, especially when you consider that your let-down can occur when you hear your baby cry or think about nursing your baby.

The Time To Stop

Once you’ve created this powerful bond with your baby, the challenge you soon face is how to continue breastfeeding once you return to your normal pattern of life, in particular working. This is a very worrying time for mothers, who sometimes stop breastfeeding thinking there is no option. Others will look for help, learn how to express and store their milk, and deal with their new situations. Whatever option you choose, understand that breastfeeding is a commitment and it is important that you receive the support, encouragement and help of those close to you to maintain lactation.

New mothers always ask me when is the right time to stop breastfeeding. My answer is always, “You must decide what is best for you”. This is an individual choice for each woman. However, it is advisable that at around six months, you start introducing soft foods to your baby. You should increase the quantity and variety of foods as your baby grows and gets teeth, but breastfeeding is important for his first two years of life.

So relax and enjoy your breastfeeding experience: it is powerful, empowering, pleasurable and rewarding.