Introduction:
Gavin de Becker is described as the nations (USA) leading expert on predicting violent behaviour. The book is a parents guide to keeping our children safe from violence and abuse. It covers topics from choosing childcare for babies and toddlers to keeping your teenagers safe

Good points about the book/parts you found helpful:
I found this a really reassuring book. Gavin de Becker is very realistic about the dangers our children are likely to meet and encourages us to trust our intuitions and our own ability to protect our child.

There is a chapter on what we should teach our children to give them the best chance of being able to seek help and protect themselves if they are seperated from us accidentally when young and inevitably as they get older. There are chapters on recognising the signs of sexual abuse and potential abusers and on choosing childcare and schools for our children as well as talking frankly about the relatively very small risks of our children being abducted or meeting with serious violence

Bad points, inaccuracies:
This book is written for the USA so the resources he suggests we turn to just aren’t here in our country. Sections on how to choose a pediatrician etc aren’t relevant to us and there is a big section on guns and how to protect your children from them.

Comments and other opinions:

There is a lot of useful information that everyone should read, particularly how to recognise when somebody may be preying or intending to prey on you or your child, and what we should be teaching our children in order to give them the skills they need to protect themselves. Some of it may be distressing to read, there are real life stories of people who have found themselves in some of the situations described, and they don’t all have happy endings.
I think it needs to be read, the scary parts are outweighed by the amount of information that I haven’t found elsewhere.

Whilst we often hear health benefits cited as a reason to breastfeed, many supporters are hesitant to discuss bonding; despite sound scientific evidence.

This is hardly surprising, because whilst many formula feeding mums can acknowledge their child might have more colds or minor infections – the suggestion they may not be effectively bonded with her infant is likely to provoke a hair raising reaction in most quarters.

Bonding is of course a complex issue and fathers/aunts/ siblings/grandmas etc bond with baby too. Unlike illness, beyond the science aspect – for most parents it’s extremely hard to quantify. You can’t measure feelings, nor compare to what someone else is feeling. Formula feeding mothers love and care for their infants and cannot understand how this would be different if they breastfed.

The only people who can truly compare bonding between breast and bottle fed babies, is mothers who have done both. Even one of each is not really reliable, due to all the other possible influencing factors.

As a mum of eight; five formula fed and three breastfed – I want to share my experiences with you in this article, as you can imagine it has taken a lot of soul searching on my part to ponder the question; what is the big deal about breastfeeding and bonding?

If breastfeeding is considered just as a method of transferring milk into baby, then on the surface there does not seem to be that much difference. One could argue that bottle feeding mums have the advantage as their babies can look straight into their eyes, something that most newborns correctly latched on will not manage to do until they are older.

As a breastfeeding mum it can be easy to feel just like a milk machine and that is all baby wants you for. Everyone else can get a cuddle and the minute baby gets close to you, all baby wants is milk and will not settle until you feed him. You may be sore, you are probably leaking milk everywhere and well it can all be rather undignified to start with. A far cry from the rose tinted pictures of mum breastfeeding baby happily that you imagined! Rather then looking adoringly down on your newborn, you are probably busting for the loo, as you haven’t managed to get off the settee for the last few hours!

I am deliberately painting a negative picture, because breastfeeding can be blooming hard work to start with and that’s when all is going well. Throw in a baby who is not latching well, thus causing mum to be in pain, mastitis, thrush, cracked nipples etc and it can be a relief to go over to bottle. You often hear it don’t you, I only started bonding with my baby once we had switched to formula and the pain stopped. I was dreading feeding him as it hurt so much………………..

I can relate to that, because I have been there, done that. It *was* a relief at the time, the regrets come later. When you raise your head out of its sleep deprived state, when you ‘have your body back’ when your baby is not in your arms constantly anymore, when those chubby hands are caressing a plastic bottle instead of your breast. When baby gets excited at the sound of the bottle lid coming off, rather then you lifting your top. When your baby simply doesn’t smell like your baby anymore!
When you stand with your seriously ill baby on your shoulder and you look at a breastfeeding display in the children’s ward, citing all the things that breastfeeding protects against, all the things that are making your baby so ill and you *know* that you have failed *that* baby.

If only you had tried harder, the pain wasn’t really that bad if only, if only, if only……………….

Of course none of us have a crystal ball, breastfed babies *do* get ill and hindsight is a wonderful thing. And of course you *love* your baby. You would challenge anyone who dare suggest that you could love your baby anymore were you still breastfeeding. But still, you see other mothers breastfeeding and you are simply green with envy. You justify it to yourself that they obviously had a much easier ride then you. Their baby could not possibly have been as hungry as yours. They do not have other children to take care off. Their skin is not as sensitive , whatever was the problem or was perceived to be the problem you have a justification for having to give up.

And at the end of the day it’s just milk right. You love your baby just as much, you know your baby just as much. A happy mother = a happy baby! Formula is not poison, ok breast milk is best but formula is good enough…………

Putting aside the obvious health issues here, you are deluding yourself. It *does* matter, and it matters a great deal - but you do not know that, because you have been robbed of your nursing relationship before it even started. And how could you know really? You simply do not know what you are missing, as you have not been able to experience it.

Now fast forward a few babies. Quite a few babies in my case. You seek and find the right support whilst you are still pregnant. You listen, you learn, you surround yourself with other happily breastfeeding mothers and it is beginning to dawn on you that actually they did not have an easier ride then you. They had support when it mattered! So you grow quietly hopeful that maybe, just maybe you will be able to feed this baby yourself. Maybe it will not all end in tears, regrets and recriminations.

And then your new baby girl is here, born at home surrounded by all your loved ones and she latches on beautifully, so far so good. There is no pain, as you both know what you are doing. You have the confidence to co-sleep from the start, making night feeds so much easier. You have your breastfeeding counsellor on speed dial, lol, but really you do not need her as it just works. And you fall hopelessly and utterly in love with this little bundle. You treasure every moment you have with her at the breast. You love that drunken sailor look she gets all the time. You love the fact that she only wants you and all you have to do is lift your top and let her disappear under your jumper and she is happy.

And you simply cannot bear to be parted from her. Even when she is fast asleep in her basket you *need* to move her from room to room with you or you feel as though your right arm has been cut off. You know when she will want feeding as your milk will let down seconds before she wakes up. You put her at the other end of the bed to give yourself some room to sleep and you wake up seconds before she does and you realise that you haven’t moved but your newborn has managed to wriggle across until she is right next to your boob! You cannot stop sniffing her because she smells SO good. So familiar and sweet and you get such a kick out of seeing her grow. Knowing that it is all your milk that has caused those chubby dimples. And then you get the first smile as she is coming off the boob, your milk dribbling down her chin. And then the first raspberry blown that has you both in fits of giggles. Chubby hands stroking your breasts, a little mouth contently glugging away and you just feel on top of the world.

Your older children imitating you by breastfeeding their dolls, suggesting baby needs feeding so they can get on with their play and then your toddler coming up to you and asking to have some too. So you end up with both of them at the breast and of course your toddler does not know what to do, but you feel such a rush of love and it heals so many wounds, wounds you never even knew you had.

The conversations you have with your teenager, as to why she was not breastfed, did you not love her enough? Ouch! How do you answer that one???

And through it all those breastfeeding hormones are working their magic. Everyone around you is surprised at the change in you. The kids and your husband are commenting on how much calmer you are. “Mum you are a much nicer person you know!” From a friend:” What has happened to you, you have really changed!” (Incidentally that friend ended up breastfeeding her last baby for 3 years, having f/f the first 4!)

And what about you? You gain a new self belief. You at long last feel comfortable in your own skin. You are WOMAN hear me roar! Your milk has superpowers it must have. Your baby grows into a toddler and tells you so, so it must be true! And you discover another thing about breastfeeding that you never knew. It is such a brilliant parenting tool when you have a toddler. How on earth did you ever manage without it before?
There are hardly any tantrums, you have the perfect tool right there, strapped to your chest and you use it willingly and gladly. And there is such joy, such indescribable joy. You are finally doing what you were meant to be doing. It’s natural and all of a sudden you are the one who other mums come up to and tell their breastfeeding story of pain and failure and justification and you see yourself and how you used to be.

And you feel sad, so very sad that these mothers will not be experiencing the joys and the sheer magic of breastfeeding. And you get angry too, angry at the system that lets mothers down, angry at the health professionals who robbed you of your own nursing relationship with your older children and you vow to do something about it. You become a breastfeeding counsellor yourself and you have come full circle really.

Breastfeeding it makes a difference it really does!

—————————–

Read article commentary here on the “one of those women” blog.

What are breasts for?
by Charlotte Young, iwantmymum.com

Breasts in papers line the shops,
Breasts on billboards, skimpy tops,
Breasts on beaches out on show,
What are breasts for? do you know?

I think that some perhaps forgot,
(The formula companies helped a lot)
Monkeys, cats and even camels,
Are all like us and we’re called Mammals.

Mammal means that milk we make,
On instant tap for babe to take,
So why then now in modern age,
Is bottle feeding all the rage?

Did women’s breasts break over time?
Did breastmilk become less sublime?
Did something better come along?
Maybe nature got it wrong!

Alas the answer’s sadly not,
Nothings changed, not a jot,
At least in terms of women’s breasts,
And doing what they do the best.

The other a poor substitute,
Which evidence does not refute,
Increasing risk of death, disease,
Cancers, cot death, being obese.

For this the parents have to pay,
A pound or two, but every day!
It then needs making, every feed,
At 3am not what you need!

With babies dying every day,
I really think its time we say,
Give women the support they need,
To feed their babies AND succeed!

I also adapted it slightly to fit to the tune of heads, shoulders, knees & toes!

Breasts in papers line the shops, line the shops,
Breasts on billboards, skimpy tops, skimpy tops,
There’s breasts on beaches out on show,
What are breasts for? do you know? do you know?

I think that some perhaps forgot, they forgot,
formula companies helped a lot, helped a lot,
Cos monkeys, cats and even camels,
feed their young and are called mammals, are called mammals.

Mammal means that milk we make, milk we make,
On instant tap for babe to take, babe to take,
So why then now in modern age,
Is bottle feeding all the rage? all the rage.

Did women’s breasts break over time? over time,
Did breastmilk become less sublime? less sublime.
Did something better come along?
Maybe nature got it wrong! got it wrong.

Alas the answer’s sadly not, sadly not,
Nothings changed now, not a jot, not a jot,
At least in terms of women’s breasts,
And doing what they do the best, do the best.

The other a poor substitute, substitute,
Which evidence does not refute, not refute
Increasing risk of death, disease,
Cancers, cot death, being obese, being obese.

For this the parents have to pay, have to pay,
A pound or two, but every day! every day,
It then needs making, every feed,
At 3am not what you need! what you need.

With babies dying every day, every day,
I really think its time we say, time we say,
Give women the support they need,
To feed their babies AND succeed! AND succeed.

This is more difficult than it sounds because the argument is not balanced - it IS heavily weighted in favour of breastfeeding. So when you provide research-based information about ALL the advantages and disadvantages of both methods, without any comment of your own, it still seems as if you are being biased. To avoid this appearance of bias some antenatal teachers *doctor* the evidence to make it appear balanced.
Kim Wildner presents a good chapter on this in her book, “Mother’s Intention : How Belief Shapes Birth”.

She writes, “Let us look at “balanced” first.”to make two parts exactly equal.” What if the two parts are not equal? What if a parent will be making decisions that will affect her and her baby with both short and long
term consequences. Is it fair to distort reality so that the information she has to choose from seems ‘equal’, even though it really isn’t? Why would a parent want information that appears balanced, but isn’t
factual?”

This is a dilemma many midwives and childbirth educators have to grapple with. It takes a brave person to state an unpalatable truth about an issue calmly and clearly - but not to do so, is to collude with the
untruth.

However it is quite possible to state the truth but remain non-judgemental, and sympathetic to the social mores that make a radical change in behaviour so difficult.

4 months
Baby Einstein - Discovery Water Play Gym
Skwish Classic
Whoozit
Pop-Up Surprise Ball
Lamaze - Fish Bowl

10 months
Stacking Boxes
Baby Beach Band Complete with Clam Shakers, Lobster Maraca, Starfish Cymbal, Fish Tambourine & Octopus Drum.
Galt Sorting Wheel
Classic Pop-Up Toy
LeapFrog LeapStart Learning Table
First Steps Baby Walker

18 months upwards
Pintoy Wooden 6 peg Hammer Bench
Painting
Tomy Rainbow Aquadraw
Drawing
Play Doh
Magnetic books,
Stickers
Cart
Fuzzy-Felt
Lilydoll
First Abacus
Trike
Rainbow Sound Blocks
LEGO Duplo
Easy PC Keyboard
Buggy
Rocking Horse
WoodenTrike
Magna Doodle
Thomas & Friends Giant Floor Puzzle
Crocodile A-Z Puzzle
Toy Pan Set 15pc
Wooden tea cup set
Play Food
Dolls House
Little People
Toy Post Office

3 yrs
Charlie and Lola - Daytime and Nightime Lola
Ravensburger Puzzle Charlie & Lola
Kitchen
Playhouse
Plasticine
Hammer & Tap
Snakes & Ladders and Ludo
Dora the Explorer Velvet Colouring Set
Tomy Thomas & Friends Motor Road & Rail: Steam Along Thomas Set

4 yrs
LeapFrog Leapster
Daisy Peg board
Make Your Own Accessories
Guess Who
Buckaroo
Charlie & Lola Giant Floor Puzzle

Train Set

Montessori education is a balanced program that addresses all aspects of a child’s development: intellectual, social, moral, physical and aesthetic. Montessori education is highly individualised, which is why it works so well for such a wide variety of children; from typical or gifted learners, through to children with learning disabilities.

Quick jump within article to:
The Montessori materials
Independence with Co-operation
Absorbing Through the Senses
Learning With Each Other
Hands on Experience
In Their Own Time
Help Only When Needed
Academic Outcome

The Montessori Materials

The Montessori materials are key to the Montessori approach to education. They are different from traditional “teaching aids” because their purpose is to give the child the chance to discover and learn for him-or herself (rather than being told what he/she should know). The materials are “self-correcting” which means that the child can use them and learn from them without constantly checking back in with the teacher to see if they “got it right”. Exploring the materials (learning how to learn) is as important as “getting the answer right”.

The materials are designed so that children can learn academic subjects (like math, for example, or geography or writing) in a concrete or physical way, before progressing to an abstract understanding. This has many benefits:

It is because the Montessori materials are self-correcting that the children can progress at their own rate. No child is held back while the whole class learns something that that one child already understands. And no child suffers through a group lesson that is way above their head. Children are excited, motivated, interested. Self-esteem is high.

Independence with Co-operation

In a true Montessori school you will find independent children who are encouraged not only to do things for themselves but also to think for themselves. You will find children who have learnt how to explore and solve problems for themselves. Most importantly you will see small children who are often perceived as only being aware of their own needs helping each other and who, without being asked to, will put things away and perform acts of kindness purely to benefit the group as a whole.

Absorbing Through the Senses

Maria Montessori observed that children under six absorb limitlessly and effortlessly from the world around hem and in so doing lay down all the foundations for later life - they become adults with all the characteristics and language of the culture into which they have been born simply by living. In this huge task, however, they have some help. They have a special kind of mind that she called an absorbent mind - a strong desire to explore everything around them using their senses and a drive to become independent. She identified certain windows of opportunity for the child that she called ’sensitive periods’ during which the child is irresistibly drawn to the things he needs to help him develop his full human potential.

Learning With Each Other

Everything in the classroom is designed to support these windows of opportunity. The Montessori ‘nursery school’ is called the Children’s House because everything in it is designed to allow the child to become independent - the materials are child sized and the equipment is laid out in an orderly fashion on low shelves that are easily accessible for the children.

The equipment is aesthetically pleasing and is meticulously cared for (and handled with respect) which encourages the children to take care of it too. Children between the ages of 3 and 6 are grouped together in their own mini society. The younger children learn from watching the older children and the older ones benefit by helping the younger children. The mixed age group allows the children to develop socially, intellectually and emotionally - it is an essential part of any Montessori school.

Hands on Experience

The curriculum is divided into four main areas. Practical life not only gives the children the opportunity to practise the skills of everyday life but also helps them to develop concentration and develop co-ordination of mind and body. The sensorial materials capitalise on the fact that children use their senses to learn. Through these materials they are encouraged to order and classify the physical properties of the world they live in. The materials for mathematics help the children to learn and really understand mathematical concepts because they are presented using concrete materials. Children are prepared for language (to write and read) from the minute they come into the class through a series of activities that gradually build all the individual skills required so that when they are ready it is just a natural progression.

Geography, history, biology, botany, zoology, art and music are covered with a hands-on approach that is based on the fact that children learn most effectively from their own experiences. Many childrens houses will include nature tables, plants, animals (children are taught how to care for them to encourage development of a sense of responsibility)

In Their Own Time

In a Montessori school you will see children choosing their activities independently and moving from one activity to the next - always returning things to the shelf after they have used them. You will experience an atmosphere of natural calm and see young children concentrating for surprising periods of time. Children work individually, in a group or with a friend. The morning should last for a minimum of three hours - three hours in which there is no fixed ‘timetable’. Groups arise spontaneously rather than at a fixed time every day. Maria Montessori observed that this unfettered period of time was essential for the children to develop the kind of concentration that you see when a child becomes involved with something that is essential for his development. There are no time limits for the child - he may work with whatever he chooses for as long as he likes and as his workspace is defined he can be sure nobody will disturb his work/remove the materials.

Help Only When Needed

In a Montessori school the child is guided by a trained adult who will show him how to do the things that he is ready for (by demonstrating), after which he can work with them independently. The adult observes the child and will not interfere so long as the child is working with the material productively.

When a difficulty arises she is able to step in and give help but is always careful never to give more help than is needed. Each child’s individual needs are assessed through observation so that he is shown new things when he is developmentally ready and new knowledge is always built on what he already knows.

The ‘directress’ is not teaching the child she is putting him in charge of his own learning through his own exploration. This may seem a subtle distinction but it is a key part of the Montessori approach. He/she constantly role models the behaviour they would like the children to demonstrate, from how to handle equipment to speaking/socialising with others.

Academic Outcome

Some people believe that because Montessori nurtures life skills and emotional/psychological development as well as academic development, “academic results” must suffer compared to mainstream/Independent education. In fact the converse is true; OFSTEAD state Montessori leads to better outcome and research supports this claim.

One example of many was a study undertaken by Virginia University psychology professor Dr Angline LiIlard and former Wisconsin University graduate student Dr Nicole Else-Quest. They compared the outcomes of children at a public inner-city Montessori school with children at traditional schools and found Montessori educated children had better social and academic skills.

“We found significant advantages for the Montessori students in these tests for both age groups,”

Lillard said.

“Particularly remarkable are the positive social effects of Montessori education. Typically the home environment overwhelms all other influences in that area.”

Among the 5-year-olds, Montessori students proved to be significantly better prepared for primary school in reading and maths skills than the non-Montessori children. They also tested better on “executive function”, the ability to adapt to changing and more complex problems; an indicator of future school and life success.

Montessori children also displayed better abilities on the social and behavioural tests, demonstrating a greater sense of justice and fairness. And on the playground they were much more likely to engage in emotionally positive play with peers, and less likely to engage in rough play.

Among the 12-year-olds from both groups, the Montessori children, in cognitive and academic measures, produced essays that were rated as “significantly more creative” and using “significantly more sophisticated sentence structures”. The Montessori and non-Montessori students scored similarly on spelling, punctuation and grammar. This parity occurred despite the Montessori children not being regularly tested and graded.

There are now moves within the UK to adopt more Montessori techniques into mainstream education. A pilot scheme within several deprived inner city London schools has demonstrated startling results, improving behaviour and academic outcome; regardless of social background. In Essex one School which has implemented Montessori philosophies had a dramatic effect on the behaviour of pupils within a very short space of time. (http://www.timesonline.co.uk/tol/life_and_style/education/article1290561.ece)

Recommended Reading:

I have to date not been able to uncover any evidence demonstrating mainstream practices as the most effective way for a child to learn. If you aware aware of such evidence please contact us.

Recommended Webpages:
http://www.boyd.k12.ky.us/eclc/MONTESSORI%20ED%20AREAS%20OF%20STUDY.htm

This material is © Ayala Ochert and as such this document should not be reproduced either online or in print without express permission.

First Published: Times Higher Education Supplement, 12 March 2004

Parents who bring their baby to bed with them know the dangers. As they are constantly reminded by well-meaning family and friends, their marriage will suffer and the baby will remain overly dependent and will refuse to leave the parental bed when it gets older. But, in January, headlines across the country warned of a much more serious danger.

According to The Lancet , babies under eight weeks who share their parents’ bed have a higher risk of cot death, even if their parents aren’t smokers.

It was well known that bedsharing is risky if parents smoke, drink heavily or take drugs, but before this study, there was no evidence of a risk for babies of non-smoking parents. The Lancet study, which looked at 745 cases of cot death in 20 European countries, was said to be the biggest of its kind. As soon as it was published, the Foundation for the Study of Infant Deaths changed its advice, saying that no parent should bedshare in the first eight weeks of their baby’s life. Yet, with all the hype surrounding The Lancet paper, the highly provisional nature of that particular finding was overlooked, even though several of the paper’s co-authors disagreed with the FSID advice.

“In my opinion, there’s not enough evidence to tell non-smoking parents not to bedshare,” says Peter Blair, the Bristol University epidemiologist who supplied the English data for the study. More significantly, after reviewing the evidence, the Department of Health has reached the same conclusion - not including the controversial “eight-week” recommendation in its updated advice to parents.

Blair says The Lancet paper simply presented a “secondary analysis” of the data, a theoretical model that predicted a higher risk for babies under eight weeks who bedshare. The raw data itself, however, showed no such increased risk. “There hasn’t been one study published yet that has shown a real risk among non-smokers,” he concludes. Another “big flaw” of the study, adds Blair, is that alcohol consumption - a known risk factor when bedsharing - was not measured in all the countries included in the study.

The advice against bedsharing for non-smokers has dismayed those, such as anthropologist James McKenna, who have long argued the benefits of “co-sleeping”. McKenna, who runs a mother-baby sleep lab at the University of Notre Dame in Indiana, says there is substantial evidence that co-sleeping is the normal, natural way that babies have slept since humans first evolved. He believes that under circumstances that most closely mimic those early conditions - a breastfeeding mother sleeping alongside her baby on a firm surface with minimal bedding - co-sleeping may even protect babies from cot death.

McKenna, a primatologist by training, explains that the evolution of bipedalism in our species created much narrower pelvises, with the result that human babies are born with just 25 per cent of their adult brain capacity at birth (compared with 45 per cent in our closest cousin, the chimpanzee). This, he says, makes human newborns the most neurologically immature and the most dependent of all primates. During the first three months of life, when the risk of cot death is highest, babies are not good at regulating their own breathing or body temperature.
Helen Ball, director of Durham University’s Parent-Infant Sleep Laboratory, says: “We’ve ended up giving birth to these underdeveloped infants who haven’t really finished gestating, and they need a period outside the uterus to finish gestating and be in constant contact with the care-giver during that period. The closer they are to a care-giver, the better the chance of having their breathing and body temperature regulated for them.”

The cause of cot death is not known, but recent theories suggest that it stems from an “arousal deficiency”. Some babies are unable to wake themselves when they stop breathing for one reason or another. Using infrared video cameras and sleep-monitoring equipment, McKenna and Ball observed hundreds of sleeping babies and parents. Both found that babies who slept with their mothers woke twice as frequently as those who slept alone. “It gives them a lot of practice of getting awake and breathing,” McKenna says.

They also found that the sleep cycles of mothers and babies synchronise when they sleep next to each other. This pattern of dreaming, deep sleep, and waking together is even stronger when the mother breastfeeds her baby, and breastfeeding mothers appear to be much more sensitive to the noises and movements their baby makes during the night.

Yet early research into infant sleep, carried out in the 1950s, looked exclusively at babies who slept in a cot in a separate room. This, says McKenna, led to skewed ideas about what is “normal”. “Parents are set up to have the worst possible experience with their children’s sleep when they are told that babies should and do sleep through the night. They don’t.
They’re not designed to sleep through the night.”

In fact, he adds, research has shown that babies who sleep “too well”, spending a lot of time in deep sleep, are those who are most at risk of cot death. “I stand by my statement, based on my 20 years of research, that co-sleeping between a mother and a baby is inherently protective,” McKenna says.

The modern western practice of putting babies to sleep in cots in separate rooms is unique; in most parts of the world, babies still sleep alongside their mothers, just as our ancestors did. “In most Asian countries, they don’t know what you mean if you ask where the baby is going to sleep,” McKenna says.

In 2000, a paper published by the global task force on sudden infant death syndrome, as cot death is also known, noted the paradox that those countries with the lowest rates of cot death, such as Japan and Hong Kong, are those where bedsharing is the norm.

In the West, bedsharing is still much frowned upon. “We are a society that favours individualism and autonomy over interdependence, and we equate where babies sleep and how they sleep with moral character,” McKenna says.

“This issue of morality has never been separated from our general childcare advice, and we tend to devise childcare practices in terms of who we want children to become rather than who they actually are.” Nevertheless, studies suggest that, contrary to expectations, babies who share their parents’ bed become more independent toddlers and are less likely to have psychiatric problems as adults.

So strong is the taboo against bedsharing that even those parents who do share their beds don’t consider themselves bedsharers. If they put the baby to sleep in a cot and only later in the night bring them into bed, they often tell researchers that their baby “sleeps in a cot”. This, says McKenna, distorts the results of studies such as the one in The Lancet , making it appear that far fewer people bedshare than is really the case.

One of the main reasons that mothers bring their babies into their beds is that it makes breastfeeding much easier - rather than waiting for a baby to wake up hungry and cry, a mother will detect the baby squirming and can feed her baby without either having to be fully awake. So breastfeeding mothers often find that they sleep better when their babies are alongside them.

With breastfeeding on the rise, thanks to successful promotion of its health benefits, so too is bedsharing, making the safety question even more pressing, Ball says. One of her main problems with The Lancet paper is that it doesn’t separate breastfeeders and bottlefeeders in its analysis. She also fears that discouraging bedsharing, especially during the critical first few weeks, might have the unintended effect of discouraging breastfeeding.

Worse still, McKenna says, the most important finding of The Lancet paper was hidden in the rush to condemn bedsharing. “The fact that this study showed a much higher risk of Sids for babies sleeping in a separate room has been made completely invisible. Perhaps more than any other, this study actually confirmed the importance of co-sleeping,” he concludes.

Declining breastfeeding rates and the aggressive marketing of breastmilk substitutes has blurred the distinction between breastmilk and formula. Claims that infant formula is safe, economical, easy to use, and nutritionally complete are challenged in this article, the intent of which is to ralse he awareness of health workers to the non-publicized side of infant formula. Non-proprietary, referenced data is provided to illustrate that formula and breastmilk are not the same thing, and that health outcomes of infants who consume each may be different. Guilt is often cited by health workers as a reason to avoid informing parents about the risks of artificial feeding. Suggestions are offered for addressing this reasoning. KEYWORDS : breastfeeding, breastmilk, hazards, infant formula. JHL 9:97-107,1993

INTRODUCTION

Religious, cultural, and scientific beliefs throughout history have influenced what and how infants are fed. Forms of artificial feeding have existed since antiquity, including milk from other species, pap, gruel, panada, and broth. Rapid development in science, technology, and broth. Rapid developments in science, technology, and medicine, and changes in social and economic trendy in the late 1800s, gave birth to a new type of baby food, commercial infant formula.1 By the eiid of the 1800s, proprietary infant foods were being sold in at least 17 countries. Early formulations were developed by physicians and industry and promoted to both parents and health professionals; currently they are promoted through multimedia public advertising campaigns. The categories discussed are not inclusive of all known or potential, hazards of the use of infant formula. References were chosen for their clarity of sample groups and distinction between health outcomes of breastfed. formula-fed, and mixed-fed infants.

INCREASED MORBIDITY AND MORTALITY

The widespread belief that breastmilk confers health benefits only in developing countries is contradicted by the overwhelming data published in the last ten years. Clinicians in developed countries often inform parents that formula is equivalent to breastmilk, reassuring them that health outcomes are the same. Yet in 1981, Allen Cunningham published Hospitalization patterns of a homogeneous, middle class, white, 1,18 population and concluded that, “I would expect 77 hospital admission for illness during the first four months of life in every 1000 bottle-fed infants. The comparable figure for breastfed infants is five hospital admissions”

Formula-fed babies develop acute diseases at higher rates.

Formula feeding is consistently associated with immune system disorders. Breastfeeding enhances serum as well as secretory responses to commonly used vaccines; high antibody levels to diphtheria and polio are seen up to one to two years after vaccination in breastfed babies. This is thought to occur because breastmilk primes the infant to produce antibodies. Formula has no such effect.16

A risk/benefit analysis by the United States National Institute of Environmental Health Sciences estimated that for every 1000 infants born in the US each year, four will die because they are not breastfed.17 Most of the infant deaths worldwide (1.5 million/year) related to artificial feeding are due to diarrheal illness.

In the United States, five hundred children aged one month to four years die each year from diarrhea.18 At least 70 percent of these deaths are caused by rotavirus infection in children four to 36 months of age, against which breastmllk has a known protective effect.” One sudden infant death per 1000 live births occurs as a result of failure to breastfeed in western industrialized nations.19.11

Formula feeding has been identified as a risk factor for sudden infant death syndrome (SIDS, cot death) in the results of the SIDS study conducted by the National Institute of Child Health and Human Development.21 Seventy-nine percent of deaths from SIDS in New Zealand are attributable to three factors-maternal smoking, prone infant sleeping position, and not being breastfed.22

A multicenter study in British neonatal units showed breastfeeding to be the single most effective method of preventing necrotizing enterocolitis (NEC) in preterm infants. Infants born at more than 30 weeks gestation whose diet contained any breastmilk rarely experienced NEC. It was 20 times more common in those babies fed only formula. The authors estimated that exclusive formula feeding could account for 500 extra cases of NEC each year, and the death of 100 (20 percent) of these infants.23

Formula-fed preterm infants are at higher risk for respiratory failure, bronchopulmonary dysplasia and retinopathy of prematurity if their diet is not supplemented with inositol during the first week of life.24 Inositol, a component of membrane phospholipids, significantly reduces the severity of respiratory distress syndrome (RDS) by enhancing the synthesis and secretion of surfactant in immature lung tissue.25

Inositol concentrations in human milk are several times higher than in formula, and even more is found in preterm colostrum. Many formulas lack inositol altogether. Preterm infants fed inositol-rich breastmilk increase their serum inositol levels; premies receiving formula show no concomitant rise in serum inositol levels.26

The increased morbidity and mortality of formula-fed infants is reflected in the greater expenses for health care of these children. When an accounting is done of the health care dollars spent on additional hospitalizations, out-patient care, and emergency room service, the total is in the hundreds of millions of dollars. In 1981, this number was estimated at $300 million.27

INFANT FORMULA IS ASSOCIATED WITH LEARNING DEFICIENCIES

Infant formulas provide nutrients whose goal is to support growth in human infants. They are not tailored like breastmilk to enhance the growth and development of the brain and central nervous system-the distinguishing organ and system of humans. Lower intellectual performance of formula-fed infants has been documented by Morrow-Tlucak et al. They fround that scores on the Bayley Mental Development Index were lower in formula-fed children at one to two years of age Scores were directly correlated with duration of breastfeeding.27

Bauer et al. showed that scores on the McCarthy Scales of Childrens’ Abilities were significantly lower at three years of age for children breastfed the least.28 Lower performances of formula-fed children were seen on developmental tests by Taylor and Wadsworth in five-year-old children.29

Formula-fed preterm infants scored significantly lower in the Bayley Mental Development Index when Morley et al. studied the developmental status of 771 premies at 18 months of age.30 Formula-fed premature infants had lower IQ scores at age seven to eight years than breastmilk-fed premature infants even after adjustment for the mother’s education and social class.31

CARDIORESPIRATORY DISTURBANCES DURING BOTTLE-FEEDING

Signficant alterations in breathing patterns have been observed during bottle-feeding of both term and preterm infants. Rapid milk flow from artifical nipples results in repeated swallowing and airway closure which decreases the time available for breathing. In preterm infants, decreases in TcO2 tension and 02 saturation during bottle-feeding are seen frequently and are often accompanied by apnea (absent airflow for >20 seconds), bradycardia (heart rate <100 beats per minute) and cyanosis (blue coloring).32,33

The high frequency of cardiorespiratory disturbances during bottlefeedine indicates that many premies lack the respiratory control and a ability to self-regulate a rapid milk flow. Soft pliable premie nipples have a high flow rate which may reduce feeding time, but which can compromise the infant’s breathing and increase the cardio-respiratory load.34

Both preterm and term infants experience occasional episodes of prolonged airway closure (up to 30 seconds) after swallows; obstructed breaths during bottle-feeding further at the time available for effective breathing.35

Term neonates also experience decreases in 02 saturation below 90 percent during bottle-feeding. Decreasing the milk flow per suck may minimize the feeding-related 02 desaturation by increasing the time available for breathing by spacing swallows. Apnea and bradycardia occur during bottle-feeding more frequently than is recognized in healthy fullterm infants. In one study of 50 healthy term babies, nine developed bradycardia during bottle-feeding, apnea preceded the bradycardia in six of these babies, and hypopnea (marked reduction in ventilation) occurred in three. One of the nine experienced central apnea (no respiratory efforts) and two developedcyanosis.36

Increased apnea and obstucted breathing in the First days of life during bottle-feeding was seen in some infants who subsequently experienced SIDS. Mathew suggests that aberrant respiratory patterms appearing only during bottle-feeding may have potential for identifying future SIDS infants. It is unknown if this respiratory defect persists in SIDS babies but disappears in normal babies.37

ALLEPGIC MANIFESTATIONS OCCUR AT GREATEIR PATES AND ARE MORE SEVERE IN FORMULA-FED INFANTS

Cow’s milk is the most common allergen during infancy and childhood. Up to 7.5 percent of formula-fed infants demonstrate allergy to cow’s milk-based formulas.38 Up to 50 percent of children sensitive to cow’s milk show soy hvpersensitivity also.39

Allergic reactions include hives, wheezing, vomiting diarrhea, eczema, malabsorption, and failure to thrive. Merrett et al. studied 500 babies born to allergic families ind concluded that any breastfeeding even for a short time was associated with much lower incidence of wheezing, prolonged colds, diarrhea, and vomiting.40 et al. documented that by three to four months of age, formula-fed or formula-supplemented infants had marked rises in IgE and IgG antibodies to cow’s milk protein; exclusively breastfed infants shored no such rise. Sixty-two percent of the formula-exposed infants showed allergic symptoms of chronic nasal congestion and diarrhea, contrasted with 13 percent of the breastfed babies.41

Host et al. reports that 2,5 percent (39/1539) of infants exposed to cow’s milk formula in the newborn nursery developed cow’s milk- allergy, compared to none (0/210) of the infants who avoided exposure. Nine infants had symptoms of cow’s milk allergy while exclusively breasted when their mothers drank cow’s milk. All nine had been given formula in the nursery, although only one of the nine mothers knew this. The authors suggest that the early exposure to cow’s milk protein in the hospital may have been the source of sensitization.42

In an attempt to reduce their allergenicity, some formulas have been modified by using hydrolysed casein and hydrolysed whey bovine (cow) protein sources. These formulas are generally referred to as “hypoallergenic.” Soy formulas remain antigenic and have provoked adverse reactions in some cow’s-milk-allergic infants; the American Academy of Pediatries (AAP) recommends against their use for the management of infants with documented cow’s- milk-protein allergy.43

Casein hydrolysate and more recently whey hydrolysate formulas are frequently recommended for IgE-mediatd cow’s-milk-allergic infants, but the AA.P states, ‘No published, well controlled, double-blind studies exist to support the support the use of either casein or whey hydrolysates for prophylaxis or treatment of infants with milk hypersensitivity.44 Anaphylactic reactions (life-threateningshock) to casein hydrolysate formulas [Nutramigen,45 Alimentum 46 and Pregestimil47] and to whey hydrolysate formulas [Carnation Good Start 48 and Alfare (Nestle)49] have been reported.

The AAP states that a whey hydrolysate formula may be an acceptable alternative to cow’s milk-based or soy formulas for infants who are intolerant, but not allergic, to cow’s milk.44 “Hypoallergenic”, does not mean “non-allergenic”. Continuing to use the term “hypoallergenic” may be misleading, given the reported life-threatening reactions that have occurred in infants fed these formulas. Consumers, parents, and health care providers can be confused by this term and may not have identified the highly sensitized child.

Protein fractions still exist in all of these formulas (particularly Good Start) that are capable of causing reactions in sensitive infants. Sampson et al. recommend that, “In milk-allergic children who had a severe life-threatening reaction after the ingestion of milk, it may be prudent to administer the first dose of Alimentum in a physician’s office, where resuscitation can be initiated in the event that allergic symptoms develop”. 50

By definition, a “hypoallergenic” formula is one tolerated without symptoms by 90 percent of subjects allergic to cow’s milk. This places the other 10 percent at risk of consuming a food whose safety for them is questionable. United States federal proceedings required the Carnation Company (a subsidiary of Nestle SA) to drop advertising claims that the formula would not cause allergic reactions, to stop describing the product as hypoallergenic, and to cease citing scientific evidence for its health claims. A new amino-acid-derived infant formula, Neocate (Scientific Hospital Supplies, Gaithersburg, Maryland) is undergoing clinical trials in the US and UK to determine its safety for use in cow-milk-allergic infants.

CONTAMINANTS IN INFANT FORMULA

Formula-fed infants are at higher risk for ingestion of lead, aluminum, and other heavy metals as well as iodine. The amount of lead in formula has continued to drop over the last decade and lead-soldered cans have been phased out of use. Low levels of lead exposure can negatively affect cognitive development of infants and young children, even at levels as low as 5-10 ug/dL. Lead intoxication in infants is more common than previously believed. This is frequently due to the practice of boiling the water used to reconstitute powdered or concentrated formula. Label Constructions advise to boil water for five minutes before mixing formula. However, this action concentrates any lead in the water, thus exposing infants to substantial amounts of lead with each feeding, depending on the amount of lead in the water and how long it was boiled. Use of no- or low-iron formula also increases lead absorption. To minimize lead levels in formula, water should not be boiled unless it is bacteriologically unsafe, lead levels should be checked in the municipal drinking water, plumbing should be checked in dwellings and replaced if it contains lead or lead solder in the joints. First draw water should not be used. Parents can run the water about 15 minutes to decrease lead levels in the first morning run of water. Researchers suggest that lead screening begin at the age of six months for children with any frequent contaminant of powdered formulas available likelihood of lead exposure, including babies fed powdered or concentrated formula.73

Aluminum levels in formula can be up to 60 times higher than in breastmilk. Infants with renal problems are more likely to deposit large amounts of aluminum in brain and bone tissue. Two infants with renal problems died of aluminum intoxication; powdered formula was the source .74 Potential sources of aluminum contamination in formula include the raw materials, especially soybeans, contaminated additives such as calcium and phosphorous salts, the manufacturing process itself, and storage containers. Human milk contains <5-45 ug/L of aluminum while one soy formula measured 684-2346 ug/L.75 Calcium and phosphorous metabolism can be disturbed by aluminum contamination in nutrients. The use of soy formula in term infants has been reported to decrease bone mineral content76 and to be associated with smaller carpal bones on x-ray at three months.77 Preterm infants can experience bone demineralization and rickets when fed soy formula. The increased amounts of calcium and phosphorous added to these formulas to lower serum aluminum concentration” could place infants at risk for hypocalcemic tetany, as previously discussed on pages 100-1.

Formula-fed infants can be exposed to levels of iodine close to ten times that found in breastmilk. Iodine enters formula in milk from cows who eat feed high in iodine and from the iodine used by the dairy industry in teat washes and sanitizing solutions for milking equipment. Hypothyroldism can result from high levels of iodine. Some researchers feel the iodine level is too high in formula, especially since little data exists on iodine levels in formula-fed infants and the effects it may have on neonatal thyroid function.

In 1983, Michigan infant formula was found to be contaminated with halogenated hydrocarbon solvents such as trichloroethylene and perchloroethylene from well water used in the making of formula. The wells had been sampled for contaminants; they were not checked for halogenated hydrocarbon solvents, which are the most common groundwater contaminants.

Bacterial contamination of formulas continues to be of concern as more incidents occur and clinical illness results from tainted products. During November-December 1985, an outbreak of Salmonella eating occurred in the United Kingdom, which resulted in the death of one infant and admission to hospital of 15 percent of the other affected infants. The source was powdered formula contaminated at the factory. Raw milk or improperly pasteurized milk can introduce bacteria to the drying process used to manufacture powdered formula.79 Enterobacter sakazakii has been found as a frequent contaminant of powdered formulas available in thirteen countries including the US.80 It has been identified as the cause of sepsis and meningitis in neonates who received formula containing this type of bacteria.81,82

In June 1990, 63,760 gallons of a liquid soy concentrated formula was placed under a Class I recall by the US Food and Drug Administration (FDA). Class I means the product can be life threatening. FDA inspectors noticed swollen cans of formula, some of which were ready to burst. One of the lots could have been life-threatening to infants. The company did not determine the source of the contamination and a month later found that cans from an entire production run had started to swell. The plant was shut down by the company.83 The FDA has published guidelines for bacterial testing of powdered formulas, listing both the microorganism and the amount that would result in an adulterated product.

SUMMARY

Some health workers reassure parents that babies do just as well on either type of food and that in developed countries there is no difference in health outcomes between the two feeding methods. Others have little knowledge of lactation management and are not comfortable spending time with breastfeeding mothers.

Evidence continues to grow that the health outcome and cognitive abilities of formula-fed and breastfed infants may be different. Formula-fed infants may not be developing their health and cognitive abilities as their natural potential would have permitted. The trend away from breastfeeding is particularly worrisome in light of these data. Given the explosion of new research on breastmilk and breastfeeding, perhaps health workers should take more than a neutral stance on infant feeding methods.

Health workers can contribute to more complete parental in-formed decision-making by initiating infant feeding discussions at appropriate prenatal times. These include routine prenatal visits, childbirth classes, early pregnancy classes, breastfeeding classes, etc. I emphasize the following information in prenatal breastfeeding classes:

This material is © Annalisa Barbieri as such this document should not be reproduced either online or in print without express permission.

First Published: Tuesday, 13 November 2007, The Independent

In December 2004, I wrote in these pages about how I found myself “still breastfeeding” a 14-month-old, when previously I had viewed “extended breastfeeders” as a bit odd, needy and, frankly, freaky. When I first became a mother, I had envisaged myself as a mother with a clipboard, with me in charge, not the baby. I never expected to be the sort of mother I am now, breastfeeding a four-year-old on demand. I thought I knew myself, but motherhood introduced me to a self I never even knew was lurking.

To pick up where I left off three years ago: at just over a year old, my daughter seemed to be losing interest in breastfeeding. But as it turned out, that was the lull before the storm. Just as she started walking, at 18 months, she started to feed intensively. This is normal: as babies reach major developmental stages, they need to feed more. Whereas she had never been able to tell me when she was hungry as a baby, now she beat her chest with her fists – like Tarzan’s Cheetah – to tell me that she wanted milk. And she wanted milk a lot. I’d be lying if I said there weren’t times when I wished I’d weaned her. I found it hard, but I was lucky. Far from being isolated, I co-run a pro-breastfeeding website that has lots of long-term breastfeeders as members. I wasn’t going through anything others hadn’t previously.

From the age of two, my daughter started to switch breasts – that is to say, she would no longer feed on one breast, then sedately take the other. She would switch, sometimes manically, between the two, because she had learnt that the let-down (the flow of milk) is faster if you stimulate the breasts in this way. It was also about this time that she started a habit I find extremely annoying to this day: twiddling. While she fed off one breast she would twiddle the other nipple, as if trying to tune in to a short wave radio station. Again, this was to stimulate the milk so that when she did latch on to the second breast, it was all ready to go.

I found feeding between the ages of two and four quite hard at times. She needed to feed a lot, sometimes 50 feeds a day, although they were quick. When we moved house, her feeding became almost frenzied, as if she thought I would leave her. Docking on to the “mothership” became vitally important. I’m not sure how I would have met her needs so quickly during this time without breastfeeding. And I’m not sure I could have parented during the terrible twos without it: it was like having an entire cavalry at your beck and call. Breasts are a powerful parenting tool.

Despite this, breastfeeding is often blamed for many childhood malaises. Your baby is hungry/ sleepy/won’t sleep/colicky/you’re tired? Give up breastfeeding! The very thing that can make life easier is jettisoned, purely out of ignorance. Imagine if every time you said you found parenting a little bit hard, someone said, “Put your child up for adoption.” It’d be ridiculous, wouldn’t it?

No matter how hard I found breastfeeding, however, I couldn’t stop, for two reasons. The more knowledgeable I became, the more vital I knew sustained breastfeeding to be. And, second, because it is obvious how much breastfeeding means to my daughter. There’s the beauty in feeding an older child: there is no second guessing – she tells me just how important my milk is to her, how it “makes everything better”. When she gets a cold, she tells me that she needs my milk to “kill the cough”. One night, she started to run a desperately high fever (104) and I had no medicine or way of getting any. I fed her all night; she injected her germs into me while my body made the antibodies she needed and fed them back to her. We both worked through the night and, by morning, she was better, as if the fever had never happened. Knowing that you have the wherewithal to comfort and cure your child within your own body is hugely magical and empowering. The bonuses that breastfeeding gifts you make the not-so-easy times fade into nothing.

Because we don’t have a habit of feeding walking, talking children in this country, I stopped feeding my child in public when she got to be about two. I didn’t want anyone else’s ignorance to negate something she found so comforting. Now, there’s a word: comfort. I remember, pre-motherhood, challenging a friend of mine who was breastfeeding her 18-month-old child. “But isn’t it just for comfort?” I said. “What’s wrong with wanting to comfort my child?” she said. Now, this is what I tell people, too. We – or rather, not me; not any longer – seem to be terribly afraid of comforting children. Sometimes it seems as if the more hands-off you are as a parent, the more of a success you are deemed to be.

Breastfeeding is about comfort, but it’s also about nutrition, and that continues for as long as you breastfeed your child, whatever age they are. My milk is a living fluid – full of enzymes, macronutrients, minerals, vitamins, essential fatty acids, T-cells and at least 200 types of immunoglobin. And that’s just what’s known – there are ingredients in breast milk that we don’t even know about yet. My milk changes, hour by hour, to meet the needs of my child. It isn’t like any other woman’s milk, anywhere on the planet, because my daughter isn’t like any other child in the world.

In September, just as my child was about to turn four, I went to Italy with her. I’d been the year before and had encountered gentle curiosity about us still feeding. This time was different. “It’s a tragedy,” said one aged cousin, “that she’s still feeding.” “Who,” I asked, “is it a tragedy for? Not me and not my daughter.”

I smiled and offered tea, but she wasn’t able to answer. Breastfeeding is an emotive subject – the most emotive I’ve written about. It brings up all sorts of stuff in people; even friends that have hitherto been supportive probably think I’m in freak territory now, even though I’m just doing what Mother Nature intended – humans are the only mammals that don’t let their offspring feed to term. I can’t deny that I like to normalise breastfeeding in a world that sees it as increasingly alien, and I’m also aware that some women don’t have the support network I do and feel they need to feed in secret or enforce weaning when they don’t really want to, because family and friends put pressure on them.

Naomi Stadlen, a psychotherapist, breastfeeding counsellor and author of What Mothers Do, Especially When it Looks Like Nothing, once told me that she thought people might feel threatened by the intimacy between a mother and her breastfeeding child. An uncomplicated response to the information “Yes, I’m still breastfeeding”, might be curiosity; any stronger reaction was likely to be the other person projecting their problem on to you. It was a useful piece of information.

My child turned four at the end of September; her need to breastfeed seems to have dramatically declined, although, yet again, this may change. Feeding her is a wonderful time we have together and no matter how busy I think I am, it makes me sit down and be with her. She has lots of skin-to-skin contact with me, which I now know is important for neurological development. I’ve learnt that the natural age of weaning is closer to six years – when the first permanent molars appear – than six months. If I have another baby, my daughter may wean during pregnancy as milk supply can dip at that time. But if she continues to feed during pregnancy and beyond – called tandem feeding and perfectly possible – or if I don’t have another baby, then she’s in charge. She will wean when she is, uniquely to her, developmentally and immunologically ready (a child’s immune system doesn’t mature until they are about seven); she will then lose the ability to suckle. I’m interested to see where this goes and how much more I can surprise myself. All I know is that I’m glad I’ve got this far.

Annalisa Barbieri is co-founder of www.iwantmymum.com
Further reading: The Drinks are On Me, by Veronika Robinson, £11.99 www.artofchange.co.ukwww.kathydettwyler.orgwww.lalecheleague.orgAnn Sincott is writing a book on long-term breastfeeding and asks women to compile a questionnaire: http://homepage.ntlworld.com/ann.sinnott/index.htm

Why mother’s milk is best