Category: Child Development

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To Share or Not to Share (the Family Bed)

40Alcohol, Anxiety, Appetite, Attachment, Child Development, Empathy, Featured news, Health, Parenting, Sleep, Smoking October, 14

Some of the most common questions posed to parents of newborns, particularly by other parents, relate to sleeping patterns. Choices around sleep can be personal and sometimes controversial.

In western cultures, it is normal to put infants in different rooms. But in much of the rest of the world, the baby either sleeps with parents (bed-sharing) or in close proximity to the parent (co-sleeping).

These differing traditions often present a dilemma to parents in western societies who hear opposing points of view when seeking advice.

James McKenna, professor of anthropology at the University of Notre Dame considers that despite the dominant view (no bed-sharing), parents increasingly are opting for co-sleeping or bed-sharing. In fact, half of U.S. parents with infants bed-share with their children during at least part of the night.

This is especially true for breastfeeding mothers as co-sleeping can make night-time feeding easier to manage. It is thought by many that co-sleeping while breastfeeding results in the mother being more in-tune with the infant’s immediate hunger needs and as a result, the infant quickly learns that their needs can be satisfied. This contributes to the development of secure attachment

According to the American Academy of Pediatrics and Academy of Breastfeeding Medicine, mothers should sleep in close proximity to their baby not only to help facilitate breastfeeding but also to improve the survival rate of the developing infant. 

McKenna also indicates that from an anthropological viewpoint the proximity and sensory touch associated with bed-sharing induces positive behavioural and physiological changes in the infant. Studies have found long-term benefits of bed-sharing or co-sleeping. For example, children who bed-shared were found to have less anxiety and a higher level of comfort in social situations later on.

Traditional western medical views on bed-sharing tend to be rather negative. Based on the Joint Statement on Safe Sleep: Preventing Sudden Infant Deaths in Canada, the main reason cited is the threat of sudden infant death syndrome (SIDS).

The Joint statement defines SIDS as, “the sudden death of an infant less than one year of age, which remains unexplained after a thorough case investigation, including the performance of a complete autopsy, an examination of the death scene, and a review of the clinical history.”

Because it is difficult to distinguish specific causes of death that occurred during sleep, in many SIDS cases the cause may be cited as “unintentional suffocation due to overlaying,” which may be used to discourage bed-sharing.

Yet in many of the studies where infant deaths are discussed, parental smoking, alcohol consumption and unsafe sleeping practices are often major factors, as opposed to bed-sharing per se. Understanding preventative measures and safe sleeping practices can help reduce the incidence of SIDS.

Further, some research has found a strong link between breastfeeding and lowered risk of SIDS. Fern Hauck of the University of Virginia reviewed 18 studies that looked at the relationship between these two variables and found that babies exclusively breastfed had a 70% lower risk of SIDS, and the risk is lowered further the longer breastfeeding continues. Researchers attribute this lowered risk to infants being able to awaken more easily, reducing the risk of sudden death.

Daniel Flanders, pediatrician at North York General Hospital in Toronto, states that as a physician he follows the guidelines for the prevention of SIDS, but feels that strong recommendations against bed-sharing undermine parental choice on how to raise one’s child. He notes that in non-westernized communities bed-sharing is often a major part of the cultural practice of child rearing, and therefore his approach is to present the most relevant and up-to-date information available so the parent can make an informed decision.

There are several measures one can take to reduce the risks associated with bed-sharing. One of the most important things for the baby’s safe sleep is ensuring that the surface the infant sleeps on is firm, smooth and flat. Sheets should be tucked and never loose, whether the child sleeps with the parents, in a sidecar or in the crib.

If parents choose to bed-share there should be ample space for all, with both parents agreeing to the arrangement. The bed should not be shared with multiple children, especially if one or more are slightly older. Also, if the bed is raised off the floor there should be a mesh guardrail around the bed to prevent the baby from falling over. If the bed is against the wall, parents should ensure that there is no gap between the bed and the wall at all times.

Although bed-sharing is often discouraged by many in the medical community due to its association with an increased risk of SIDS, this does not mean that the practice is without benefit. Done safely, bed-sharing and co-sleeping offer unique opportunities for the development of closeness between parent and child.

Parents must choose the arrangement that works best for them and their families. For more information: Safe Sleeping Practices for Infants

– Contributing Writer: Saqina Abedi, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Dr. Mom and Dad

00ADHD, Anxiety, Attention, Child Development, Depression, Environment, Featured news, Health, Intelligence, Leadership, Motivation, Parenting, Psychiatry, Psychopharmacology, Self-Control, Sleep September, 14

We live in a world of self-diagnosis. With access to online medical databases like WebMD and kidshealth.org, it is easy to type symptoms into Google, find a diagnosis and present findings to the family physician.

Self-diagnosis may seem harmless, but it can become problematic when we diagnose ourselves or our children with more complicated conditions, behavioral disorders like Attention Deficit Hyperactivity Disorder (ADHD).

The over-diagnosis of ADHD and the over-prescription of medications like Ritalin, Adderall, and Vyvanse (to name a few) have been longstanding problems in the health care community. Clinical psychologists Silvia Schneider, Jurgen Margraf, and Katrin Bruchmuller, on faculty at the University of Bochum and the University of Basel found that mental health workers such as psychiatrists tend to diagnose based on “a rule of thumb.” That is, children and adolescents -often males- are diagnosed with ADHD based on criteria such as “motoric restlessness, lack of concentration and impulsiveness,” rather than adhering to more comprehensive diagnostic criteria.

Parentsmotivation to get help for their child’s problems along with free access to online information may play a role in the over-diagnosis of ADHD.

A study by Anne Walsh, a professor of Nursing at Queensland University of Technology found that close to 43% of parents diagnosed and 33% treated their children’s health using online information. Of concern, 18% of parents actually altered their child’s professional health management to correspond with online information. Considering the questionable quality of some online health information, these numbers are worrisome.

Furthermore, as primary caregivers can sometimes be persuaded, it is possible that parental conviction of the child’s diagnosis may play a role in physician decisions to treat. With basic diagnostic criteria for ADHD readily available online, some parents may be quick to self-diagnose their “restless and impulsive child.”

“It sometimes happens that parents come to me convinced that their child has ADHD [based on their own research] and in many circumstances they are correct,” says Dan Flanders, a pediatrician practicing in Toronto, Canada.

 According to Flanders, there are certain traits that make a child more likely to be misdiagnosed with ADHD. “Children who have learning disabilities, hearing impairment, or visual impairment may be mistaken as having ADHD because it is harder for them to focus if they can’t see the blackboard, hear their teacher or if they simply cannot read their homework.”

Flanders adds that gifted children, children with anxiety or depression, and children with sleep disorders are commonly misdiagnosed with attention disorders. “Gifted children learn the class objectives after the first 10 minutes of a class whereas their classmates need the whole hour. For the remaining 50 minutes of class these children get bored, fidgety, distracted, and disruptive. The treatment for these children is to enrich their learning environment so that they are kept engaged by the additional school materials.”

Children with anxiety and depression can be misdiagnosed with ADHD because there may be an interference with a child’s ability to learn, focus, eat, sleep, and interact with others. For children with sleep disorders, “one of the most common presentations of sleep disorders is hyperactivity and an inability to focus during the day. Fix the sleep problem and the ADHD symptoms go away.”

It is, however, important to note that these disorders are not mutually exclusive of each other. “A child can have a learning disability, anxiety, and independent ADHD all at the same time.” 

While it is often beneficial for parents to consult online databases for background information, Flanders warns against relying solely on information found online because the information may not be up-to-date and cannot replace a thorough psychological assessment.

Why, then, do parents resort to this quick fix of information?

Walsh reported that parents use online health information for a range of reasons including feeling rushed and receiving limited general lifestyle guidance from their doctors.

Flanders points out that the doctor’s approach should always be to review the data honestly and objectively with parents and then openly present the treatment options available to them.

“The most important part of ADHD treatment is making sure of the diagnosis. There are so many children who are started on medication inappropriately. Throwing medication at the problem is not the answer unless the diagnosis is well established and the differential diagnoses have been exhausted.”

– Contributing Writer: Jana Vigour, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today