Wednesday, May 30, 2012

The Sleep Training Debate and Poor Journalism = A Bad Combination

Okay, we all know that sleep training is one of the most often-debating topics among parenting circles. Some parents swear by the "cry-it-out" method (I don't care for this term, but it's the common terminology) while others think it's akin to torture for an infant. I have to say, that before having a child I had not given this topic a lot of thought or research. Although I was in grad school in Human Development for 4 years, I do not ever recall reading one single research article on this topic. After having a child, sleep, namely, how to get my son to sleep, became an all-consuming topic for me. I soon realized that I had never read a research article on this topic because there are very few good, solid studies conducted about sleep training, how or if it works, and its effects on children. 

Now, my point with this post is not to come down on one side or the other regarding sleep training. Overall, I think it is up to each family to decide how to manage sleep issues in their family based on their values and needs. My point is to illustrate how the media often frames controversial issues like this in a way that is misleading and oversimplifies the research they claim to be referencing. 

First, let me discuss a few things that we do know in regards to responsive parenting. These are based on hundreds of research articles:

- infants whose parents respond to them in a responsive way, especially in the first 3 months, but I would say first 6 months, generally develop better overall, learn to self-regulate better, and ultimately cry less
  **Note: most pediatricians would not recommend sleep training prior to 6 months of age. Newborns do not have the ability to self-soothe well and must be responded to promptly. Older babies, however, do have the ability to put themselves to sleep (assuming no health problems are present).

- infants whose parents chronically neglect them or their cries for attention have poorer outcomes overall
  **Note: if infants' needs are repeatedly ignored, of course, they will not develop ideally. Pediatrician-recommended sleep training methods do not involve chronic neglect of an infant's needs.

- infants of depressed mothers are at risk for poor attachment which can lead to further problems with self-regulation, behavior, and later attachments
  **Note: extreme sleep-deprivation is a risk factor for depression, particularly postpartum depression

Several recent articles in the media have claimed to show that new research indicates that sleep training (i.e., cry-it-out) is harmful to babies and their developing brains (posts herehere, and here). First of all, with the exception of one, none of the referenced studies actually looked at sleep training itself. If you look at the titles of many of the referenced studies, they use words like "childhood maltreatment," or "maternal loss". In other words, they are studies of children who have been extremely maltreated, probably to the point of being reported to child protective services. Secondly, several of the studies referenced in these articles used rat studies to test hormone levels as a marker for stress (namely cortisol). Only one of the studies tested hormone levels in human infants.

Finally, let me point out some of the words used in these articles that are assumed to synonymous with sleep training:

intense stress early in life

chronic stress

 repeatedly neglected

 babies whose cries are usually ignored

To my mind, none of these words imply what happens during the commonly recommended sleep training methods. Most pediatricians will tell you that sleep training usually involves some bouts of crying with some parental soothing at regular intervals that only continues for about 3-4 nights. As I said before, the chronic, intense stress that the research articles find to be associated with poor outcomes for kids refer to events much more dramatic than sleep training. They are usually referring to events like the death of a mother or the experience of a natural disaster. 

In the interest of further explaining how these media outlets provide misleading information, let me present a quote referenced in one of the above-mentioned articles regarding "cry-it-out" (emphasis added by me): 

Could a lack of nurturing explain our "Prozac Nation?" Narvaez points out that she's witnessed the long-term physical effects of it firsthand. 
"I was raised in a middle-class family with a depressed mother, harsh father and overall emotionally unsupportive environment -- not unlike others raised in the USA," she writes. "I have only recently realized from extensive reading about the effects of early parenting on body and brain development that I show the signs of undercare -- poor memory (cortisol released during distress harms hippocampus development), irritable bowel and other poor vagal tone issues, and high social anxiety." 

I have no doubt that the effects Ms. Narvaez describes are real, but no where does she mention anything about experiencing sleep training as a child. All the parenting characteristics she describes (i.e., a depressed mother and a harsh father) are characteristics that are well-known in the research to be associated with less-than-optimal development. These characteristics, however, are not synonymous with sleep training. Parents can be loving, responsive, and caring and still decide to use sleep training to help their infant learn to sleep.

Again, I am not writing this post to come down on one side or the other regarding sleep training. My goal is to simple point out the misleading nature of the media coverage of this topic. Overall, I think there needs to be much more research on this topic. As parents I think it helpful to be informed of the research out there but not in a misleading or biased way. For a very comprehensive and well-written piece on much of the sleep training research, I encourage you to read this by Alice Callahan, PhD, author of Science of Mom. If you are struggling with how to handle your child's sleep, this article will offer well-researched, unbiased information to guide your decision. 

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Thursday, May 24, 2012

Research Reveals Genetic Links to Postpartum Depression

Any woman who has given birth knows the emotional upheaval that often follows this life-changing experience. For some women, however, this emotional roller coaster isn't a brief experience, but one that develops into postpartum depression. Researchers estimate that somewhere between 10 and 20% of women experience postpartum depression in the first six months after the birth of their child. When you think about it, this is a very significant number of women. In addition to the suffering of these women, depression can also be very detrimental to the formation of attachment between mother and infant. This can set up an unfortunate, and even, unhealthy, dynamic between parent and child that can take years to repair.

This is why I was so interested to read about a new line of research showing the possibility of a blood test that could indicate which women might be at-risk for developing postpartum depression. Researchers at the University of Warwick have been able to identify certain gene variations that seem to put women at risk for developing postpartum depression. This gene variation affects the functioning of aspects of the hypothalamus, the part of the brain that is partially responsible for the release of hormones into the body. Women with this particular gene variation are more susceptible to the environmental stresssors (i.e., childbirth and its related stresses) which often prompt the development of postpartum depression. Much more research is needed to clarify how these processes work, but the researchers are hopeful that they might be able to develop a blood test to determine which women are at-risk for postpartum depression.

If such a blood test were developed, this could be extremely helpful in making sure mothers receive quick and effective treatment for postpartum depression. The sooner mothers receive treatment, the sooner their suffering can be relieved and they will be more able to establish a strong, loving attachment with their baby. Mothers and babies all over the world could benefit greatly from this. I will keep an eye on this research and share any new developments with my readers.

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Wednesday, May 9, 2012

National Children's Mental Health Awareness Day

Today is National Children's Mental Health Awareness Day. I've been making a point to blog about this for the past few years and you may wonder why. I feel this is an important issue because it is often overlooked. Like adults, children can have mental health problems, but unlike us, they have less life experience to know how to cope with it.

This topic is also especially on my mind this year after reading Victoria Costello's book about mental illness entitled Lethal Inheritance. She points out that mental health problems many times have a genetic component and symptoms may arise early in a child's life but parents are often not cued into these warning signs.

When thinking about mental health issues, I think many people often only think of children who have experienced a traumatic event, been neglected, or abused. While these children are, of course, at high risk for mental health issues, any child can have a predisposition towards mental illness.

Parents, especially mothers, play a key role in not only identifying symptoms in their children, but also seeking treatment for their own mental illness, if necessary. Mothers with mental health problems, especially depression, are less able to form strong attachments and healthy relationships with their infants and children. However, mothers who seek treatment have children who are more likely to avoid mental health problems themselves.