Dr. Amy Tuteur is an obstetrician who posts as The Skeptical OB regularly. Her posts are always well thought out and articulate and usually contrarian. Her posts are more detailed than mine tend to be, and tend to articulate her point of view explicitly. I hope you enjoy this article reposted with her kind permission. Check out her blog to see other timely and interesting material.
Child centered parenting is a relatively new phenomenon, made possible by the increased security and increased leisure of contemporary life. Where once it was commonplace to send even young children out to work to contribute to the family’s support, childhood is now acknowledged as a protected space.
The change in philosophy has led to a change in the expectations about mothers. After World War II mothers, who were previously held responsible for raising healthy children with good manners, were also tasked with raising emotionally secure adults. This responsibility was seen as requiring a “child centered” approach, giving pride of place to children’s needs over mothers’ needs.
So far, so good. But in the intervening years, the purported responsibilities of mothering have grown dramatically, notably expressed as a commitment to “intensive mothering” also known as attachment parenting. Among those responsibilities is one entirely new claim, the notion that mothers are not responsible merely for physical health, acculturation and emotional security, but are also responsible for a child’s brain development. Whereas there is copious scientific evidence to support assigning the health and socialization tasks to mothers, there is little to none supporting the notion that mothers exercise substantial control over children’s brain development. No matter. An virtual industry has arisen to promote the idea that only mothers can develop a child’s brain.
Canadian sociologist Glenda Wall details the new responsibility in her paper HYPERLINK “http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBD-4YJ14B4-2&_user=10&_coverDate=06%2F30%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1370757039&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5b94801a0d125d0dc70be71a733e1ab6″HYPERLINK “http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBD-4YJ14B4-2&_user=10&_coverDate=06%2F30%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1370757039&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5b94801a0d125d0dc70be71a733e1ab6″Mothers’ experiences with intensive parenting and brain development discourse.
Over the 1990s and into the current decade government agencies, non-profit foundations, and child-rearing experts undertook to educate parents and the public in general about the importance of spending ample, one-on-one quality time with children in order to stimulate brain development and future brain potential…
The claims being made in the advice literature that has resulted, while presented as fact, have been the subject of some scientific debate. Several authors suggest, among other things, that there is in fact little evidence in the field of neurology to support the claim that ‘extra enrichment’ … has any beneficial effect on future intelligence or success.
Despite scientific critiques however, the brain development advice itself borrows from the language and authority of neuroscience to frame children’s brains as technologically complex machines that need the correct inputs in order to attain maximum efficiency at a later time …
Wall explains how this new responsibility has put increased pressure on mothers.
Parents and caregivers are cast as the engineers and programmers charged with the task of making the correct inputs, and the potential consequences of neglecting to give children what they need in this regard are portrayed as dire…
In other words, there are now new ways for mothers to screw up and bring opprobrium down on themselves. Not only are mothers blamed for children’s poor manners and psychological issues, but they are now held to be at fault if their children are not intellectually superior.
Wall’s critique is insightful, not merely because she explores the lack of evidence for our new found belief that mothers are responsible for optimal brain development. Wall also casts light on the cultural assumptions that buttress this belief: the assumption that we exercise far more control over health and development than we actually do, and the assumption that parents should do more than aspire to intellectual and professional success for children, they should consciously plan for it.
In an age of intensive, and child-centered parenting, the imperative for parents to plan for, control, and manage the lives of their children to optimize their future chances … The institutional practices that have grown up around prenatal education and planning, the promises made in the marketing of educational toys, and the promotion of lessons, and various types of cultural enrichment all contribute to a cultural understanding that parents (and especially mothers) have a duty, and the ability, to control and shape the lives of their children to a very fine degree.
These assumptions have profound implications for mothers and children.
The view of childhood embedded in brain development discourse is certainly one of children as highly malleable, as parental projects full of potential, but potential that can only be activated with appropriate and intensive parental inputs. Children’s current happiness is also emphasized less in this discourse than is their future potential for success.. Rather it is desirable only in so far as it contributes to potential success, and coincides with parental behavior that promotes brain development. At the same time childhood intelligence has become elevated as an important virtue (over and above happiness) and manifestations of it are more likely to be seen as evidence of good parenting.
Hence the moralizing and hectoring that is so common among attachment parenting proponents. Everything they champion – breastfeeding, babywearing, etc. – is not merely a choice, but it is supposedly a demonstration of commitment to raising smarter, more successful children. In other words, mothering has become a competition.
The focus on intelligence in brain development discourse is linked to an implicit endorsement of competition in this regard between children and between parents. As Nadesan notes … the brain development turn in the 1990s accelerated a trend in parental desires to have children who exceed the norm intellectually…
Proponents of attachment parenting need to look carefully at the assumptions underlying their philosophy and stop the hectoring and moralizing that seem to flow from their philosophy.
AP proponents assume that they can enhance the neurodevelopment of their own children and disparage mothers who refuse to optimize the neurodevelopment of their children. Yet there is really no evidence that mothers’ choices enhance neurodevelopment and hence no basis to assume that mothers who make different choices don’t care about their child’s intelligence.
AP proponents assume that children in their role as future adults are in competition with one another and that mothers should strive to give their children competitive advantages. They also assume that parents are in competition with each other and that a child’s achievements are weapons in that competition. The parent with the smartest child wins.
Of course it takes many years to find out whose child is the smartest and no one wants to wait. Because of their implicit belief in their ability to control outcomes, AP proponents don’t bother to wait. They simply compete on the basis that their children are going to be smarter than those of women who make different choices!
Attachment parenting is a parenting philosophy, but it is also a reflection of cultural assumptions and simple human competitiveness. AP proponents believe that they are fashioning superior children and have contempt for those who make different parenting choices. They assume, imply and often flat out assert that mothers who make different choices don’t care to give their children a competitive advantage. It hasn’t occurred to them that many mothers know that AP practices don’t give children a competitive advantage and indeed reject the notion that raising children has anything to do with competition.
I urge readers to submit a guest post. I’d love to give you a forum to be heard.
Nocturnal enuresis, the medical term for bed wetting, is a really common problem. About 15-25% of 5 year old boys wet the bed regularly. About 15% of these boys become dry at night each year, so that almost all are dry by the late teens. The exact cause of nocturnal enuresis remains elusive, but it likely is related to delayed maturation of certain brain functions. For some reason delay in the maturation of this brain function is more common in boys than in girls, with a ratio of about 3:1 boys to girls with nocturnal enuresis. Most parents whose child wets the bed if asked will remark on how soundly the child sleeps. They can get the child up, take them to the bathroom, bring them back to bed, and the child never really wakes up. They often have no recollection of being taken to the bathroom if asked about it the next morning. Nocturnal enuresis runs in families, and up to 65-85% of children with nocturnal enuresis have a positive family history.
Treatment of nocturnal enuresis consists begins with education. First, and most important, is making sure the child and the parents realize that this is not something the child can stop by just trying harder. Punishment, derision, and reward systems just don’t work well, and can diminish the self esteem of these children. Once the child finds the bedwetting to be a big enough problem that they really want to try to treat it, attempts at treatment are appropriate.
The most effective and best treatment is use of alarm systems for most families. It is important for physicians to warn parents away from some of the heavily advertised and grossly overpriced alarm systems they may see promoted in some places. An AFP article has links to several good commercially available systems. A good alarm system consists of a moisture sensor that is placed in the underwear to detect the first little bit of urination, and triggers an alarm that wakes the child so that the child can turn off, and after going to the toilet can rearm. The biggest cause of failure of the alarms is that they often wake everyone in the house except the child wetting the bed. Some of the newer systems have a buzzer rather than a loud alarm that can be a better choice for some children if waking the rest of the family is a problem. Once the child has matured to a point where the alarm wakes them, the alarm systems often work. Success rates with alarm systems have been shown to be up to 60% in some studies. They can be retried every few months if they are unsuccessful initially. Often use for up to 15 weeks is needed.
Medications to treat nocturnal enuresis are also available. The FDA approved medication is DDAVP nasal spray or oral tablets. It is used at bedtime, and reduces the production of urine and therefore reduced bedwetting. It is fairly effective when used, but does not work on nights not used, and is very expensive. I find this medication most often used for special occasions, like overnight stays and summer camp.
Some studies show that only about 1/3 of children with nocturnal enuresis are brought for medical attention. It’s important that when they are brought in we are prepared to give solid advice and realistic expectations.
I’ve always thought birth pools ana underwater birth was wierd, unnatural and seemed dangerous. Advocates are passionate about its benefits, but it looks like they are ignoring the risks. I turned away a couple of patients years ago because water births just seemed too frightening for me to accomodate. Now the risks are becoming more understood. Here is an excellent article on KevinMD by Amy Tuteur MD who posts as The Skeptical OB.
Waterbirth dangers to newly born babies
by Amy Tuteur, MD
Waterbirth has become a central component of “natural” childbirth dogma, despite the fact that for primates giving birth underwater is entirely unnatural. You don’t need a medical degree to appreciate the idiocy of birth in water. read more
In the early years of my practice I was stationed at Keller Army Hospital, West Point, NY. Ralph Olson, MD, a pediatrician spending the last years of his practice on active duty as a reserve physician after many years in private practice, consulted on a 4 year old patient for me who had a longstanding cough. She seemed to cough every time she was around her parents, but never seemed very sick, and I thought she had a psychogenic cough, but wanted Ralph’s opinion and suggestions. Ralph walked across the lobby of the clinic and suggested I watch while he showed me how to cure this problem. Many childhood maladies like temper tantrums and continually dropping toys, this is an attention gaining behavior. The standard advice is to practice good ignoring skills, and it will resolve. This is true, but Ralph had a better treatment.
I watched as he got down eye to eye with the little girl and her Mom, and he told the child that this cough was from an invisible frog in her throat, and that to get the frog out of her throat she and her Dad needed build a frog trap to catch it and get rid of it forever. They needed to get a match box, and they needed paint it green, with spots and eyes, and let it dry. Then her Dad would hold it open in front of her mouth, she would cough really hard, and the frog would be pushed out and her Dad could catch the frog in the matchbox and close it quickly. Then they could throw the trap away with the frog caught inside, and the cough would be gone.
I called the girl’s Mom a couple of days later, and the method worked perfectly. I have tried this at least twice since, and it has not failed yet. Feel free to add this to your parenting or pediatric doctor’s bag of tricks. It makes you look really wise and you’ll be a hero to at least one set of parents. I’m sure this could work with a single parent, but like the one day potty training method, having Dad, who often is around less implement this gives him some good time with the child, and seems to work better.
My wife and I strongly believed that our daughter should learn to play on a team. We had her join the same type of youth soccer and baseball as our son. We thought that learning to play as a part of a team, to set goals, to win and lose, and to be coached were important life skills that girls in past generations often missed. We are glad we did, and here is data supporting out viewpoint. Tara Parker-Pope in the NY Times reports.
Almost four decades after the federal education law called Title IX opened the door for girls to participate in high school and college athletics, a crucial question has remained unanswered: Do sports make a long-term difference in a woman’s life?
A large body of research shows that sports are associated with all sorts of benefits, like lower teenage pregnancy rates, better grades and higher self-esteem. But until now, no one has determined whether those improvements are a direct result of athletic participation. It may be that the type of girl who is attracted to sports already has the social, personal and physical qualities — like ambition, strength and supportive parents — that will help her succeed in life.
Now, separate studies from two economists offer some answers, providing the strongest evidence yet that team sports can result in lifelong improvements to educational, work and health prospects.
There may not be another parenting technique that works at every age from birth to adulthood, is simple enough to explain in a couple of minutes at a well child visit, and that every parent can master in a few days.
Non-verbal touch is a technique where a parent catches their child doing a desired behavior, and taking care not to interrupt them gives them a gentle touch to reinforce that behavior. If your infant is staring at a brightly colored picture on the wall, rather than interrupt them to tell them about the nice red stripe or blue star, simply gently pat them on the head. If your three year old is working diligently to put the square peg in the square hole, rather than verbally encourage them simply gently pat their back. If your teen is reading a book rather than comment that you are happy they are reading rather than watching TV or playing Nintendo, simply quietly touch them lovingly on the foot or shoulder.
The key to this technique is to not interrupt the behavior you want to reinforce, and to do it ridiculously often. Experts say over 100 non-verbal reinforcing touches a day is ideal for young children. It will take an effort at first to become natural at this parenting technique, but with practice it will become second nature. Verbal encouragement is more effective to redirect a child to a desired behavior, or as praise after a desired behavior is completed. Non-verbal touch is used during the desired behavior to subtly reinforce the behavior and increase the chances of it being repeated.
My wife once told me you never want to be an “interesting” case. It’s OK to be a “fun” case though. I saw a fun case in the office this week, at least fun for me. Fun for me often means seeing something I don’t every day, I can diagnose with confidence, and where good advice will lead to a good outcome for the patient. Today one of my young partners asked me to see a child with a rash. Dad was concerned about chicken pox, and though my associate was pretty sure it was not chicken pox he wanted me to see what I thought. After looking at the boy with multiple discrete reddish bordered pustules of the torso and legs, I asked Dad if they had a hot tub. They do, and I advised them this was a classic case of hot tub folliculitis. This is more common in children, but adults also can get the problem. A bacteria called Pseudomonas aeruginosa can survive in very warm water, and can get into the hair follicles causing them to get infected. All it takes to cure this is time, staying out of the hot tub, and getting your parent to drain the hot tub, sterilize it, refill it, and add the correct chemicals to keep the water bacteria free. Fun case, help a young associate learn about a not-so-common disorder, and reassure a parent at the same time. This is one pseudomonas infection where antibiotics like levaquin are not needed, and we can avoid potential levaquin side effects.
I remember when we had our first baby. I was in the Army, stationed hundreds of miles from either of our families, and although I felt well trained as a family physician, we faced the same parenting dilemmas as every young parent. How to get the baby to sleep through the night, and later was our son ready to start kindergarten at barely 5 years old. I have found both as a parent and in giving advice to parents as a family doc tor that the “non-verbal touch” technique is extremely satisfying. This is a technique where a parent reinforces desired behavior by simply giving the child a non-verbal reassuring touch to encourage the behavior without interrupting the child. This can be done literally dozens of times daily with young children and is an excellent way to help children learn to play independently. Tseng and Biagioli in the July 16, 2009 American Family Physician present an excellent review of advice to family physicians on counseling parents on Early Childhood Concerns. Specifically they address sleep issues in young children, thumb sucking, picky eating, and school readiness. Here is one of the tables of data from that article
Table 1
American Academy of Sleep Medicine 2006 Guidelines for Prolonging Sleep in Infants
Lay the infant down to sleep at a designated time and do not respond to any crying until morning
Level 1
Graduated extinction
Gradually respond less frequently to the infant’s cries (e.g., initially respond within five minutes of crying, then space out the response to every 10 minutes, then longer)
Level 2
Bedtime routines
Maintain the same sleep and wake schedule daily
Level 1
Scheduled awakenings before expected awakening time
If the predicted awakening times for the infant are, for example, 1:00 a.m., 4:00 a.m., and 7:00 a.m., awaken the infant 15 minutes earlier than the predicted time; the infant will eventually sleep through the predicted times
note: Some methods listed may not be feasible for some families; for example, a family that lives in a thin-walled apartment complex may have complaints from neighbors if they attempt to let their infant cry through the night. Parents can try a method that fits with their values, culture, and living arrangement.
*— American Academy of Sleep Medicine classification of evidence: level 1 = high-quality randomized studies; level 2 = lower-quality randomized studies.
Information from reference
Thanks for reading this medical blog. Leave a comment and contribute to the discussion.
I’ve been practicing long enough to have seen the weight of medical and public opinion swing from very pro (1970-80’s) , to fairly con (1980-1990’s) , to the current fairly pro regarding routine neonatal circumcision. More evidence is accumulating that there are significant benefits to neonatal circumcision in both men and their female partners. In the
The Skeptical OB on Attachment Parenting
Dr. Amy Tuteur is an obstetrician who posts as The Skeptical OB regularly. Her posts are always well thought out and articulate and usually contrarian. Her posts are more detailed than mine tend to be, and tend to articulate her point of view explicitly. I hope you enjoy this article reposted with her kind permission. Check out her blog to see other timely and interesting material.
Originally published Thursday, June 17, 2010
Only YOU can develop your child’s brain!
Child centered parenting is a relatively new phenomenon, made possible by the increased security and increased leisure of contemporary life. Where once it was commonplace to send even young children out to work to contribute to the family’s support, childhood is now acknowledged as a protected space.
The change in philosophy has led to a change in the expectations about mothers. After World War II mothers, who were previously held responsible for raising healthy children with good manners, were also tasked with raising emotionally secure adults. This responsibility was seen as requiring a “child centered” approach, giving pride of place to children’s needs over mothers’ needs.
So far, so good. But in the intervening years, the purported responsibilities of mothering have grown dramatically, notably expressed as a commitment to “intensive mothering” also known as attachment parenting. Among those responsibilities is one entirely new claim, the notion that mothers are not responsible merely for physical health, acculturation and emotional security, but are also responsible for a child’s brain development. Whereas there is copious scientific evidence to support assigning the health and socialization tasks to mothers, there is little to none supporting the notion that mothers exercise substantial control over children’s brain development. No matter. An virtual industry has arisen to promote the idea that only mothers can develop a child’s brain.
Canadian sociologist Glenda Wall details the new responsibility in her paper HYPERLINK “http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBD-4YJ14B4-2&_user=10&_coverDate=06%2F30%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1370757039&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5b94801a0d125d0dc70be71a733e1ab6″HYPERLINK “http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBD-4YJ14B4-2&_user=10&_coverDate=06%2F30%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1370757039&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5b94801a0d125d0dc70be71a733e1ab6″Mothers’ experiences with intensive parenting and brain development discourse.
Over the 1990s and into the current decade government agencies, non-profit foundations, and child-rearing experts undertook to educate parents and the public in general about the importance of spending ample, one-on-one quality time with children in order to stimulate brain development and future brain potential…
The claims being made in the advice literature that has resulted, while presented as fact, have been the subject of some scientific debate. Several authors suggest, among other things, that there is in fact little evidence in the field of neurology to support the claim that ‘extra enrichment’ … has any beneficial effect on future intelligence or success.
Despite scientific critiques however, the brain development advice itself borrows from the language and authority of neuroscience to frame children’s brains as technologically complex machines that need the correct inputs in order to attain maximum efficiency at a later time …
Wall explains how this new responsibility has put increased pressure on mothers.
Parents and caregivers are cast as the engineers and programmers charged with the task of making the correct inputs, and the potential consequences of neglecting to give children what they need in this regard are portrayed as dire…
In other words, there are now new ways for mothers to screw up and bring opprobrium down on themselves. Not only are mothers blamed for children’s poor manners and psychological issues, but they are now held to be at fault if their children are not intellectually superior.
Wall’s critique is insightful, not merely because she explores the lack of evidence for our new found belief that mothers are responsible for optimal brain development. Wall also casts light on the cultural assumptions that buttress this belief: the assumption that we exercise far more control over health and development than we actually do, and the assumption that parents should do more than aspire to intellectual and professional success for children, they should consciously plan for it.
In an age of intensive, and child-centered parenting, the imperative for parents to plan for, control, and manage the lives of their children to optimize their future chances … The institutional practices that have grown up around prenatal education and planning, the promises made in the marketing of educational toys, and the promotion of lessons, and various types of cultural enrichment all contribute to a cultural understanding that parents (and especially mothers) have a duty, and the ability, to control and shape the lives of their children to a very fine degree.
These assumptions have profound implications for mothers and children.
The view of childhood embedded in brain development discourse is certainly one of children as highly malleable, as parental projects full of potential, but potential that can only be activated with appropriate and intensive parental inputs. Children’s current happiness is also emphasized less in this discourse than is their future potential for success.. Rather it is desirable only in so far as it contributes to potential success, and coincides with parental behavior that promotes brain development. At the same time childhood intelligence has become elevated as an important virtue (over and above happiness) and manifestations of it are more likely to be seen as evidence of good parenting.
Hence the moralizing and hectoring that is so common among attachment parenting proponents. Everything they champion – breastfeeding, babywearing, etc. – is not merely a choice, but it is supposedly a demonstration of commitment to raising smarter, more successful children. In other words, mothering has become a competition.
The focus on intelligence in brain development discourse is linked to an implicit endorsement of competition in this regard between children and between parents. As Nadesan notes … the brain development turn in the 1990s accelerated a trend in parental desires to have children who exceed the norm intellectually…
Proponents of attachment parenting need to look carefully at the assumptions underlying their philosophy and stop the hectoring and moralizing that seem to flow from their philosophy.
AP proponents assume that they can enhance the neurodevelopment of their own children and disparage mothers who refuse to optimize the neurodevelopment of their children. Yet there is really no evidence that mothers’ choices enhance neurodevelopment and hence no basis to assume that mothers who make different choices don’t care about their child’s intelligence.
AP proponents assume that children in their role as future adults are in competition with one another and that mothers should strive to give their children competitive advantages. They also assume that parents are in competition with each other and that a child’s achievements are weapons in that competition. The parent with the smartest child wins.
Of course it takes many years to find out whose child is the smartest and no one wants to wait. Because of their implicit belief in their ability to control outcomes, AP proponents don’t bother to wait. They simply compete on the basis that their children are going to be smarter than those of women who make different choices!
Attachment parenting is a parenting philosophy, but it is also a reflection of cultural assumptions and simple human competitiveness. AP proponents believe that they are fashioning superior children and have contempt for those who make different parenting choices. They assume, imply and often flat out assert that mothers who make different choices don’t care to give their children a competitive advantage. It hasn’t occurred to them that many mothers know that AP practices don’t give children a competitive advantage and indeed reject the notion that raising children has anything to do with competition.
I urge readers to submit a guest post. I’d love to give you a forum to be heard.