The (faulty) neuroscience behind attachment parenting

Yesterday, I read this article on Slate.com about how sleep training (‘crying it out’) may not be as dangerous as some groups may lead you to believe it is. Frequent readers of this blog may know that I haven’t tried much sleep training with BlueEyes, despite his frequent night waking, because I felt more comfortable soothing or nursing him to sleep. And then it is nice to read in books like Sue Gerhardts “Why love matters: how affection shapes a baby’s brain” that this is the ‘right’ thing to do, because neuroscience tells us so. 

But wait a minute, I’m a neuroscientist myself (and one who is very interested in the developing brain too). So why do I read a book about the brain without questioning where those references come from, whether the author interprets them correctly and whether she leaves out any relevant research? Let’s say I was sleep deprived for a while and of course it is nice to hear that the strategy that you’re choosing is the right one, because neuroscience tells us so. But both the Slate article and this paper by Bruce Maxwell (that DrSpouse tweeted to me) show that if you take a good look at the real neuroscience behind these parenting advices, the science is really not that solid. The rationale behind responsive parenting or attachment parenting is that responding adequately to your baby’s needs keeps their cortisol levels low, which is important because high cortisol levels will have lasting, negative effects on the developing brain. However, as I said before, the science is not that solid: evidence either comes from children that are neglected heavily (such as orphans in third world countries), or from animal studies where young monkeys or rats are isolated from their mothers. These results are then extrapolated to children whose parents let them cry it out. Or, as the slate piece points out, the results come from a study that looks at cortisol levels during hospital-based sleep training, but this study really fails to include any relevant control group. However people abuse this study by drawing conclusions that are really not warranted by the data.

So do I still ‘believe’ in my parenting strategy? Yes, because it’s honestly just parenting for lazy people, and it’s a style that seems to work for us. However, I will never again think that I am doing it this way because of the neuroscience evidence, because that is really too thin to draw such firm conclusions. We need to do much better controlled studies, or longitudinal studies looking at the outcomes of different parenting strategies to say things like this. And I think it is sad and even unethical that writers of parenting books and articles take such a one-sided view and lead lay parents to believe that there is scientific evidence for any parenting strategy.

Is bed-sharing unsafe?

The other day I read that "Bed-sharing raises cot death (SIDS) risk fivefold". You probably know that we have been co-sleeping (as in bed-sharing) with BlueEyes since he was about 5 months and we might co-sleep with prospective baby from a much earlier age. So I thought "Yikes!" when I read this press release about a study by Carpenter et al. However, there are a number of limitations to this study, which have been nicely summarized by here at EvolutionaryParenting.com. This is the summary of ten important variables that have not been included in this paper:

1. The researchers importantly did not consider whether the bedsharing was planned. Previous research from Venneman (2009) showed no increased risk in planned bedsharing (versus unplanned). This is an incredibly important omission.
2. The paper did not consider the effects of the mother smoking during pregnancy, only smoking post birth. This is a missing risk factor.
3. Breastfeeding information is too limited to draw conclusions. No difference has been drawn between frequency and percentage of breastfeeds versus formula feeds for those ‘partially feeding’.
4. The paper only considered ‘illegal drug use’. Many postnatal mothers (0-12weeks after the birth) are prescribed analgesic medication for related birth induced injuries including but not limited to Caesarean healing, known to have a sedative effect. This was not considered at all.  This is a missing risk factor.
5. Prematurity was not considered at all. This is a missing risk factor.
6. Parental exhaustion was not considered at all. Some experts suggest this is considered to be less than 4-5 hours sleep in the past 24 hour period, other experts advise parents to use their instinct. Parental exhaustion naturally impacts on responsive to infant cues. This is a missing risk factor.
7. The researchers did not examine the effect of maternal (and paternal) obesity. This is a missing risk factor.
8. No differentiation was made between having one or both parents in the bed and importantly the location of the baby. It is advisable that the mother sleeps in between the father and infant. Equally it was not noted if older siblings were also present in the bed. This is a missing risk factor.
9. The researchers did not consider fully the impact of alcohol consumption by the father when bedsharing. This is a missing risk factor.
10. No mention was made of whether parents were aware of the risks of bedsharing and how to minimize these before sharing a bed with their infant.

And to end, here are guidelines for safe co-sleeping from James McKenna's lab website.

'Nighttime parenting' by Sears

I already admitted recently that we bought our first baby sleep book. After a year of not sleeping much longer than 3-4 hours (or less) at a time, I felt that maybe we were missing something. Previously I resisted getting a baby sleep book, because I thought (and still think) that worrying about lack of sleep takes even more of your energy than just not sleeping well. I also believe that sleep is not something you can force onto your children, but that the only thing you can do is create an environment in which they feel safe to fall asleep. So we didn’t buy any of the books that say that you have to let your baby cry-it-out, but instead got ‘Nighttime parenting’ from Bill Sears, the father of attachment parenting. Does it make sense to get a book on something that you already do (namely breastfeeding and co-sleeping)? It kind of does, which is why I’m writing about it.

The book starts out explaining what attachment parenting is. Sears doesn’t say that you have to breastfeed, babywear and co-sleep, but he just says that attachment parenting helps you achieve two goals:

• To know your child. 
• To help your child feel right.

And I like the way he talks about ‘nighttime parenting’, suggesting that you shouldn’t put your baby in a separate room from 7PM to 7AM (as some people around us suggest) but that you should also be there for him at night. But what annoyed me a bit was how he made it sound so overly romantic: you lay down with your baby after a nice warm bath, hold him in your arms and nurse him to sleep. Yeah right. In our house, that works only some of the time. Most of the time however, BlueEyes will nurse, almost fall asleep and then turn around and sit up, crawl out of bed and start playing. So then usually Dr. BrownEyes will come in and walk around with BlueEyes until he either sleeps or wants to nurse again (which he will tell by crying). This is far from the romantic picture dat Sears is painting in his book, which is filled with 70s pictures of people cuddling with their sleeping baby in the family bed…

In another chapter Sears talks about the ‘high need baby’, with which he means babies that have a hard time sleeping and/or cry a lot. I’ve been wondering whether BlueEyes would qualify as a high need baby, and to be honest: I have no idea. I don’t really have a lot of firsthand experience with other babies (I had never even changed a diaper before BlueEyes was born!), so I can’t say how he compares to other children (well except for all the stories about children who sleep through the night at 6 weeks old…). But the solution for a high need baby is basically even more co-sleeping, breastfeeding and babywearing than for a regular baby.

So was this book useful? You might be surprised, but yes it was! Because now I know that we’re not just doing something, but that it’s sort of normal to still nurse a 1 year old to sleep and to walk around the room with him when he wakes up at night in order for him to fall asleep again. And that it’s just a matter of waiting until he will sleep better.