Friday, August 31, 2007

Increased carrying reduces infant crying

A randomized controlled trial

The crying pattern of normal infants in industrialized societies is characterized by an overall increase until 6 weeks of age followed by a decline until 4 months of age with a preponderance of evening crying. We hypothesized that this "normal" crying could be reduced by supplemental carrying, that is, increased carrying throughout the day in addition to that which occurs during feeding and in response to crying.

In a randomized controlled trial, 99 mother-infant pairs were assigned to an increased carrying or control group. At the time of peak crying (6 weeks of age), infants who received supplemental carrying cried and fussed 43% less (1.23 v 2.16 h/d) overall, and 51% less (0.63 v 1.28 hours) during the evening hours (4 PM to midnight). Similar but smaller decreases occurred at 4, 8, and 12 weeks of age.

Decreased crying and fussing were associated with increased contentment and feeding frequency but no change in feeding duration or sleep. We conclude that supplemental carrying modifies "normal" crying by reducing the duration and altering the typical pattern of crying and fussing in the first 3 months of life. The relative lack of carrying in our society may predispose to crying and colic in normal infants.

PMID: 3517799 [PubMed - indexed for MEDLINE]
Pediatrics 1986 May;77(5):641-8.

Sunday, August 26, 2007

Infant Carriers and Spinal Stress

by Rochelle L. Casses, D.C.

As we are finally realizing the benefits of "wearing" our infants while we perform our daily activities, we must be careful not to compromise the integrity of our child's spine through the use of improper carriers. Spondylolisthesis (specifically, Type II/isthmic) is a condition that can result from excessive stress in the low back, such as a baby's spine might experience in certain carriers on the market today. It is relatively uncommon, but when aggravated is extremely painful. This article explains which styles of baby carriers promote healthy spine development in an infant and describes the unnecessary stress and resulting spinal condition that can result from using certain carriers.

A healthy adult spine has four curves when viewed from the side, located in the neck (cervical spine), mid-back (thoracic), low back (lumbar) and base of the spine (sacrum). Upon entering the world, a newborn has only two curves in her spine: the mid-back and the base of the spine. These two curves are called the primary or kyphotic curves. They have an apex or "hump" at the back of the body. The curves in the neck and low back develop later and are termed secondary or lordotic curves. The curve in the cervical spine develops as the child begins to lift his head and the neck muscles are strengthened. The curve in the lumbar spine results as the child starts to crawl. The lordotic curves have an apex at the front of the body. These four curves — two primary and two secondary — are extremely important in the spine (both adult and child), for this is how the body handles the stress of gravity. If these curves do not exist, the body's center of balance is shifted, causing undue stress on the spinal column and spinal cord.

A baby's spine is placed in a compromising position in many of today's popular carriers. If the carrier positions the infant upright, with the legs hanging down and the bodyweight supported at the base of the baby's spine (i.e. at the crotch), it puts undue stress on the spine which can adversely affect the development of the spinal curves and, in some cases, cause spondylolisthesis.

Spondylolisthesis is defined as the forward slipping of a vertebra on the one below it. The degrees of severity are determined using the Meyerding grading scale, with grade 1 being the least amount of slippage and grade 5 being complete slippage off the vertebra below. This condition may have a related stress fracture at the pars interarticularis, a structure at the back of the vertebra that takes most of the stress inflicted on the spine when it is arched backwards. When present, a spondylolisthesis occurs at the fifth lumbar vertebra 90% of the time and at the fourth lumbar vertebra 9% of the time.

Spondylolisthesis is documented in approximately 5% of white males, but is prevalent in native Eskimos (as high as 60% of the population is affected). There has been much discussion on the high percentage of affected Eskimos as to whether it is a genetic predisposition or related to environmental factors (i.e., papoose carriers). Knowing how dynamic and vital the biomechanics of the spine are, I believe that environmental factors are the cause. If the trend continues in the U.S. to carry infants in carriers (or place them in walkers, jumpers, etc.) that place their spines in a weight bearing position before the spine is developmentally ready to do so, I believe we will see an increase in the incidence of spondylolisthesis.

Spondylolisthesis has been referred to as congenital anomalies of the spine, but there is no supporting embryological evidence for this assumption.1 There are factors that predispose a person to this condition, such as weakness in the posterior structures of the vertebra, failure of muscles and ligaments to absorb forces, anomalies of the lubosacral spine, and activities that place high stress on the posterior structures of the spine. Little is known about spondylolisthesis. More research needs to be done specifically addressing the weight bearing position of some carriers. In the meantime, we can take preventative steps by choosing alternate carriers, both for ourselves and as gifts for others.

What I have found to be the ideal carrier is the sling. There are many variations of the sling, but one should look for the following in any type of carrier:
Before an infant can hold her head on her own, the carrier should support the neck. A sling cradles the infant just like your arms would, unlike vertical carriers which can actually allow a whiplash type injury.
The carrier should not place the infant's spine in a weight bearing position too early. (The young baby should be horizontal or inclined, with the spine supported along its length.)
When a baby wants to be more upright to see the world around him (usually around age 4 to 5 months), the carrier should allow him to sit cross-legged, so his weight is dissipated through his legs and hips, as opposed to the style that has the legs hanging down, where the young spine has to bear the entire weight.

When considering the purchase of a baby carrier, you can often just ask yourself if you would be comfortable in it. Would you feel like you were in a hammock (a sling), or in a parachute harness, with your legs hanging down? Laying in a hammock is better for all of us.

Other benefits of sling type carriers include easy accessibility to breastfeeding, ability to wear baby facing toward or away from wearer, ability to wear sling on back, front or side.

You may be wondering, "What about backpacks? Are they bad? At what age or stage of development is it okay to carry a child in a backpack? What should you look for when buying one?" Wait until your child can sit alone well before carrying him in a backpack. The seat of the backpack should support the child's entire bottom — not just between the legs, leaving the legs to dangle. One that has a foot rest is preferred.

The choice of infant carriers is a small thing when compared to all the other concerns that face parents, but it is a decision that can have lifelong effects. By choosing a sling type carrier for your baby, you may be preventing a lifetime of backaches and other spinal stresses.

Rochelle and Scott Casses own a chiropractic clinic in Carslisle, Pennsylvania, USA. Their 11-month-old son Palmer has accompanied them to work since he was born. Rochelle and Scott schedule their appointments so that while one of them is with a patient, the other handles reception duties and cares for Palmer. Rochelle says, "The patients really enjoy seeing Palmer, and he enjoys the interaction each day." A section of their office serves as a playroom for Palmer as he becomes more mobile. (1996)

Hensinger, R. N.; Spondylolysis and Spondylolisthesis in Children and Adolescents; Journal of Bone and Joint Surgery, August 1989 71A: 1098-1107
Shahriaae, H.; A Family with Spondylolisthesis; Journal of Bone and Joint Surgery, December 1979 61A: 1256-1258
Tower S. S. and Pratt W.; Spondylolysis and Associated Spondylolisthesis in Eskimo and Athabascan Populations; Clinical Orthopedics, January 1990
Wiltse, Leon; Fatigue Fracture: The Basic Lesion in Isthmic Spondylolisthesis; Journal of Bone and Joint Surgery, January 1975 57A: 17-22

This article was originally written for The Continuum Concept Letter (now defunct) and has been edited for this website.

Copyright ©1996 by The Liedloff Society for the Continuum Concept, All Rights Reserved.

Friday, August 24, 2007

Children's fear of new foods may be in their genes

NEW YORK (Reuters Health) - UK researchers have provided an explanation for why some children hate to try new foods -- it's in the genes.

In a large study of twins, which included both identical and fraternal twin pairs, Dr. Lucy J. Cooke of University College London and her colleagues found that nearly 80 percent of children's tendency to avoid unfamiliar foods was inherited.

"Parents can be reassured that their child's reluctance to try new foods is not simply the result of poor parental feeding practices, but it is partly in the genes," Cooke and her team write. And, they add, repeatedly offering foods to children can make the foods more familiar, and eventually even liked.

Both humans and other animals show a reluctance to try new foods, known scientifically as "food neophobia." This avoidance may have had an evolutionary advantage in preventing exposure to potentially toxic foods, the researchers note in the American Journal of Clinical Nutrition. "In the modern environment where foods are generally safe to eat, neophobia appears principally to have an adverse effect on food choices, particularly on intake of foods and vegetables," they say.

To investigate the role of inheritance and upbringing in food neophobia, Cooke and her team surveyed the parents of 5,390 twin pairs 8 to 11 years old. Studying twins allows researchers to separate out the effects of genes and environment -- identical twins share 100 percent of their genes; fraternal twins share only about half; while both types of twins have the same childhood home environment if they are raised together.

Identical twins were much more likely to share tendencies toward food neophobia than fraternal twins were, the researchers found, with inheritance accounting for 78 percent of these tendencies. Shared environment had no effect, with the remaining 22 percent influenced by non-shared environmental factors.

Past studies of other behavioral similarities among family members have also found they are strongly influenced by genes and "surprisingly little" by the shared environment, Cooke and her colleagues note.

But these findings do not mean that parenting is unimportant in these behaviors. It's more likely, they add, that parents treat children differently, possibly because they sense differences in their needs, or that more genetically different children experience the same situation differently.

And inheritance doesn't have to determine this behavior, the researchers add. Laboratory research has shown that the more frequently children are offered a particular food, the more likely they are to come to like it.

"New foods can become familiar, and disliked foods become liked, with repeated presentation, although the process might be more laborious with a highly neophobic child," they write. "Guidance in effective feeding techniques and modification of other influential environmental factors may help to minimize the negative effects of neophobia on children's diets."

SOURCE: American Journal of Clinical Nutrition, August 2007.

Wednesday, August 22, 2007

Hello from The Baby Loft

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