BABIES WHO WANT TO WALK; AND BEDWETTING

NEW YORK TIMES COLUMN: FAMILIES TODAY:
BABIES WHO WANT TO WALK; AND BEDWETTING
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Are there any studies about babies who develop learning disabilities if they never crawl? Or, is this an old wives’ tale? A friend’s baby is almost 11 months old and he will not crawl. He is trying to walk but will not crawl.

A. I am not aware of any studies on the long-term development of children who don’t learn to crawl before walking, but I have known many children who skipped crawling entirely, went straight on to walking and never developed any learning disabilities that anyone was ever aware of.

I don’t think it helps parents to scare them about unknown or improbable risks that they can’t do anything about. On the other hand, if there is already other evidence that this 11-month-old is not developing on target in any way (leaving out crawling on the way to walking as an isolated finding is not evidence), then early identification and intervention can make an enormous difference in optimizing the child’s ultimate progress.

If your friend is worried, she should start with her pediatrician, who should be able to provide an initial developmental assessment. See our newly revised “Touchpoints Birth to 3: Your Child’s Emotional and Behavioral Development” (Da Capo 2006) for information on the range of behaviors a healthily developing 11-month-old can be expected to display: They are so much fun!

Q. I have a daughter who outgrew bedwetting years ago. This year she started sixth grade and has now resumed wetting the bed every night.

My daughter and I agree that the bedwetting must be due to stress. But she is doing well in school, with good grades and new friends. There are no big negative stress factors — just the newness of sixth grade.

What can I do to help her stop this problem?

A. Bedwetting in a child who has been dry for six months or more is altogether different from bedwetting that has never ceased. When a child this age who has been dry for years starts bedwetting, it is concerning. I would look for possible causes for this sudden change, for example, a urinary tract infection, or diabetes and other less common medical or neurological causes. Check on it with her pediatrician.

In this situation, stress can only be settled upon as a cause after medical ones have been ruled out. After you have determined that there is no medical reason for her bedwetting, then you and she can face together any new stress that she may feel about entering sixth grade.

Sixth grade can be a time of great change and great anticipation. If they didn’t start in fourth or fifth grade, boys and girls are likely to start showing new nervousness and excitement about each other now. Some girls have already had their first period and the others ought to know their time is coming.

Sixth or seventh grade may be the start of middle school– what a terrible time to lump together so many children undergoing such drastic upheaval, without the pressure to act grown up from older students (9 -12 high schools), or the opportunities to feel grown up provided by younger ones (K-8 elementary schools)! No longer nurtured by a single teacher, students may already be moving from class to class, teacher to teacher, and feeling much more like they must fend for themselves.

For many children this age, it seems like time to say goodbye to childhood, and to prepare for the unknown. As much as they may act as if they were eager to forge ahead, many sixth graders struggle with mixed feelings about the end of this somewhat more carefree period of their lives.

I am impressed that your daughter is so open and eager to work on her problem with you Rather than feeling so ashamed that she wants to hide it. Her close relationship with you is the single most important protective factor against whatever you and she may fear about the adolescent years ahead!

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

THE ANCIENT PRACTICE OF SWADDLING

NEW YORK TIMES COLUMN:  FAMILIES TODAY:
THE ANCIENT PRACTICE OF SWADDLING
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Are there any negative side effects to swaddling with the baby’s arms down along the sides of the body?

A. Swaddling – snugly wrapping your baby in a blanket – is an age-old, nearly universal strategy for comforting young infants. It seems to have fallen out of favor a few hundred years ago in many cultures, but not in the Middle East, and not among many Native American tribes.

Many Native American peoples have long used cradle boards – a flat board to which cloth or animal skin was attached – to keep their babies snug, warm, easily carried and out of harm’s way.

Many cradle boards have “bumpers” at the top ingeniously extending beyond the baby’s head so that it is fully protected. In some tribes they were positioned at a gentle angle for feeding or upright so that the babies in them could watch other family members at work and begin to learn about their world.

In fact, we would expect that these babies would be able to muster up more energy for visual learning since the cradle boards kept their little bodies at ease and under control.

Recently, swaddling seems to have been making a comeback, in the United States, the United Kingdom and other European countries. This may be because now that we understand the advantages of positioning babies on their backs for sleep to decrease the risk of Sudden Infant Death Syndrome, we need a way to help babies fall asleep and stay asleep in that less comfortable position.

Swaddling has many obvious benefits, helping to keep babies warm, calm and comfortable. Swaddled babies will rouse less and sleep longer. At the beginning of life, the snugly fastened wraps recreate the womb’s supportive fit, cutting down on a newborn’s startles and jerks – motor reflexes that otherwise make the baby feel uncomfortable and often start to cry.

Modern science has established numerous other benefits of swaddling, and special circumstances in which it is particularly helpful. One study has even shown that premature infants may have improved neuromuscular development when regularly swaddled.

But you ask about negative effects. A recent study showed that Hopi infants raised in cradle boards did not start walking any later than those raised without them. There are, though, studies that link swaddling to early hip problems (hip dysplasia and dislocation), but the risk may be the result of the specific position of the legs under the swaddles. These studies suggest that it is important to avoid fully extending the legs, or rotating hips outward when swaddling a baby. Swaddling babies so that their hips and knees are bent and with enough slack to allow movement appears to be safer for their hips.

In warm climates or over-heated buildings, care must be taken not to let an infant’s body temperature rise dangerously high when tightly wrapped. There are a few studies that have found that babies swaddled from head to toe all day long for several months may be more likely to be deficient in Vitamin D, presumably because swaddling cuts down on their exposure to sunlight, which is needed to activate Vitamin D.

Other studies suggest that very tight swaddling may slightly increase a baby’s vulnerability to respiratory infections, perhaps because it limits the normal expansion of chest and lungs. These studies seem to suggest avoiding prolonged swaddling, swaddling from head to toe, and overly tight swaddling. This shouldn’t interfere with the containment and comfort that swaddling still can offer, and many pediatricians feel that swaddling a baby for 12 to 20 hours a day in the first weeks is perfectly fine, and that it can be gradually decreased after a month or two depending on a baby’s comfort without it.

As for swaddling the arms alongside the body, we have not found any studies to suggest that this is a problem. However, it is important to leave the arms free often enough that babies can discover their fingers and thumbs, so that they can learn to use them to comfort themselves by fondling the soft edges of their blankets, their own soft cheeks, or by sucking on them.

Swaddled or not, it is critical to position babies on their backs when asleep, or likely to fall asleep so that they are at less risk for SIDS. It is also critical that when awake all babies are given plenty of time to play while on their tummies so that they can strengthen their arm, shoulder and back muscles. This has become a major concern for babies who spend much of their awake time in car seat-like baby carriers. We did once encounter an 8-month-old with delayed motor milestones, not yet sitting on his own. He had been a fussy baby, and his mother had religiously adhered to an intensive regimen of swaddling that some pediatricians recommend for such babies. Swaddling does seem to reduce crying and can even soothe pain. We had no way of knowing whether he’d had too much swaddling for his own good, but we’ll always wonder.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.