OBJECTIVE. Western parents are given conflicting advice about whether to introduce a “scheduled” approach to infant care or to follow their infants' demands. Attempts to address this issue using randomized, controlled trials have been unsuccessful. This comparative study collected evidence about methods of parenting and associated infant crying and sleeping in 2 communities with substantially different approaches to infant care (London, United Kingdom, and Copenhagen, Denmark) and in a “proximal care” group, where parents planned to hold their infants ≥80% of the time between 8 am and 8 pm, breastfeed frequently, and respond rapidly to infant cries.
METHODS. Validated behavior diaries were used to measure parental behavior and infant crying and night waking longitudinally at 8 to 14 days, 5 to 6 weeks, and 10 to 14 weeks of age. Feeding and sleeping practices were measured by questionnaire.
RESULTS. Proximal care parents held infants for 15 to 16 hours per 24 hours and coslept with them through the night more often than other groups. London parents had 50% less physical contact with their infants than proximal care parents, including less contact when the infants were crying and when awake and settled. London parents also abandoned breastfeeding earlier than other groups. Copenhagen parents fell in between the other groups in measures of contact and care. These differences in caregiving were associated with substantial differences in several aspects of infant crying and settled behavior at night. London infants cried 50% more overall than infants in both other groups at 2 and 5 weeks of age. However, bouts of unsoothable crying occurred in all 3 of the groups, and the groups did not differ in unsoothable bouts or in colicky crying at 5 weeks of age. Proximal care infants woke and cried at night most often at 12 weeks. Compared with proximal care infants, Copenhagen infants cried as little per 24 hours, but woke and cried at night less often at 12 weeks of age.
CONCLUSIONS. “Infant-demand” care and conventional Western care, as practiced by London parents, are associated with different benefits and costs. As used by proximal care and Copenhagen parents, infant demand parenting is associated with less overall crying per 24 hours. However, the proximal form of infant-demand parenting is associated with more frequent night waking and crying at 12 weeks of age. Copenhagen infants cry as little per 24 hours as proximal care infants but are settled at night like London infants at 12 weeks of age. Colicky crying bouts at 5 weeks of age are unaffected by care. The findings have implications for public health care policy. First, they add to evidence that bouts of unsoothable crying, which are common in early infancy, are not much affected by variations in parenting, providing reassurance that this aspect of infant crying is not parents' fault. Second, the findings provide information that professionals can give to parents to help them to make choices about infant care. Third, the findings support some experts' concerns that many English parents are adopting methods of care that lead to increased crying in their infants. There is a need for informed debate among professionals, policy makers, and parents about the social and cultural bases for the marked differences between London and Copenhagen parents' approach to care.
I read the report "Infant Crying and sleeping in London, Copenhagen and When Parents Adopt a 'Proximal' Form of Care" with great interest. However, I was dismayed to see that the data is presented in a misleading fashion and may lead to advocating parenting practices that are not in the best interest of children.
The author states "As used by proximal care and Copenhagen parents, infant demand parenting is associated with less overall crying per 24 hours. However, the proximal form of infant-demand parenting is associated with more frequent night waking and crying at 12 weeks of age. Copenhagen infants cry as little per 24 hours as proximal care infants but are settled at night like London infants at 12 weeks of age."
Dr. St.James-Robert's implies that the Copenhagen group's approach achieves the best of both worlds: less crying, and better nighttime sleeping. And, in an interview reported on NPR (<http://www.npr.org/templates/story/story.php?storyId=5452458>, Dr. St.James-Roberts advocates taking the Copenhagen approach, advising that at six weeks, parents should "Move over to something that is setting more limits and introducing more routines and that will then help babies learn to sleep through the night from about 12 weeks onward."
But if "Copenhagen infants cry as little per 24 hours as proximal care infants but are settled at night like London infants at 12 weeks of age", then they must be crying more during the day.
Dr. St.James-Roberts's results are not surprising, though his conclusions are. Infants whose parents are unresponsive at night will indeed adapt: by giving up on the environment that disappoints and retreating into sleep. However, neuroscientists know that the increased stress hormones generated during this experience of abandonment have a negative effect on the growing brain, with long-term costs in terms of both physical and mental health. In fact, parenting infants with the goal that they -- quote -- "sleep through the night" is contrary to the goal of raising children who are physically and emotionally healthy, and can reach their maximum potential for a fulfilling life. It is unfortunate that research continues on how to get infants to "sleep through the night" without consideration of damage that might be caused depending on the method employed.
It is unfortunate that in testing his hypothesis that "infants who received proximal care would be more likely to wake and cry at night at 12 weeks", Dr. St.James-Roberts's ignored neuroscientific discoveries about how a young child's brain develops in correlation to parental responsiveness.
Nina Lauderdale Mother to a 2 year-old daughter
Conflict of Interest:
None declared