| 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.
Full article and response: pediatrics.aappublications.org/cgi/content/abstract/117/6/e1146 |
