OCN L evel 4 P ostn ata l M ate rn it y N urs e C are A w ard
Understand the benefits of implementing a good sleep routine.
Q1. These are the 6 preventative measures by the Department of Health to reduce
the risk of Sudden Infant Death Syndrome. Justify 4 preventative measures in
further detail using the table below
1. Back to Sleep
2. Feet to foot
3. Not too hot
5. No smoking
6. In the same room as parents for the first 6 months
1A – Protective measure "Back to sleep"
Why this reduces the risk of SIDS?
On the basis of new evidence and last statement published in 2000 by AAP on SIDS
it has been advised that back sleeping is very important and it lowers the risk of
SIDS and it is a preferred position. Prior to 2000 there has been a major decrease in
the incidence of sudden infant death syndrome SIDS.
In 1992, in response to epidemiologic reports from Europe and Australia, the AAP
recommended that infants be laid down for sleep in a non-prone position as a
strategy to reduce the risk of SIDS. (Kattwinkel 1992)
A study conducted in California ( Willinger M, et al 1997-2000) after the Back to
Sleep era (1997–2000) found that the SIDS risks associated with side and prone
position were similar in magnitude (adjusted odds ratios ORs: 2.0 and 2.6,
respectively). Further examination found that the risk of SIDS was exceptionally high
for infants who were placed on the side and found on the stomach (adjusted OR:
8.7). Previous studies have found that side sleep position is unstable. The probability
of an infant rolling to the prone position from the side sleep position is significantly
greater than rolling prone from the back. ?(Bacon C, et al. 1996, J Pediatr.1996, Wu
KT, et al.1998)
Research on Back Sleeping and SIDS
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The single most effective action that parents and caregivers can take to lower a
baby’s risk of SIDS is to place the baby to sleep on his or her back for naps and at
Compared with back sleeping, stomach sleeping carries between 1.7 and 12.9 times
the risk of SIDS. (American Academy of Pediatrics, 2000).
The mechanisms by which stomach sleeping might lead to SIDS are not entirely
known. Studies suggest that stomach sleeping may increase SIDS risk through a
variety of mechanisms, including:
? Increasing the probability that the baby re-breathes his or her own exhaled
breath, leading to carbon dioxide buildup and low oxygen levels
? Causing upper airway obstruction
? Interfering with body heat dissipation, leading to overheating. Carroll, J. L., ;
Siska, E. S. (1998).
As studies suggest that stomach sleeping may increase sids risk through a variety of
mechanisms, including increasing the probability that the baby re-breathes his or her
own exhaled breath, leading to carbon dioxide build up and low oxygen levels.
Therefore, from the research and studies carried out, it is evident that "back sleep"
protective measure reduces the risk of SIDS.
Babies automatically swallow or cough up fluid if they throw up while on their backs.
This reflex operates to make sure the airway is always open.
There is evidence that healthy babies placed on their backs are more likely to have
serious or fatal choking episodes than those placed on their stomachs. (Davis,
1998). (Pin, 2007).
Furthermore, in countries (including the united states that have seen a major change
in infant sleep position – from mainly stomach to mostly back sleeping – the incidence
of serious or fatal choking has not increased. (Salls, 2002).
Recent research has shown that preterm infants are at higher risk for sids; therefore
placing preterm infants on their backs for sleep is critically important. (Bhat, 2006)
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Some preterm babies who have active respiratory disease may have improved
oxygenation if they are placed on their stomachs.
Thus, the stomach sleep positions during acute respiratory disease may be
appropriate for infants in a high monitored inpatient setting. However,
epidemiological studies have shown that, when placed on their stomachs to sleep at
home, low birth weight or preterm babies may be at higher risk for sids than babies
born full term.
Because preterm babies often remain in the hospital for several days to weeks
before discharge, the AAP Task Force recommends that these infants be placed on
their backs to sleep as soon as possible after the respiratory condition has stabilised.
(Bhat, 2006). This practice will allow the parents to become familiar with the position
they should use at home.
From the research I have carried out above, it is evident that The American
Academy of Pediatrics recommends that healthy infants be placed on their backs for
sleep, as this is the safest position for an infant to sleep. It is also evident that putting
your baby to sleep on his back decreases his chance of sudden infant death
syndrome (SIDS). It is also suggested from other findings too that the protective
measure "Back to sleep” is followed accordingly ?.
Protective measure "Not too hot"
Research on back sleeping and sids has also shown studies suggest that stomach
sleeping may increase sids risks through a variety of mechanism one to include;
"interfering with body heat dissipation, leading to overheating. ?Carroll, J. L., & Siska,
E. S. (1998).
Overheating during sleep
Babies should be kept warm during sleep, but not too warm. Studies show that an
overheated baby is more likely to go into a deep sleep from which it is difficult to
arouse. ?Fle m in g, ( 1 990). ?Gilb ert ( 1 992). P o nso nby ( 1 992). P o nso nby, ( 1 993). ?Willia m s,. ( 1 99 6).
Some evidence indicates that increased SIDS risk is associated with excessive
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clothing or blankets and a higher temperature in the room.
SIDS risk is higher for infants who sleep on a soft surface or with their heads
covered than for infants who sleep on a firm surface or without their heads covered.
It is not known whether the risk associated with head covering is related to
overheating, lack of oxygen, or re-breathing exhaled air. We do know that it is a
particular concern, it can be quite dangerous for some infants, and it may contribute
to SIDS. ?( ? B la ir ,. ( 2 008).
Increased SIDS risk also has been associated with the season of the year. In the
past, SIDS deaths have been more common during cold weather—possibly because
infants are more likely to be overdressed or placed under heavier blankets, which
may cause them to overheat—but statistics indicate that this association seems to
be waning. (M allo y, 2004). ?Studies also have found that overheating may increase the risk of
SIDS for a baby who has a cold or infection.
Parents and caregivers should not overdress babies and should keep the thermostat
at a comfortable temperature. In general, if the room temperature is comfortable for
an adult, then it is appropriate for a baby. ? A m eric a n A ca d em y o f P ed ia tr ic s, ( 2 00 0).
Therefore, it is very important that the protective measure "Not to hot" is followed
accordingly to avoid SIDS. Use a room thermometer to check the temperature, and
make sure the right amount of bedding is used as well as clothing. There are
well-known concerns that overheating increases the risk of Sudden Infant Death
Syndrome (SIDS). Back-sleeping increases a baby's access to fresh air and makes
her less likely to get overheated.
SIDS is real, it’s serious, and the precautions are real as well.
Protective measure "No smoking”
Smoking during and after pregnancy and the infant/baby exposed to passive
smoking can cause detrimental health issues to the infant such as;
An underlying defeat or brain abnormality higher nicotine concentration in their lungs
affecting the critical development. Research currently use the Triple-Risk model as a
contextual construct for understanding SIDS death the triple-risk model describes the
convergence of three conditions that may lead to the death of an infant from SIDS ?.
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(J. J. Filiano ; H. C. Kinney, 1994)
According to the triple risk model, all three elements must be present for a sudden
infant death to occur
1. The baby’s vulnerability is undetected.
2. The infant is in a critical developmental period that can temporarily destabilize
his or her systems.
3. The infant is exposed to one or more outside stressors that he or she cannot
overcome because of the first two factors.
If caregivers can remove one or more outside stressors, such as placing an infant to
sleep on his or her back instead of on the stomach to sleep they can reduce the risk
of SIDS. (Filiano, J. J., & Kinney, H. C. 1994).
A triple-risk model (how a combination of 3 contributing risk factors) for SIDS was
published in an issue of Pediatrics, ( ?et al. Pedia tr ic s, 2012) ?and defined vulnerable
infants as the following:
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Further research has shown infants born to mothers who smoked during pregnancy
are three times more likely to die of sids than those born to mothers who did not
smoke during pregnancy.
Exposure to passive smoking (sometimes called second-hand smoke) in the
household also doubles a baby's risk of sids. (Ariagno, R. 1994), (Schoendorf, K. C.,
& Kiely, J. L. 1992)
It has also been confirmed in Research that "exactly how smoking during pregnancy
affects the infant is not clear but smoking might negatively affect development of the
Studies of the mechanism underlying the association between smoking and sids
have found that during the last half of pregnancy, changes occur in nicotine binding
sites on the baby's brain stem specifically in areas involved with arousal, heart and
breathing functions, sleep and body movement control. ( Ariagno, R. 1994).
Infants who died from sids have a higher nicotine concentration in their lungs
compared with infants who did not die from sids. (Hackman, R. 2002).
This finding supports the statement that tobacco smoke exposure in the postnatal
environment is important in sids risk. (McMartin, K. I., et al. 2002). (Anderson, H. R.,
& Cook, D. G. 1999). However, the mechanism for the association between
second-hand smoke and sids is unknown.
Research shows infants whose mothers did not smoke during or after pregnancy and
infants not exposed to passive smoking are at a reduced risk of sids. As smoking
during pregnancy can cause a lot of health issues for the infant that can lead to
It is evident that the two major risk factors that are found with sudden infant death
syndrome are smoking during pregnancy and smoking after the baby is born.
Carbon monoxide, which is released whenever a cigarette is smoked, is considered
to be the biggest factor in SIDS (cases of cot death). There is a large and convincing
body of evidence showing that smoking during pregnancy and around a baby
increases the risk of cot death. Effects that smoking has on a developing foetus,
such as impairing lung development, affecting the brain, and its impact on other
important physiological processes.
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In the same room as the parents for the first 6 months.
The desire to optimize infant sleep duration and consolidation, however, must be
balanced with safe infant sleep, a fact reinforced by the 3500 infants who tragically
die of sudden infant death syndrome (SIDS) or other sleep-related deaths annually.
(Pediatrics. 1995). ?According to the Eunice Kennedy Shriver National Institute of
Child Health and Human Development’s “Safe to Sleep” campaign, most SIDS
deaths occur when infants are 1 to 4 months old, 90% occurring before the age of 6
months. ( ?Clin Pediatr (Phila. 1995). ?Despite these figures, the recently published
AAP Policy Statement, SIDS and Other Sleep-Related Infant Deaths, recommended
that infants sleep in their parents’ room on a separate surface, ideally for the entire
first year but at least for the first 6 months. ( ?Pediatrics. 2016)
Sleeping together permits parents to closely monitor their babies throughout the
night for example a parent may be more likely to notice if her baby has adopted a
dangerous sleep position or has become ill.
Therefore, the parents can attend to the babies needs straight away than if the baby
was to sleep in a separate room to the parents, and baby adopted a dangerous
sleep position which can lead to SIDS. Infants who are younger than 4 months are
particularly at risk, because they may assume positions that can create a risk of
suffocation or airway obstruction or may not be able to move out of a potentially
It is recommended that infants sleep in the parents’ room, close to the parents’ bed,
but on a separate surface designed for infants, ideally for the first year of life, but at
least for the first 6 months.
It is very important to know the difference and understanding between room sharing
is a safer option but bed sharing is not and is a risky procedure which can lead to
On the contrary, evidence is growing that bed sharing increases the risk for sids and
can also lead to suffocation, entrapment or injury (American Academy of Pediatrics,
2011). In some situations, bed sharing can compound the risk posed by other
factors for example the risk for sids is even higher than either risk factor alone when
bed sharing occurs with;
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? A mother who smokes has recently consumed alcohol, or is fatigued.
? The infant is covered by a blanket or quilt
? There are multiple bed sharers. Hauck, F. R., et al. (2003). Scheers, N. J.,
Rutherford, G. W., & Kemp, J. S. (2003). Carpenter, R. G., et al. (2004).
Q2 Explain the need to start a good sleeping routine with a newborn
a) What are the reasons for implementing a good sleep routine with a
newborn for both the parent and baby?
The reasons for implementing a good sleep routine with a newborn is essential to
good health "sleep is critical to health" and the same applies to the reason for
implementing a good sleep routine for the parent too. During the deep states of
NREM sleep, blood supply to the muscles is increased energy is restored, tissue
growth and repair occur, and important hormones are released for growth and
development rapid eye movement (REM) or "acute" sleep, during REM sleep, our
brains are active and dreaming occurs.
? baby/parents will be more relaxed
? develop normal human circadian rhythms
Parent: sleep routine reasons;
? not feeling depressed
? not feeling sleep deprived
? think more clearly, sufficient sleep helps to complete tasks better and and
enjoy life more fully
Baby: sleep routine reasons;
? creates a bond
? helps a baby to develop a circadian rhythm
? feel relaxed and well rested
It takes three months for the infant brain to develop the ability to provide melatonin in
levels needed to sleep.
Babies need sleep to support healthy development. Parents need sleep to maintain
sanity. Sleep is a universal human need.
Another important factor relating to importance of sleep has been defined by by
National Institute of Mental Health as the following;
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The national institute of mental health (NIMH), in its workshop on arousal and
modulatory systems, defined sleep and wakefulness in this way: "sleep and
wakefulness are endogenous, recurring, behavioural states that reflect coordinated
changes in the dynamic functional organisation of the brain and that optimise
physiology, behaviour and health homeostatic and circadian processes regulate the
propensity for wakefulness and sleep” (National Institute of Mental Health, 2013)
I have gone into deeper research of sleep importance and the benefits of sleep to
human development which touches upon the critical aspects/reasons of
implementing a good sleep routine for both newborn and the parent.
Learning. ?Sleep has been shown to be important for maturation of infants’ brains
and consolidation of their memories. ( ?In fa n t Child Dev. 20(1 ): p. 35-4 6 . 2011 ?) Several
studies have shown that babies with more efficient nighttime sleep (greater
percentage of time spent asleep during the night) had higher cognitive scores. ( ?Early
(H um D ev. 8 1(3 ): p . 2 89-9 2. 2 005 ?)
Here’s one striking example of sleep affecting learning: Dr. Rebecca Gómez and
colleagues at the University of Arizona played a 15-minute recording of a fake
language to 15-month-old infants. Four hours later, the infants were tested for their
memory of the new language. Those that napped after hearing the recording had
better abstract memories of the language, which gave them more flexibility in
learning, compared to those that didn’t nap after hearing the language. ?Psy ch o l Sci.
17(8 ): p. 670-4 . 2006. Twenty-four hours later, the nappers still remembered the
grammatical structure of the language, while the napless babies had no memory of
the language at all. ( ?Dev S ci. 1 2(6 ): p . 1 0 07 -1 2. 2 009 ?)
Mood. ?Babies that sleep more at night have been found to have an “easier”
temperament, being more approachable, less distractible, and more adaptable.
( ?Early Hum Dev. 84(5 ): p. 289-9 6 . 2008. ?) In a study of well-rested vs. fatigued infants (i.e.
missed nap), the fatigued infants were more easily frustrated and more distressed by
a brief separation from their mothers. ( ?In fa n t Men ta l Healt h Jo urn al. 20 (4 ): p. 410-4 28 . 19 99 ?)
In multiple studies of interventions that improved infants’ sleep, parents noted that
their babies were more secure, predictable, less irritable, and less fussy. ( ?Sle ep .
29(1 0): p . 1 263-7 6. 2 006 ?)
Growth. ?Several studies have shown that babies that get less sleep gain more fat as
infants ( ?J Sle ep Res. 19(1 Pt 1): p. 103-1 0 . 2010) . and are at higher risk of being overweight
at 3 years of age. ( ?Arc h P ed ia tr A do le sc M ed . 1 62 (4 ): p . 3 05-1 1 . 2 00 8 ?)
Why do parents need sleep?
When infants don’t sleep, their mothers don’t either. And mothers of infants with
sleep problems are at higher risk of ?postpartum depression ?. Approximately ?10-15%
of U.S. mothers report being depressed during the first year of their baby’s life (and
how many more go undiagnosed?). The association between infant sleep problems
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and maternal depression has been shown in study after study ( ?Ped ia tr ic s. 117(3 ): p.
836-4 2. 2 006) ? ( ?Ped ia tr ic s. 1 1 9(5 ): p . 9 47-5 5. 2 00 7) ? ( ?J P ae d ia tr C hild H ealt h . 4 3(1 -2 ): p . 6 6-7 3 . 2 0 07 ?)
Studies that have specifically tested sleep interventions have found that when baby’s
sleep improved, so did mom’s symptoms of depression. ( ?Arc h Dis Chil d . 92 (1 1): p. 95 2-8 .
2007 ?) ( ?BM J. 3 24(7 345): p . 1 062-5 . 2 0 02 )
b) How might you support a parent to implement this routine?
Remind mum and advice if appropriate to aim to begin baby to sleep at night,
encouraging clear habits from the start will help as well as making sure it is a series
of relaxing steps.
? adopt the same strategy every night at around the same time every night
? not putting baby to sleep too late
? not over stimulate the baby before bedtime
? rattling toys, sounds and lights can be a distraction as watching them may
keep him awake rather than teach him that it's night-time
? turning down the lights at bedtime including television will encourage
newborns to begin sensing night as a time to sleep
? lullabies and gently nursing rhymes will calm him and help him to understand
that it's time to sleep
? Relax before bed – try a warm bath, reading, or another relaxing routine.
Remind mum to go easy on herself, try putting feet up and take some deep
breaths to recharge batteries
? Avoid caffeine and nicotine late in the day and alcoholic drinks before bed
? Don’t lie in bed awake. If you can’t get to sleep, do something else, like
reading or listening to music, until you feel tired
? See a doctor if you have a problem sleeping or if you feel unusually tired
during the day. Most sleep disorders can be treated effectively
Q3 – Exp la in th e re le va n ce of in fa n t bra in deve lo pm en t to sle ep
tr a in in g t h eo ry
It is very important that the most appropriate sleep training technique is carried out in
order to avoid the infant being affected emotionally and psychologically causing
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hindrance to brain development.
For example if you leave a baby to cry, yes, eventually the baby may stop, but not
necessarily because they’ve settled happily to sleep. They might have given up and
'neurologically withdrawn’ because no one has come to them. This is not good for
their brain development.
Thus, the process of growing of the brain, linking one neuron with another, crucially
depends on social and emotional experiences concerning the baby’s attachment to
their primary carer.
The evidence based research I have carried out is outlined below which supports my
analysis and understanding of the relevance of infant brain development to sleep
The early years of human development establish the basic architecture and function
of the brain. ?McC ain 2007. This early period of development, (conception to ages 6-8),
affects the next stage of human development, as well as the later stages. We now
better understand, through developmental neurobiology, how experience in early life
affects these different stages of development.( ?McC ain 2007). ?Poor early development
affects health (physical and mental), behaviour and learning in later life.
The architecture and function of the brain is sculpted by a lifetime of experiences
which affect the architecture and function of neurobiological pathways. ( ?McC ain 20 07)
(G ilb ert 2 009)
Stimuli transmitted to the brain through sensing pathways pre- and post-natally, as
well as in later stages of life, differentiate the function of neurons and neural
What does 'crying it out' actually do to the baby and to the dyad?
Neuronal interconnections are damaged. When the baby is greatly distressed,it
creates conditions for damage to synapses, the network construction which is
ongoing in the infant brain. The hormone cortisol is released. In excess, it's a neuron
killer but its consequences many not be apparent immediately (Thomas et al. 2007).
A full-term baby (40-42 weeks), with only 25% of its brain developed, is undergoing
rapid brain growth. The brain grows on average three times as large by the end of
the first year (and head size growth in the first year is a sign of ?intelligence ?, e.g.,
Gale et al., 2006).
Self-regulation is undermined. The baby is absolutely dependent on caregivers for
learning how to self-regulate. Responsive care—meeting the baby's needs before he
gets distressed—tunes the body and brain up for calmness. When a baby gets
scared and a parent holds and comforts him, the baby builds expectations for
soothing, which get integrated into the ability to self comfort. Babies don't
self-comfort in isolation. If they are left to cry alone, they learn to shut down in face of
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extensive distress–stop growing, stop feeling, stop trusting (Henry & Wang, 1998).
Q3 – a , E xp la in h ow b abie s a re b o rn w it h a ll th e n euro n s th ey n eed
My understanding and analysis of how babies are born with all the neurons they
need first and foremost the brain starts forming before birth, which is built upon a
strong foundation. Brain development is very important during the first three years of
life. Brain cells are “raw” materials consisting of special cells known as neurons.
Heredity (nature) determines the basic number of “neurons” (brain nerve cells)
children are born with, and their initial arrangement.
At birth, a baby’s brain contains 100 billion neurons. The brain starts forming
prenatally, about three weeks after conception. Before birth, the brain produces
trillions more neurons and “synapses” (connections between the brain cells) than it
needs. During the first years of life, the brain undergoes a series of extraordinary
In the brain, the neurons are there at birth, as well as some synapses. As the
neurons mature, more and more synapses are made. At birth, the number of
synapses per neuron is 2,500, but by age two or three, it’s about 15,000 per neuron.
The brain eliminates connections that are seldom or never used, which is a normal
part of brain development.
My understanding of neurons is supported by the evidence based research I have
Between conception and age three, a child’s brain undergoes an impressive amount
of change. At birth, it already has about all of the neurons it will ever have. It doubles
in size in the first year, and by age three it has reached 80 percent of its adult
volume. (Prasatwa MW, et al. 2007) (Nowakowski RS. 2006) (Rakic, P. 2006)
About seven weeks after conception the first neurons and synapses begin to develop
in the spinal cord. These early neural connections allow the fetus to make its first
movements, which can be detected by ultrasound and MRI even though in most
cases the mother cannot feel them. These movements, in turn, provide the brain with
sensory input that spurs on its development. More coordinated movements develop
over the next several weeks. Merce LT, et al. 2005
Q3 – B, Exp la in th e pro cess of syn ap se fo rm atio n an d th e co rre ct
co ndit io ns r e q uir e d i .e . t h e a b sen ce o f t h e s tr e ss h orm one
In the first three years, a child’s brain has up to twice as many synapses as it will
have in adulthood.
Now that we’re a little more familiar with the fundamentals of the brain, let’s take a
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look at brain development in children. Between conception and age three, a child’s
brain undergoes an impressive amount of change. At birth, it already has about all of
the neurons it will ever have. It doubles in size in the first year, and by age three it
has reached 80 percent of its adult volume. (Prasatwa MW, et al. 2007)
(Nowakowski RS. 2006) (Rakic, P 2006)
Even more importantly, synapses are formed at a faster rate during these years than
at any other time. In fact, the brain creates many more of them than it needs: at age
two or three, the brain has up to twice as many synapses as it will have in adulthood
(Figure 3). These surplus connections are gradually eliminated throughout childhood
and adolescence, a process sometimes referred to as blooming and pruning.
(Huttenlocher P. 2002)
The excess of synapses produced by a child’s brain in the first three years makes
the brain especially responsive to external input. During this period, the brain can
“capture” experience more efficiently than it will be able to later, when the pruning of
synapses is underway. (Huttenlocher P. 2002) the brain’s ability to shape itself –
called plasticity – lets humans adapt more readily and more quickly than we could if
genes alone determined our wiring. (Fregni F, et al. 2005) The process of blooming
and pruning, far from being wasteful, is actually an efficient way for the brain to
achieve optimal development.
The limbic system, located in the inner brain beneath the cortex, is a collection of
small structures involved in more instinctive behaviors like emotional reactions,
stress responses, and reward-seeking behaviors. The hippocampus is involved in
memory formation and spatial learning. The hypothalamus is the control center for
one of the body’s key stress systems, regulating the release of cortisol and other
stress hormones. The amygdala evaluates threats and triggers the body’s stress
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response.(Carter R, 2009) (Morgane PJ,. 2005) (Anderson GM, et al.2006)
Q3-C , Exp la in how ap pro ach es su ch as "c ry in g it out" would have
an a d vers e e ffe ct o n a c h il d b ased o n y o ur k n ow le d ge?
Based on my knowledge the approach “crying it out” can have an adverse effect on a
child emotionally and psychologically as well as affecting the brain development.
When a baby/infant is left to cry and the parent is not in the same room the baby can
go into a frozen mode in another words the baby is in distress and does not call out
for their parents. Babies don't self-comfort in isolation. If they are left to cry alone,
they learn to shut down in face of extensive distress–stop growing, stop feeling, stop
trusting. A baby’s brain is not developed enough to know when the parent will attend
to the baby’s need. Therefore, this too can cause great distress to the baby.
The other concern is what if the baby has vomited, or slipped down under the
blankets and that can result to a SIDS.
Prolonged distress in early life, lack of responsive parenting, can result in a poorly
functioning vagus nerve, which is related to various disorders as irritable bowel
Moreover, neuronal interconnections are damaged. When the baby is greatly
distressed,it creates conditions for damage to synapses, the network construction
which is ongoing in the infant brain.
Crying it out is "harmful" where one could expect negative mid-to-long-term effects
such as trauma, separation anxiety, lack/loss of trust in parents and others.
What happens in the first few years of life is vital for the development of a baby’s
brain. Therefore it is very important to be nurturing towards your child in their early
Parental nurturing increases hippocampal volume (and also that of the amygdala).
The hippocampus and amygdala are parts of the brain responsible for behavioural
regulation and emotional processing. Therefore it is obvious that the best way to
ensure a child grows to have good emotional self regulation (or self soothing/self
settling skills) is by responding to them as much as they need when they are young.
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