Thursday, February 18, 2010

Medical News: Developmental Delay Linked to 'Flat Head' Syndrome - in Pediatrics, General Pediatrics from MedPage Today

from MedPage

"Babies with misshapen heads from lying on their backs too long may be at heightened risk for developmental delays, researchers said, although they stressed that infants should still sleep in the supine position"
The worry about SIDS (Sudden Infant Death) is understandable. Parents have been terrified about the possiblity of SIDs and it is heartbreaking when SIDS occurs. The Back to Sleep campaign has reduced the number of SIDs cases, but parents have become terrified to put their children in any other position than on their backs.
SIDS has been linked to low levels of a hormone called Serotonin and the enzyme that makes it in the baby's brainstem.  Brainstem circuits control breathing, blood pressure, and heart rate during sleep, Hannah C. Kinney, MD, of Children's Hospital Boston, and colleagues reported in the Feb. 3 issue of the Journal of the American Medical Association. A baby with an abnormality in control of these systems might not be able to respond to a life-threatening challenge like asphyxia by rousing from sleep or turning its head the researchers explained.
 These researchers suggest that the back to sleep campaign has saved those babies who would not have been able to move their heads or bodies in response to changing physiology. 

Now researchers are saying that flat heads from back lying are associated with neurodevelopmental delay. A fascinating and troubling finding. The authors are at pains to say that these babies may have developed plagiocephaly because they already had a problem and caution that parents should still ensure babies lie on their backs to sleep.

I wonder if we are not having a problem that is self perpetuating here.  Neurophysiologists like James Prescott (a hero of mine) tell us that the brainstem gets 'set' at birth by the environment the baby meets. If the baby gets skin to skin with his/her mother, the brain stem gets set for love, happiness and contentment - states associated with serotonin.  If babies are whizzed off to the resuscitaire, their brain stems are set for fear and distress. That state is associated with a lack of serotonin.

These days, with the back to sleep campaign, many children are not having any tummy time, they are not being carried and they are certainly not sleeping with their mother, all of which adds up to mean they are not having the stimulation from movement and touch that they get from being held, carried and laid in different positions. I suspect the brainstem issue could relate to how they are treated at birth and the neurodevelopmental delay that is associated with plagiocephaly could be due to lack of stimulation.

Babies need to be carried, they need to sleep with their mothers to get the stimulation necessary for optimal brain growth . One of my many heroes, Dr James McKenna at Notra Dame University has done many mother-infant sleep studies.

Go to  Dr McKenna's home page to find the latest research and information about the sleep studies.

Dr McKenna's sensible and baby/mother friendly suggestions for babies sleeping safely can be found at this link:    Babies Sleeping Safe



CO-SLEEPING RESEARCH

The psychophysiological effects of sleep-sharing are studied in sleep laboratories that mimic, as much as possible, the home bedroom. Over the past few years, over a million dollars of research money has been devoted to sleep-sharing research. These studies have all been done on mothers and infants ranging from two to five months in age. Here are findings based on mother-infant pairs studied in the sleep-sharing arrangement versus the solitary-sleeping arrangement (Elias 1986, McKenna 1993, Fleming 1994; Mosko 1994):

1. Mothers and babies who sleep together are more 'in sync' than those who do not: when either the mother or the baby moved, stirred, coughed or changed stages of sleep, the other would change in synchrony, without waking.

2. Both mother and baby generally spent more time in the same stage of sleep and for longer periods when they slept together.

3. Mothers sleep better even though their babies sleep deeply for shorter periods when they sleep together: thought to be a protective mechanism. Mothers tend to stir and babies follow if baby sleep is deep for any length of time.

4. Sleep-sharing infants arouse more and breastfeed more than babies who sleep separately; mothers to not report waking more frequently than those who slept separately.

5. Sleep-sharing infants tended to sleep more often on their backs or sides and less often on their tummies, a factor that could itself lower the SIDS risk.

6. Mothers and babies who sleep together, touch and interact a lot, even when sleeping: each affects the night time behaviour of the other.

Insightful mothers have always felt better sleeping with their babies. Babies suffer separation distress when they are apart from their mothers.

In my view, plagiocephally (flat back of head) is an iatrogenic problem. The neurodevelopmental delay associated with plagiocephaly results from the lack of stimulation caused by the 'lie your baby on its back dictum' is, also, in my view, iatrogenic.

Our culture is really weird. Anything that is good and wholesome, like birth at home with those you love, sleeping with your baby and attachment parenting is branded medically suspect. I guess the beneficiaries of the regular doctor visits, helmet makers and surgeons who correct misshapen heads have to make a living.

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