Title:
Our babies, ourselves. By: Small, Meredith F., Natural History, 00280712,
Oct97, Vol. 106, Issue 8
Database: Academic Search Premier
OUR BABIES, OURSELVES
During one of his many trips to Gusiiland in southwestern Kenya, anthropologist Robert
LeVine tried an experiment: he showed a group of Gusii mothers a videotape of middleclass American women tending their babies. The Gusii mothers were appalled. Why does
that mother ignore the cries of her unhappy baby during a simple diaper change? And
how come that grandmother does nothing to soothe the screaming baby in her lap? These
American women, the Gusii concluded, are clearly incompetent mothers. In response, the
same charge might be leveled at the Gusii by American mothers. What mother hands
over her tiny infant to a six-year-old sister and expects the older child to provide adequate
care? And why don't those Gusii women spend more time talking to their babies, so that
they will grow up smart? Both culture--the traditional way of doing things in a particular
society--and individual experience guide parents in their tasks. When a father chooses to
pick up his newborn and not let it cry, when a mother decides to bottle-feed on a schedule
rather than breast- feed on demand, when a couple bring the newborn into their bed at
night, they are prompted by what they believe to be the best methods of caregiving.
For decades, anthropologists have been recording how children are raised in different
societies. At first, the major goals were to describe parental roles and understand how
child-rearing practices and rituals helped to generate adult personality. In the 1950s, for
example, John and Beatrice Whiting, and their colleagues at Harvard, Yale, and Cornell
Universities, launched a major comparative study of childhood, looking at six varied
communities in different regions: Okinawa, the Philippines, northern India, Kenya,
Mexico, and New England. They showed that communal expectations play a major role
in setting parenting styles, which in turn play a part in shaping children to become
accepted adults.
More recent work by anthropologists and child-development researchers has shown that
parents readily accept their society's prevailing ideology on how babies should be treated,
usually because it makes sense in their environmental or social circumstances. In the
United States, for example, where individualism is valued, parents do not hold babies as
much as in other cultures, and they place them in rooms of their own to sleep.
Pediatricians and parents alike often say this fosters independence and self-reliance.
Japanese parents, in contrast, believe that individuals should be well integrated into
society, and so they "indulge" their babies: Japanese infants are held more often, not left
to cry, and sleep with their parents. Efe parents in Congo believe even more in a
communal life, and their infants are regularly nursed, held, and comforted by any number
of group members, not just parents. Whether such practices help form the anticipated
adult personality traits remains to be shown, however.
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Recently, a group of anthropologists, child-development experts, and pediatricians have
taken the cross-cultural approach in a new direction by investigating how differing
parenting styles affect infant health and growth. Instead of emphasizing the development
of adult personality, these researchers, who call themselves ethnopediatricians, focus on
the child as an organism. Ethnopediatricians see the human infant as a product of
evolution, geared to enter a particular environment of care. What an infant actually gets is
a compromise, as parents are pulled by their offspring's needs and pushed by social and
personal expectations.
Compared with offspring of many other mammals, primate infants are dependent and
vulnerable. Baby monkeys and apes stay close to the mother's body, clinging to her
stomach or riding on her back, and nursing at will. They are protected in this way for
many months, until they develop enough motor and cognitive skills to move about.
Human infants are at the extreme: virtually helpless as newborns, they need twelve
months just to learn to walk and years of social learning before they can function on their
own.
Dependence during infancy is the price we pay for being hominids, members of the group
of upright-walking primates that includes humans and their extinct relatives. Four million
years ago, when our ancestors became bipedal, the hominid pelvis underwent a necessary
renovation. At first, this new pelvic architecture presented no problem during birth
because the early hominids, known as australopithecines, still had rather small brains,
one-third the present size. But starting about 1.5 million years ago, human brain size
ballooned. Hominid babies now had to twist and bend to pass through the birth canal, and
more important, birth had to be triggered before the skull grew too big.
As a result, the human infant is born neurologically unfinished and unable to coordinate
muscle movement. Natural selection has compensated for this by favoring a close adultinfant tie that lasts years and goes beyond meeting the needs of food and shelter. In a
sense, the human baby is not isolated but is part of a physiologically and emotionally
entwined dyad of infant and caregiver. The adult might be male or female, a birth or
adoptive parent, as long as at least one person is attuned to the infant's needs.
The signs of this interrelationship are many. Through conditioning, a mother's breast milk
often begins to flow at the sound of her own infant's cries, even before the nipple is
stimulated. New mothers also easily recognize the cries (and smells) of their infants over
those of other babies. For their part, newborns recognize their own mother's voice and
prefer it over others. One experiment showed that a baby's heart rate quickly
synchronizes with Mom's or Dad's, but not with that of a friendly stranger. Babies are
also predisposed to be socially engaged with caregivers. From birth, infants move their
bodies in synchrony with adult speech; they are hard-wired to absorb the cadence of
speech and the general nature of language. Babies quickly recognize the arrangement of a
human face--two eyes, a nose, and a mouth in the right place--over other more Picassolike rearrangements. And mothers and infants will position themselves face- to-face when
they lie down to sleep.
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Babies and mothers seem to follow a typical pattern of play, a coordinated waltz that
moves from attention to inattention and back again. This innate social connection was
tested experimentally by Jeffrey Cohn and Edward Tronick in a series of three-minute
laboratory experiments at the University of Massachusetts, in which they asked mothers
to act depressed and not respond to baby's cues. When faced with a suddenly
unresponsive mother, a baby repeatedly reaches out and flaps around, trying to catch her
eye. When this tactic does not work, the baby gives up, turning away and going limp.
And when the mother begins to respond again, it takes thirty seconds for the baby to
reengage.
Given that human infants arrive in a state of dependency, ethnopediatricians have sought
to define the care required to meet their physical, cognitive, and emotional needs. They
assume there must be ways to treat babies that have proved adaptive over time and are
therefore likely to be most appropriate. Surveys of parenting in different societies reveal
broad patterns. In almost all cultures, infants sleep with their parents in the same room
and most often in the same bed. At all other times, infants are usually carried. Caregivers
also usually respond quickly to infant cries; mothers most often by offering the breast.
Since most hunter-gatherer groups also follow this overall style, this is probably the
ancestral pattern. If there is an exception to these generalizations, it is the industrialized
West.
Nuances of caretaking, however, do vary with particular social situations. !Kung San
mothers of Botswana usually carry their infants on gathering expeditions, while the
forest-living Ache of Paraguay, also hunters and gatherers, usually leave infants in camp
while they gather. Gusii mothers working in garden plots leave their babies in the care of
older children, while working mothers in the West may turn to unrelated adults. Such
choices have physiological or behavioral consequences for the infant. As parents navigate
between infant needs and the constraints of making a life, they may face a series of tradeoffs that set the care-giver-infant dyad at odds. The areas of greatest controversy are
breast-feeding, crying, and sleep--the major preoccupations of babies and their parents.
Strapped to their mothers' sides or backs in traditional fashion, human infants have quick
access to the breast. Easy access makes sense because of the nature of human milk.
Compared with that of other mammals, primate milk is relatively low in fat and protein
but high in carbohydrates. Such milk is biologically suitable if the infant can nurse on a
frequent basis. Most Western babies are fed in a somewhat different way. At least half
are bottle-fed from birth, while others are weaned from breast to bottle after only a few
months. And most--whether nursed or bottle-fed--are fed at scheduled times, waiting
hours between feedings. Long intervals in nursing disrupt the manufacture of breast milk,
making it still lower in fat and thus less satisfying the next time the nipple is offered. And
so crying over food and even the struggles of weaning result from the infant's unfulfilled
expectations.
Sleep is also a major issue for new parents. In the West, babies are encouraged to sleep
all through the night as soon as possible. And when infants do not do so, they merit the
label "sleep problem" from both parents and pediatricians. But infants seem predisposed
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to sleep rather lightly, waking many times during the night. And while sleeping close to
an adult allows infants to nurse more often and may have other beneficial effects,
Westerners usually expect babies to sleep alone. This practice has roots in ecclesiastical
laws enacted to protect against the smothering of infants by "lying over"--often a thinly
disguised cover for infanticide--which was a concern in Europe beginning in the Middle
Ages. Solitary sleep is reinforced by the rather recent notion of parental privacy. Western
parents are also often convinced that solitary sleep will mold strong character.
Infant care is shaped by tradition, fads, science, and folk wisdom. Cross-cultural and
evolutionary studies provide a useful perspective for parents and pediatricians as they sift
through the alternatives. Where these insights fail to guide us, however, important clues
are provided by the floppy but interactive babies themselves. Grinning when we talk to
them, crying in distress when left alone, sleeping best when close at heart, they teach us
that growth is a cooperative venture.
Farming peoples of subSaharan Africa have long faced the grim reality that many babies
fail to survive, often succumbing to gastrointestinal diseases, malaria, or other infections.
In the 1970s, when I lived among the Gusii in a small town in southwestern Kenya, infant
mortality in that nation was on the decline but was still high--about eighty deaths per
thousand live births during the first year, compared with about ten in the United States at
that time and six to eight in Western Europe.
The Gusii grew corn, millet, and cash crops such as coffee and tea. Women handled the
more routine tasks of cultivation, food processing, and trading, while men were
supervisors or enterpreneurs. Many men worked at jobs outside the village, in urban
centers or on plantations. The society was polygamous, with perhaps 10 percent of the
men having two or more wives. A woman was expected to give birth every two years,
from marriage to menopause, and the average married woman bore about ten live
children--one of the highest fertility rates in the world.
Nursing mothers slept alone with a new infant for fifteen months to insure its health. For
the first three to six months, the Gusii mothers were especially vigilant for signs of ill
health or slow growth, and they were quick to nurture unusually small or sick infants by
feeding and holding them more often. Mothers whose newborns were deemed
particularly at risk--including twins and those born prematurely--entered a ritual
seclusion for several weeks, staying with their infants in a hut with a constant fire.
Mothers kept infants from crying in the early months by holding them constantly and
being quick to comfort them. After three to six months--if the baby was growing
normally--mothers began to entrust the baby to the care of other children (usually six to
twelve years old) in order to pursue tasks that helped support the family. Fathers did not
take care of infants, for this was not a traditional male activity.
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Because they were so worried about their children's survival, Gusii parents did not
explicitly strive to foster cognitive, social, and emotional development. These needs were
not neglected, however, because from birth Gusii babies entered an active and responsive
interpersonal environment, first with their mothers and young caregivers, and later as part
of a group of children.
AN INFANT'S THREE RS
You are an American visitor spending a morning in a pleasant middle-class Dutch home
to observe the normal routine of a mother and her six-month-old baby. The mother made
sure you got there by 8:30 to witness the morning bath, an opportunity for playful
interaction with the baby. The baby was then dressed in cozy warm clothes, her hair
brushed and styled with a tiny curlicue atop her head. The mother gave her the
midmorning bottle, then sang to her and played patty-cake for a few minutes before
placing her in the playpen to entertain herself with a mobile while the mother attended to
other things nearby. Now, about half an hour later, the baby is beginning to get fussy.
The mother watches her for a minute, then offers a toy and turns away. The baby again
begins to fuss. "Seems bored and in need attention," you think. But the mother looks at
the baby sympathetically and in a soothing voice says, "Oh, are you tired?" Without
further ado she picks up the baby, carries her upstairs, tucks her into her crib, and pulls
down the shades. To your surprise, the baby fusses for only a few more moments, then is
quiet. The mother returns looking serene. "She needs plenty of sleep in order to grow,"
she explains. "When she doesn't have her nap or go to bed on time, we can always tell the
difference--she's not so happy and playful."
Different patterns in infant sleep can be found in Western societies that seem quite
similar to those of the United States. We discovered the "three Rs" of Dutch child
rearing--rust (rest), regelmaat (regularity) and reinheid (cleanliness)--while doing
research on a sample of sixty families with infants or young children in a middle-class
community near Leiden and Amsterdam, the sort of community typical of Dutch life
styles in all but the big cities nowadays. At six months, the Dutch babies were sleeping
more than a comparison group of American babies--a total of fifteen hours per day
compared with thirteen hours for the Americans. While awake at home, the Dutch babies
were more often left to play quietly in their playpens or infant seats. A daily ride in the
baby carriage provided time for the baby to look around at the passing scene or to doze
peacefully. If the mother needed to go out for a while without the baby, she could leave it
alone in bed for a short period or time her outing with the baby's nap time and ask a
neighbor to monitor with a "baby phone."
To understand how Dutch families manage to establish such a restful routine by the time
their babies are six months old, we made a second research visit to the same community.
We found that by two weeks of age, the Dutch babies were already sleeping more than
same-age American babies. In fact, a dilemma for some Dutch parents was whether to
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wake the baby after eight hours, as instructed by the local health care providers, or let
them sleep longer. The main method for establishing and maintaining this pattern was to
create a calm, regular, and restful environment for the infant throughout the day.
Far from worrying about providing "adequate stimulation," these mothers were
conscientious about avoiding overstimulation in the form of late family outings,
disruptions in the regularity of eating and sleeping, or too many things to look at or listen
to. Few parents were troubled by their babies' nighttime sleep routines. Babies' feeding
schedules were structured following the guidelines of the local baby clinic (a national
service). If a baby continued to wake up at night when feeding was no longer considered
necessary, the mother (or father) would most commonly give it a pacifier and a little back
rub to help it get back to sleep. Only in rare instances did parents find themselves forced
to choose between letting the baby scream and allowing too much night walking.
Many aspects of Dutch society support the three Rs throughout infancy and childhood-for example, shopping is close to home, and families usually have neighbors and relatives
nearby who are available to help out with child care. The small scale of neighborhoods
and a network of bicycle paths provide local play sites and a safe way for children to get
around easily on their own (no "soccer moms" are needed for daily transportation!).
Work sites for both fathers and mothers are also generally close to home, and there are
many flexible or part-time job arrangements.
National policies for health and other social benefits insure universal coverage regardless
of one's employment status, and the principle of the "family wage" has prevailed in labor
relations so that mothers of infants and young children rarely work more than part-time,
if at all. In many ways, the three Rs of Dutch child rearing are just one aspect of a calm
and unhurried life style for the whole family.
DOCTOR'S ORDERS
In Boston, a pediatric resident is experiencing a vague sense of disquiet as she interviews
a Puerto Rican mother who has brought her baby in for a checkup. When she is at work,
the mother explains, the two older children, ages six and nine, take care of the two
younger ones, a two-year-old and the three-month-old baby. Warning bells go off for the
resident: young children cannot possibly be sensitive to the needs of babies and toddlers.
And yet the baby is thriving; he is well over the ninetieth percentile in weight and height
and is full of smiles.
The resident questions the mother in detail: How is the baby fed? Is the apartment safe
for a two-year-old? The responses are all reassuring, but the resident nonetheless
launches into a lecture on the importance of the mother to normal infant development.
The mother falls silent, and the resident is now convinced that something is seriously
wrong. And something is--the resident's model of child care.
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The resident subscribers to what I call the "continuous care and contact" model of
parenting, which demands a high level of contact, frequent feeding, and constant
supervision, with almost all care provided by the mother. According to this model, a
mother should also enhance cognitive development with play and verbal engagement.
The pediatric resident is comfortable with this formula--she is not even conscious of it-because she was raised this way and treats her own child in the same manner. But at the
Child Development Unit of Children's Hospital in Boston, which I direct, I want residents
to abandon the idea that there is only one way to raise a child. Not to do so many interfere
with patient care.
Many models of parenting are valid. Among Efe foragers of Congo's Ituri Forest, for
example, a newborn is routinely cared for by several people. Babies are even nursed by
many women. But few individuals ever play with the infant; as far as the Efe are
concerned, the baby's job is to sleep.
In Peru, the Quechua swaddle their infants in a pouch of blankets that the mother, or a
child caretaker, carries on her back. Inside the pouch, the infant cannot move, and its eyes
are covered. Quechua babies are nursed in a perfunctory fashion, with three or four hours
between feedings.
As I explain to novice pediatricians, such practices do not fit the continuous care and
contact model; yet these babies grow up just fine. But my residents see these cultures as
exotic, not relevant to the industrialized world. And so I follow up with examples closer
to home: Dutch parents who leave an infant alone in order to go shopping, sometimes
pinning the child's shirt to the bed to keep the baby on its back; or Japanese mothers who
periodically wake a sleeping infant to teach the child who is in charge. The questions
soon follow. "How could a mother leave her infant alone?" "Why would a parent ever
want to wake up a sleeping baby?"
The data from cross-cultural studies indicate that child-care practices vary, and that these
styles aim to make the child into a culturally appropriate adult. The Efe make future Efe.
The resident makes future residents. A doctor who has a vague sense that something is
wrong with how someone cares for a baby may first need to explore his or her own
assumptions, the hidden "shoulds" that are based solely on tradition. Of course, pediatric
residents must make sure children are cared for responsibly. I know I have helped
residents broaden their views when their lectures on good mothering are replaced by such
comments as "What a gorgeous baby! I can't imagine how you manage both work and
three others at home!"
THE CRYING GAME
All normal human infants cry, although they vary a great deal in how much. A
mysterious and still unexplained phenomenon is that crying tends to increase in the first
few weeks of life, peaks in the second or third month, and then decreases. Some babies in
the United States cry so much during the peak period--often in excess of three hours a
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day--and seem so difficult to soothe that parents come to doubt their nurturing skills or
begin to fear that their offspring is suffering from a painful disease. Some mothers
discontinue nursing and switch to bottle-feeding because they believe their breast milk is
insufficiently nutritious and that their infants are always hungry. In extreme cases, the
crying may provoke physical abuse, sometimes even precipitating the infant's death.
A look at another culture, the !Kung San hunter-gatherers of southern Africa, provides us
with an opportunity to see whether caregiving strategies have any effect on infant crying.
Both the !Kung San and Western infants escalate their crying during the early weeks of
life, with a similar peak at two or three months. A comparison of Dutch, American and
!Kung San infants shows that the number of individual crying episodes are virtually
identical. What differs is their length: !Kung San infants cry about half as long as
Western babies. This implies that caregiving can influence only some aspects of crying,
such as duration.
What is particularly striking about child-rearing among the !Kung San is that infants are
in constant contact with a caregiver; they are carried or held most of the time, are usually
in an upright position, and are breast-fed about four times an hour for one to two minutes
at a time. Furthermore, the mother almost always responds to the smallest cry or fret
within ten seconds.
I believe that crying was adaptive for our ancestors. As seen in the contemporary !Kung
San, Crying probably elicited a quick response, and thus consisted of frequent but
relatively short episodes. This pattern helped keep an adult close by to provide adequate
nutrition as well as protection from predators. I have also argued that crying helped an
infant forge a strong at attachment with the mother and--because new pregnancies are
delayed by the prolongation of frequent nursing--secure more of her caregiving resources.
In the United States, where the threat of predation has receded and adequate nutrition is
usually available even without breast-feeding, crying may be less adaptive. In any case,
caregiving in the United States may be viewed as a cultural experiment in which the
infant is relatively more separated--and separable--from the mother, both in terms of
frequency of contact and actual distance.
The Western strategy is advantageous when the mother's employment outside of the
home and away from the baby is necessary to sustain family resources. But the trade-off
seems to be an increase in the length of crying bouts.
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