Crybabying

I remember (sort of) my days in Elementary School, when one of the most devastating insults a little boy could receive was to be labelled a crybaby. I’m not sure why, really. Maybe it meant you didn’t fit in with the prevailing umwelt –with what you were supposed to be as a little boy- or maybe it was just a talisman raised to guard against the fear that despite its undesirability, it might be hiding in us all –even the accuser. Children are inherently superstitious, don’t you think?

It never occurred to me to wonder about the expression at the time, nor even later when I had children of my own. Babies cry, often too much, and perhaps more to the point, often at inconvenient times: during the nights. But I never suspected that it was sufficiently upsetting that it would transmute into folklore as a children’s curse. In fact, as childhood made way for my adult clothes, I didn’t think much about it at all -let alone as an imprecation- until I happened upon an article in the CBC News: http://www.cbc.ca/news/health/babies-crying-health-study-warwick-university-1.4052932 ‘Researchers at the University of Warwick conducted a meta-analysis of studies involving about 8,700 infants in countries including Canada, Germany, Denmark, Japan, Italy and the U.K.’ and guess what? ‘[…]babies in Canada, Britain, Italy and the Netherlands cry more than babies in other countries.’ And not only that, ‘On average, Canadian babies cried 30 minutes more than babies from other countries.’ Great! There goes our long held patriotic claim to be the ‘polite nation’ -the one usually definable by what we are not: (not American, not greedy, not pushy, not… Well, you get the point). ‘Canadian babies had some of the highest levels (peaking at three to four weeks at 34.1 per cent of infants), followed by the U.K. (peaking at one to two weeks at 28 per cent) and Italy (peaking at eight to nine weeks at 20.9 per cent).’ ‘Germany, Japan and Denmark had the least amount of crying and fussing babies.’ Damn.

Mind you, if you actually look at the article reported by the CBC:  http://www.jpeds.com/article/S0022-3476(17)30218-4/fulltext – s0070, ‘Overall, fuss/cry durations were high across the first 6 weeks of life, then reduced significantly over the following 6 weeks. All studies found a “universal” reduction in fuss/cry duration between 6 and 12 weeks of age.’ The reasons for the differences were not at all clear: ‘[…] we can only speculate on the reasons why there are country differences, in particular between Denmark and the rest of Europe and North America. These could range from economic conditions, such as less social inequality, to caretaking patterns such as responsiveness, carrying behavior and management in Denmark that have been shown to differ from the United Kingdom. However, there may also be population genetic differences, and the infants both inherit their parents’ genes and are reared by them (gene-environment correlation). […]Feeding type was a further moderator of fuss/cry duration. Bottle or mixed feeding was associated with reduced duration of fussing and crying or colic from 3-4 weeks of age onward. Switch in feeding type is one frequently adopted method by parents dealing with a crying baby and has been found to reduce crying regardless of what formula change is instituted, suggesting a placebo effect.’

Unfortunately, ‘[…]this is a review of studies in North America and parts of Europe with only 1 study from Japan. No studies from threshold or developing countries were available, but these would be needed to provide adequate feedback to parents on other continents. Feeding type information was also not available for some studies.’

And what about ‘colic’ the catch-all word for persistent crying? ‘The most widely used definition for colic is the “Rule of Three’s”: an infant is considered to have colic if the infant fusses or cries for >3 hours, >3 days per week, for >3 weeks.’ Unfortunately it is, apparently, often a diagnosis of despair with no readily identifiable cause. Indeed, ‘The rapid developmental change in fuss/cry duration has implications for treatment and interpretation of treatment studies. Colic is the extreme of normal fuss/cry behavior, self-limiting, and, thus, the vast majority will spontaneously remit. Adequate management of fussing and crying in the first 3 months rather than treatment may be required. However, if excessive fuss/cry persists beyond the first 3 months, there is increasing evidence that this may indicate regulatory problems with adverse consequences for future development and may require treatment.’

But, bringing it back to Canada, my terre natale, ‘Psychology professor Dieter Wolke, lead author of the study, says Canadian parents need not worry. […] He pointed out that babies in Canada peaked around the three-four week mark but fell into a more normal range around week six.’ …Damned by faint praise again…

And what about Germany, Japan and Denmark? Especially Denmark –why does it always seem to win everything? ‘”In Denmark, it seems to be they’re more relaxed about it,” Wolke said. “They might have a little bit more support because of maternity and paternity laws … the father in the first few weeks can stay at home, too.” It’s worth noting that Denmark regularly falls at or near the top of the “best countries to live in” lists. Wolke speculates that this may foster a population that feels good about itself, and those emotions can transfer to the baby.’

Uhmm, excuse me! ‘”Babies are already very different in how much they cry in the first weeks of life,” the researchers said. “There are large but normal variations”’. So let’s not dump on les petits Canadiens, eh? It’s a squeaky wheel that gets the grease, after all. Right? …I mean that’s right isn’t it…?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Time Out, eh?

Time-outs to wring behavioural change from naughty children are all the rage nowadays. Everywhere you go there seem to be men sitting near their tantrum-laden little boys in the parking lots of stores, or women standing outside of cars fastidiously ignoring the screams of alternately pounding and pouting children confined within. Perhaps this has been going on for years, but only recently have I begun to notice the ritual. In fact, it seems so ubiquitous, that I am beginning to suspect a flaw in my own upbringing. I don’t remember being an easy child; maybe I just had easy parents. Or maybe the Encyclopedia Britannica of the age didn’t cover that aspect of childrearing.

It might be investigating the obvious, but I had to look it up at any rate. Time-outs are more acceptable attempts at behaviour modification than corporal punishment –spanking comes to mind- especially in public, where the difference between remonstration and child abuse is uncomfortably opaque. The idea of social exclusion was likely popularized in a paper by a Dr. Montrose Wolf at the University of Washington in the mid 60ies, drawing on the work by his mentor, Dr. Arthur Staats (who called it ‘time-out’).

But, unless you grew up in Winnipeg in the 1950ies, you might now regard time-outs as such an intuitively obvious way of treating both the child’s misbehaviour and the resultant parental frustration, that you would be forgiven for assuming it had been hard-wired in our DNA. Perhaps it was, but with variable penetrance, and probable mid-prairie epigenetic modification –anyway, there seem to be some issues with its application: http://www.cbc.ca/news/health/time-outs-study-parenting-1.3888166

By default, I suppose I’m an educationally impoverished repository of doctrinal wisdom when it comes to children. As an obstetrician, for years -until my own arrived, at least- my responsibilities ended with handing the freshly-liberated, and usually screaming newborn to the mother, tidying things up, and then congratulating the smiling, emotionally overcome parents before I left the room. I didn’t expect to be confronted with any of their subsequent behavioural peccadillos. But, as Shakespeare’s Cleopatra remarked, those were ‘my salad days, when I was green in judgment’.

Usually, I enjoy seeing children in the waiting room –they lend a kind of friendly family air to the office. Sometimes, however, there are things I need to discuss with the mother, procedures I need to perform, or even examinations that might alarm the child, so my enjoyment is often that of seeing the child stay in the waiting room. It’s not called that for nothing.

Clara was already a harried teenage mother of a two year old when I first met her several years ago, and I delivered three more for her in the following years. Now in her late twenties and recently divorced, she had been sent to see me for permanent birth control.

I heard the excited screaming even before I reached the front desk, and I have to admit that I hid behind a wall to assess the situation more fully before I ventured into the open. The first of the children I delivered -Edward, now around five- was stirring the pot by running around the room clutching a toy to his chest so the dauphin, despite the obvious entitlement of age, could not get it.

Clara’s long auburn hair, now partially liberated from whatever restraints she’d attempted at home, was hanging forlornly around her shoulders, while her eyes followed the action around the room like a hockey game. A large lady now, she sat uncomfortably on the edge of her seat, no doubt hoping to catch Edward and the toy if he was so unwise as to come anywhere near grabbing range. The youngest, still breast feeding, was the only one over whom she exercised even temporary dominion.

I glanced nervously around the room from the shelter of the alcove, hoping she had brought a friend or older family member with her, but Clara was the last patient of the day and the room was otherwise empty.

“Clara,” I said, face prepared, and hoping she hadn’t noticed me behind the wall. “Nice to see you again.”

The children immediately stopped running and flocked to my side to tug on my clothes. Jamie, the oldest, grabbed the toy from Edward, who was now too busy trying to reach my stethoscope to notice.

“I… I saw you… watching from the alcove, doctor,” Clara said, blushing a deep crimson because she almost said ‘hiding’. “I tried to get my sister to take care of the kids, but she had to work today…” She shrugged and reached out with lightning speed to grab Jamie’s arm before he could swat his brother. “You behave yourself, Jamie, or you’re gonna do a Time-out, eh?”

Jamie immediately akimboed his arms and made a face at his brother. “He grabbed my car…!”

Clara glared at him and frowned, but from the defiant face with which Jamie greeted the threat, I could see the battle lines hardening.

I glanced at my secretary sitting behind the front desk, but she was on the phone and I realized that I was on my own. “Let’s go into my office,” I said, with a worried look at the boys, and the little girl, Janice, who by now had decided that the way to recapture some attention was to stick her tongue out at Jamie. Only the baby seemed compliant, but that was probably because Clara was still nursing her.

My office, unfortunately, was not designed for children –there are simply too many things that could tip over or break if handled indelicately. On the way down the hall to the office, I even thought of getting my secretary to fake a call from the hospital requiring my immediate assistance, but she was still on the phone and merely winked at me as I passed. I got the impression she was just holding the receiver for show.

As soon as the troupe entered the office they began to explore, and Jamie, who had probably never seen pennies before, made a quick exploratory lunge for the penny bowl that sat in front of a terra cotta statue of a begging lady precariously balanced on a little oak table. Edward, on the other hand, was reaching for the carved wooden statue of a woman holding a child that I had put behind a plant on my desk, and Janice was trying to extract the contents of the shelf where I keep my medical journals. It was a multi-pronged attack worthy of an Alexander.

“I’m not sure this is going to work, doctor,” Clara said, trying unsuccessfully to reposition the baby onto a breast while glaring at all three of her children now crawling along the floor scooping pennies into their pockets.

I called my receptionist to come in with us. “Laura,” I said as she opened the door a crack and peeked in. “Please put the phone on hold, or something…  I need your help.” Actually, I needed a time-out.

I could feel Laura’s eyes rolling behind the door. She was the mother of three young children, so she knew what I was going to ask.

“I want you to take the kids and… occupy them for a few minutes while I talk to Clara.”

She shrugged, but I could tell from her face that she thought it might be an interesting challenge as she gathered the tribe -minus the now sleeping baby- and led it out of the door. The office felt so peaceful suddenly that Clara and I just looked at each other for a moment. I managed to gather a more complete history and when I opened the door to lead her across the hall to the examining room I could only hear quiet giggles.

Finally, after Clara and I had discussed her needs, we both tiptoed down the corridor to the waiting room. But it, too, was quiet except for Laura’s voice telling a story as the children sat around her in a little circle on the floor.

Each of them had a plastic speculum with a sticker face stuck on the top and when Laura asked a question, one of the children would make the speculum talk. They were loving it and didn’t even look up when we crossed the rug. But Laura did, her eyes glistening from quiet laughter.

Clara just stared at them, unable to speak.

Laura chuckled and then shrugged. “I gave each of them a choice of those little funny face stickers we always give to the kids and showed them how to attach them to the top of the speculum.” A contented sigh escaped as she watched them all talking quietly to each other through the specula. “From then on, it was just role playing…”

“How did you ever think of that, Laura?” I asked when they’d all left.

She shrugged again. “The specula have always reminded me of quidnuncs… you know, snoops -those who insist on sticking their noses in other people’s business.”

I had to sigh in admiration -Laura has a name for everything. I just hope she doesn’t expect me to name the specula now… But I looked up quidnunc just in case.