New AAP Policy recognizes value of nurturing family relationships

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The American Academy of Pediatrics (AAP) has issued a new policy, Preventing childhood toxic stress: Partnering with families and communities to promote relational health.

We applaud this bold recognition of the value of nurturing parenting, given AAP’s influence on its global network of pediatricians:

Source: AAP

Safe, stable, and nurturing relationships can act as a powerful, protective buffer against the biological harms of toxic stress on children. These relationships are also key to building resilience—being able to bounce back from adverse childhood experiences.

When children feel connected and supported in the early years, according to the newly updated AAP report, they are more likely to become healthy, competent and educated citizens later in life.

The policy statement, “Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health,” was published in the August 2021 issue of the journal, Pediatrics. The statement focuses on just how important relationships and positive childhood experiences are in preventing and healing toxic stress.

This policy moves away from a problem-based model that focuses on a child’s past adverse experiences and instead presents a positive, strengths-based approach that fosters solutions at the family, community and societal levels.

Related: Youth empowerment as peace education

A Slow-Moving Public Health Crisis

The AAP calls for pediatricians, parents, and policymakers to recognize toxic stress as a slow-moving public health threat that can be tempered by a preventive approach aimed at developing and strengthening healthy relationships.

“The concept of drawing on positive relationships as a shield against the toxic stress caused by adverse experiences has never been more relevant,” said Andrew Garner, MD, PhD, FAAP, a co-author of the policy statement generated by the Committee on Psychosocial Aspects of Child and Family Health, the Section on Developmental and Behavioral Pediatrics, and the Council on Early Childhood.

Related: ACEs too high with Jane Stevens

Forming Close, Healthy, and Nurturing Bonds

“Over the past few years, we’ve experienced a socially-isolating pandemic and reckoned with centuries of structural racism,” Dr. Garner said. “We must take steps to help kids form close, healthy and nurturing bonds, whether it is within the family, schools or community.”

The AAP recommends that pediatricians prioritize the trusted, respectful relationships that they share with patients and their families. They may refer families with strained relationships to evidence-based therapies, or work within their communities to make those therapies available if they are not offered.

New research also reveals that changes in the brains of parents who experienced trauma in their own childhoods may make it difficult for them to bond and nurture their children. These families can benefit from help from the community and others, especially after the pandemic.

Related: For better or worse, parenting changes your child’s DNA

“Families can help children adapt to harmful experiences and adversity by modeling their own skills at resilience,” said Michael Yogman, MD, FAAP, a co-author of the policy statement.

“This may mean demonstrating how to ask for help from family, friends, neighbors or others or demonstrating how to handle their own strong emotions,” he added. “Caregivers do not need to be perfect to help children feel safe, connected and supported.”

The AAP recommends that pediatricians watch for, screen, and address potential barriers to safe, stable, and nurturing relationships. Barriers include social determinants of health, such as inadequate housing, education inequities and food insecurity; the parents’ own adverse childhood experiences; intimate partner or neighborhood violence; parental depression; and/or substance use.

The pediatrician cannot do this work alone, however. The AAP calls for policy makers and community leaders to learn how relational health is influenced at all levels and support programs and funding that strengthen families.

This may include expanding family medical leave opportunities, increasing child tax credits, securing safe and affordable housing, supporting employment assistance and job training, promoting universal access to high-quality child care centers and schools, advancing preventive early childhood mental health services, promoting social emotional learning in schools, and expanding opportunities for playful learning in safe neighborhoods.

Related: A need for paid parental leave

The AAP also offers recommendations for families, caregivers, teachers, coaches, and others:

  • Learn about positive parenting techniques and developmentally appropriate forms of play, such as shared reading, as these foster the warm relationships that enhance literacy, executive function, and other core 21st-century life skills.
  • Learn how to handle their own strong emotions, so they can model this skill and be emotionally available when their children are distressed (“put your own oxygen mask on before helping others”).
  • Consider therapy to address unresolved trauma in the caregivers’ own history. Children are watching as caregivers strive to become slightly better versions of themselves each day, and the development of a “growth mindset” is a powerful predictor of future success.
  • Help children understand that there is nothing wrong with having strong emotions: the challenge is helping them to channel that energy into a constructive outlet like a passion, hobby, or activity that brings them joy while at the same time building generalizable skills.

Related: Manage your emotions: How to cool down before you blow up

Policymakers are encouraged to consider how adverse childhood experiences and toxic stress lead to long-term health problems from depression to diabetes and heart disease that are bankrupting the healthcare system.

“Our nation’s children are suffering both a mental health crisis and an educational challenge amid the pandemic,” Dr. Yogman said. “We must seize this opportunity and make sure that all children have someone they can turn to, that they can trust within a consistent, positive and nurturing relationship. This benefits our children, our society and our future.”

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Whistleblower: Infant formula companies boldly violating WHO code, smearing breastmilk

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“Imagine that the world had created a new ‘dream product’ to feed and immunize everyone born on Earth. Imagine also that it was available everywhere, required no storage or delivery, and helped mothers plan their families and reduce the risk of cancer. Then imagine that the world refused to use it.” ~ the late Frank Oski, MD, American pediatrician

That “dream product” this renowned child nutrition expert was referring to before his 1996 death from prostate cancer already exists—in breastmilk.

Breastmilk delivers lifelong health benefits to infants that far outweigh substitutes, doubling as both a source of superior nutrition and immunization to disease. Breastfeeding also plays a major role in establishing a foundation for infant mental health, secure mother-infant attachment, and strong family relationships.

Related: Breastmilk and baby’s gut health, the big picture and The link between breastfeeding and mental health

Yet, breastmilk is routinely pitted against the marketing prowess of multi-billion-dollar infant formula companies that in recent years at least have promoted its use as supportive to breastfeeding rather than an alternative.

This seemingly complementary role of formula to breastfeeding, as marketed, is a rather new change in course in the history of infant formula—mostly out of “regard” for the WHO’s International Code of Marketing Breast-milk Substitutes, enforceable by law in 136 of 194 developed countries.

Formula companies aren’t foolish when it comes to making money. Even formula companies in the 58 countries that do not prioritize the WHO code in their advertising legalese understand the potential damage to sales that could come with marketing formula as equal to or better than breastmilk in a culture that values advocating for higher breastfeeding rates.

Related: Nature’s case for breastfeeding

This month, the United Kingdom-based infant formula company Bobbie debuted a national U.S. marketing campaign on the first day of World Breastfeeding Week (Aug. 1-7, 2021) with a full-page ad in the New York Times that so flagrantly broke the WHO code that there should be outrage from all levels of U.S. breastfeeding support.

The silence is telling. Only one instance of social pushback against this formula company’s challenge to “breast is best” has made it to the top of search-engine lists:

Social media can be a powerful force for good when in the hands of empowered parents.

Well-supported breastfeeding parents are empowered. That support comes from many levels, from La Leche League International leaders to International Board Certified Lactation Consultants to media and culture to societal systems. In the United States, breastfeeding support has long been making gains on an uphill climb. We are not done by any means, as we live in a system that does not put family first.

Yet something has shifted in breastfeeding support internationally, and we are in danger of losing those gains.

Maybe we have become complacent. Maybe we have allowed our capitalistic economy to trump decades of research showing that breastmilk is truly best. In 2018, the U.S. threatened countries with economy-crushing tactics to avoid adopting a United Nations resolution to protect, promote, and support breastfeeding. This bewildering rejection of breastfeeding was justified by then-President Donald Trump as a show of support for mothers.

The news media was then relatively quiet in 2019, before COVID-19 struck in 2020—leaving billions of mothers around the world stranded from breastfeeding support, with the pandemic continuing to compromise face-to-face lactation support in the early weeks after childbirth when breastfeeding challenges are most likely to arise.

Infant formula companies filled the gap with questionable claims and overt WHO code violations:

  • In Paraguay, Danone specifically promoted its Nutricia infant formula as the safe infant-feeding method, purporting that COVID-19 could be transmitted to babies via breastfeeding. Danone extended this so-called support to “babies born in the pandemic” in Brazil, India, and parts of Europe.
  • In Mexico and Peru, Abbott claimed its brand Similac strengthens babies’ immune systems against viruses and bacteria.
  • In Southeast Asia, Nestle’s Indonesian brand Dancow ran ads portraying children drinking formula with the tagline (translated): “Mother, protect your sweetheart!”
  • Likewise, Danone’s Indonesian brand SGM promoted a “customer care line” via its Instagram and WhatsApp social media channels, and urged mothers to call with questions about child growth and development.
  • In both Pakistan and India, Nestle’s Lactogrow has been distributed in COVID-19 relief packages.

These and other instances are enough of a red flag that, globally, breastfeeding is on a slippery slope toward losing relevance—again.

Our grandmothers remember when breastfeeding rates dipped to near nonexistence in the U.S. between 1940 and 1970. Less than a century is not so long ago. We need a resurgence of impassioned support of breastfeeding, especially as the COVID-19 pandemic has allowed infant formula companies an opportunity to step up their marketing schemes against breastfeeding—which is as much against mothers and fathers, their infants’ health, and a confident beginning for the family.

Related: Interaction and relationships in breastfeeding families with Dr. Keren Epstein-Gilboa

After the struggles that breastfeeding had to endure to overcome formula companies’ misinformation in the 20th century, breastfeeding is not nearly as established as it needs to be in our society to be left to stand on its own against capitalism’s continued manipulation of the public when left unchecked.

We look forward to seeing, and sharing, empowered parents’ protection, promotion, and support of breastfeeding.

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In the news: Balance is as much a part of parenting as the rest

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The New York Times recently published an article entitled “I Love You. Leave Me Alone.” This headline has since been softened to “Why I Need to Hide From My Kids.”

Regardless, the article points to a problem of the pandemic – parents spending more time within physical (and emotional) proximity of their kids, without fully understanding their children’s developmentally appropriate needs for emotional care especially during stressful times, and without an established framework to ensure their own personal balance.

Balance can be an evasive state of mind, especially in families, especially when our goal is nurturing and engaged presence.

The NYT author opens the article with her own experience, describing how a dental procedure was her ticket to a day of glorious alone time in the midst of a balance-sucking pandemic with her preteen daughter who just wanted to spend time with her mom.

Related: Self-validation before self-control

Related: Engagement vs redirection in positive discipline

In many parts of the world, the pandemic has turned life upside-down for families. For more than a year now, parents have been grappling with how to best support their children through the stress of a constantly changing threat, sensitive culture, and reactive economy. Nurturing parenting helps children build resilience.

Related: ACEs Too High with Jane Stevens

It’s important that we remember that balance is as much a part of nurturing parenting as any of the other seven guidelines. Here are some tips to get you started on building balance into your nurturing:

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Ideas to help families in crisis in Afghanistan

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The fall of Afghanistan to the Taliban is so incredibly sad. In only a week, this extremist political faction has taken country of a country after 20 years of U.S. occupation and dashed the hope for a future based in democracy.

Related: Talking to our children about world tragedies

When last in rule, the Taliban was extremely hostile to anyone with views outside of their narrow law and especially oppressive toward women and children.

We have watched as this disaster unfolded in Afghanistan. To our horror, we saw throngs of people – including families with young children – crowding the tarmac of the last U.S. stronghold after evacuating the embassy – an airport in Kabul – with people hanging out of airplanes, so desperate to flee the country.

Related: Talking politics with your children

And now the reports of violence even as the Taliban “pledged” peace to the expats seeking to leave Afghanistan’s borders and the remaining Afghan citizens.

It’s hard to know what to do to help Afghan families in this humanitarian crisis. Here are links to some organizations mobilized to provide aid on the ground:

  • Afghan Journalists Safety Committee – seeking donations to establish safehouses for Afghan journalists, many of whom are women, having enjoyed greater freedom under the U.S.-backed constitutional government before the Taliban takeover
  • International Rescue Committee – seeking petitioners to send an email urging the U.S. President Joe Biden administration to take emergency action in Afghanistan
  • IRAP – seeking donations to offer assistance to Afghan refugees
  • LIRS – seeking volunteers and donations for emergency supplies to incoming Afghan refugees arriving in the U.S. cities of Fort Worth, Houston, Seattle, and Washington DC
  • Women for Afghan Women – seeking donations to support women living in Afghanistan, working to develop a grassroots approach in shifting cultural norms from oppression and violence to peace and equality
  • Women for Women International – seeking donations to support women’s mental and physical health in Afghanistan
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New study: Teens with secure family relationships bring more empathy to peer conversations

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Source: News release by the Society for Research in Child Development

Teens’ ability to empathize – to understand others’ perspectives and emotions, and to care for their wellbeing – is an important contributor to their relationships, including with friends.

Prior research shows that teens who have more secure family relationships report higher levels of empathy for others, but little research examines whether teens with more secure family relationships actually show greater empathy when observed in real-life interactions with peers, or whether their empathic capacities show different patterns of growth over time.

A new study – by researchers at the University of Virginia – tested whether teens’ secure, supportive family relationships at age 14 related to their ability to provide their friends with empathic support across adolescence and into early adulthood.

Findings indicate that secure attachment – reflecting on close relationships in an emotionally balanced, coherent, and valuing way – predicts teens’ ability to provide empathic support to their close friends.

“What’s especially interesting is that close friends also sought out more support from securely attached teens,” said Jessica Stern, postdoctoral fellow at the University of Virginia.

Related: The room of a teenage boy, a look at attachment parenting with teens

While having secure family relationships at age 14 predicted greater empathy with peers across adolescence, those teens who did not have secure family relationships in early adolescence showed a pattern of catching up, increasing their empathy toward close friends as they developed.

This study is among the first to examine associations of attachment with the development of empathic support using longitudinal methods and observations of empathic support for friends across mid-adolescence.

The findings were published in the journal Child Development. This research was supported by the National Institute of Child Health and Human Development and the National Institute of Mental Health.

The study featured a sample of 184 adolescents (86 males, 98 females) recruited from a public middle school (7th and 8th grades) in suburban and urban populations from the southeastern United States. Adolescents in the study were 58% Caucasian, 29% African American, 8% mixed race or ethnic, and 5% other identity groups.

In the current study, teens at age 14 responded to an interview about their attachment relationships, unlike most prior studies which used self-report measures of attachment style and empathy. Teens who described their attachment relationships as supportive, who valued those relationships and reflected on them with coherence and emotional balance, were rated as more secure.

Related: How to heal attachment with your teen

At ages 16, 17 and 18, teens and their nominated closest friend participated in a video-recorded, 6-minute task in which teens helped friends deal with a problem they were facing. Friends’ bids for support, as well as teens’ ability to provide empathic support, were coded from videos of this task.

The findings suggest a strong association between a teen’s having a secure attachment – or perspective on attachment relationships as supportive – and the development of the capacity to provide empathic support to close friends across a 4-year period of adolescence.

Results also suggest that friends’ support-seeking develops alongside teens’ ability to deliver empathy, with support-seeking helping empathy to develop and empathy fostering support-seeking from friends as well.

“Investing in the quality of teens’ family relationships early in adolescence may be important for building empathy and positive interactions with peers,” Stern said. “Parenting programs, family therapy when needed, and school-based interventions that help young teens feel safe and supported in their relationships with adults – not only parents but teachers, mentors, and extended kin – may equip teens to ‘pay it forward’ in their empathy and care for others.”

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WBW 2021: Protect breastfeeding by protecting nurturing

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As we reflect on this year’s theme for World Breastfeeding Week, August 1-7 – “Protect Breastfeeding: A shared responsibility” – it is imperative that we understand that protecting breastfeeding requires us to normalize nurturing.

Nurturing parenting is invariably linked to breastfeeding. While not all mothers are able to breastfeed, we recognize that breastfeeding – and breastfeeding behaviors while giving a bottle – is one of nature’s best teachers of new parents in how to sensitively and consistently respond to their baby as well as learn to develop the reciprocity of a healthy relationship between parent and child.

Related: Nature’s case for breastfeeding

Largely due to cultural pressures, even when mothers are able to get breastfeeding off to a strong start, there is a sharp decline overall in breastfeeding rates in the weeks and months after childbirth. The World Alliance for Breastfeeding Action (WABA), of which we are a member, has found that premature weaning tends to happen when mothers are without access to knowledgeable support while encountering problems with breastfeeding.

Breastfeeding problems are common, making widespread access to breastfeeding support paramount. International Board Certified Lactation Counselors, La Leche League leaders, and other trained advocates are key players in not only breastfeeding education but also nurturing parenting. The early days, weeks, and months of breastfeeding serve as a crucial time when mothers and fathers learn how to parent…to relate to their baby with nurturing behaviors, or not.

Related: Who will Baby attach to?

These early parenting lessons, which set the stage for years of a secure or insecure mother-infant relationship, are often absorbed in a time of relative isolation.

Traditionally, support to new parents was provided by the family…particularly the new mother’s mother and grandmother. However, as society has changed, mother support must come from a wider circle. This is where community support enters.

A new mother and father may have access to lactation consultants, depending on their geographic location. Some trained health care providers are able to provide ongoing support between medical appointments for acute breastfeeding problems; many are limited by their funding. La Leche League International fills the gap by training mothers with personal breastfeeding experience to volunteer in their communities by offering mother-to-mother support that complements professional care.

Likewise, we provide training to become a Certified Attached at the Heart Parenting Educator to provide holistic support to mothers and fathers in your community as they learn how to incorporate nurturing into the parenting of their children.

Related: Find a parent educator

As certified parenting educators, we offer basic support and community resource referrals to help parents make the best decisions for their families while educating them on the research-backed ways of bringing nurturing into their parenting. We help mothers view breastfeeding within the context of the whole mother-infant relationship and family dynamic, and how the give-and-take interaction that builds the foundation of secure attachment can be applied beyond breastfeeding.

Breastfeeding naturally promotes nurturing parenting. Overcoming the challenges that may come with breastfeeding sets the stage for building resilience through nurturing parenting for years to come.

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New study: Spanking harmful to child development, over time promotes misbehavior

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Spanking and other forms of physical punishment toward children are now banned in 62 nations around the globe.

Yet, this increasingly disproved child-raising practice remains legal in all 50 U.S. states with 19 states allowing physical punishment in schools. American children are far from an isolated group – 63% of children ages 2-4 worldwide are regularly subjected to physical punishment by parents or other caregivers.

Related: “I was spanked, and I’m fine!”

A new study by an international group of scientists located in Canada, the United Kingdom, and the United States underscores what much research previously has already discovered – that physical punishment of children does more harm than good. In fact, this new study details that physical punishment not only is not effective against preventing child misbehavior, but predicts increases in misbehavior over time.

The study, a review of previous research, only examined studies involving physical punishment that did not constitute child physical abuse. The majority of studies reviewed – 61 of 69 – were conducted in the U.S.

Related: What pro-spanking research misses

The study found that physical punishment of children correlates strongly with an increased risk of behavior problems in that child as well as an increased risk that the child could experience future abuse or neglect. These negative outcomes occurred no matter the child’s gender, race, or ethnicity, or the overall parenting style of the child’s caregivers. A higher frequency of physical punishment increased the elevated risk of these outcomes further.

Published in The Lancet on June 28, this new study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the UK Economic and Social Research Council.

Related: Stop hitting! An interview with Nadine Block, cofounder for the Center for Effective Discipline and Spankout April 30th

Related: Stop hitting kids in school, an interview with Nadine Block

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U.S. Economist: Don’t neglect the power of healthy families for a healthy economy

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Much talk surrounding the foundations of a robust national economy ignores the role of healthy families, especially those in which one parent may not participate full time in the paid workforce.

University of Chicago (U.S.) economist James Heckman, however, is known for his research into how a nation that invests in policies that promote healthy families is investing in its future economy. While he supports expanding early child care and education programs, he does not disregard the critical value of a healthy childhood environment in the home.

Related: API’s Eight Principles of Parenting – Provide consistent and loving care

This Q&A-style article from AEI dives headlong into Heckman’s research-backed support for family-based, healthy child development in light of overcoming inequality and facilitating social mobility, reducing the need for government-sponsored welfare programs, and empowering the next generation of workforce. Heckman’s ideas are an unique approach to typical economy-strengthening discussions. Here are some takeaways:

  • Conditions that each person is born into plays a fundamental role in the trajectory of that person’s life. This goes beyond genetics and encompasses even what happens earlier in the family tree before his/her birth.

Related: Historical trauma, breastfeeding, and healing with Camie Jae Goldhammer

  • Biological brain development may be at the core of child development, but which way that brain development goes depends on that child’s interaction with parents, siblings, other people and society. Families can nourish brain development. They can also suppress it.

Related: For better or worse, parenting changes your child’s DNA

  • Nourished brain development creates a foundation of early skills that facilitate the accumulation of skills (learning) through life – through education, interaction with others, work experience, etc. Among these early skills are self-control, perseverance, and the ability to guide oneself. Once a person has these skills, it’s easier for him/her to learn and gain other skills. A good start to a life is almost self-propelling.

Related: Nurturing doesn’t spoil kids

  • While the brain never loses the ability to learn, it’s much harder the older you get. Babies learn the easiest, so that’s where the investment into his/her life has to happen because that’s what is setting the foundation of his/her life. This is not something you can hold off on and come back to later; if a baby doesn’t get the right foundation, he/she can still learn when older but it will be much harder because the foundation is shaky.

Related: Dear little me, a letter from my grownup self

  • Research is seriously lacking in the economic returns of a family’s impact on child outcome. Research shows high returns (13% per annum) on early childhood programs, but Heckman predicts that the returns on a healthy family’s impact on child outcome would far outpace (an estimated 30-40%) that of early childhood programs. Early childhood programs are only successful when they “turn on” the parents – the program empowers the parents, the parents get engaged. Reaching the mother, specifically, is the key.

Related: What really matters when it comes to daycare

  • Parent education and support are important for all families, though the disadvantaged will accrue the most benefits. What defines advantages in parenting? Rather than higher income, good parenting involves attachment, interaction, and engagement with the child – this is what builds the foundation of learning starting in infancy.

Related: A need for paid parental leave

  • When considering universal child care, especially in a society where mothers are encouraged and expected to work full time outside of the home, there is real danger of high-quality parenting being replaced by mediocre child-raising in child care centers. This has happened in Canada and elsewhere. Our society has to guard against this.

Related: Parental presence, real-life

  • While some high-quality child care programs are very generous in their investment into the child’s future, child care centers can’t compare to the value of a parent in that child’s life. The key is to support parents to provide the home life that best supports their children.
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