Category Archives: Parenting

Does a rub or a cuddle relieve pain?

I suspect most parents will have been there with a little one – a fall, a knock, a misfired football, and then the tears. In a bid to relieve the hurt, you give the sore a good rub, a strong cuddle or maybe a peck to ‘kiss it better’.

But why? Does a rub genuinely relieve pain, or is it just the only thing we can think of to show we care?

What is pain?

First, we need to understand what pain is.

Our skin and tissues underneath have different types of nerve cells coarsing through them. These help the brain sense the environment by signalling touch, temperature, pain, depending on what the fine nerve endings are set up to detect. Some nerve cells, for example, are studded with molecular receivers that grab chemicals wafting over them or change shape with varying temperature, while others fire when bent, stretched or vibrated.

When stimulated, the nerve cell pings an electrical signal down to our central nervous system, which then uses all the messages to interpret what’s going on in the environment and elicit the most appropriate action.

A gentle touch or a warm fire, will trigger our mechanoreceptors (touch) or thermoreceptors (temperature) and we may experience a nice fuzzy feeling. Pain receptors, technically known as nocireceptors, have a high threshold for stimulation. So we feel pain when certain stimuli – temperature, pressure, chemical – are intense enough to trigger the high threshold nocireceptors, which fire off signals that our brain processes as “too hot”, “too hard” or “too irritating”. This helps us take immediate action (‘move away!’) and means we generally learn what’s safe and what’s not. And while it might seem attractive to not feel pain, it causes serious problems if it isn’t there – individuals without this sense are prone to chewing chunks of their tongues off or to frequent bone breaks.

What shapes the feeling of pain?

One idea of pain relief says that stimulating the mechanoreceptors with a rub ramps up the ‘touch’ signals being sent to the central nervous system, which at least partly overrides the input from the nocireceptors. Known as the ‘Gate Control Theory‘, this shifts the balance of sensation from ‘pain’ to ‘touch’ – in a way, distracting our central nervous system with another stimulus.

There is also a special class of slow-acting touch nerve cells, triggered by gentle stroking, which seem to signal pleasurable sensations. Some studies suggest that these interact with the pain pathway to dampen painful sensations.

As well as the signals from the body, the brain coordinates input from other processing centres, which allows us to take into account past experience, from where on the body messages are being received and the context in which the stimulation is happening. Maybe that’s why a hug from a loved one can feel extra comforting.

And chemical signals in our brain shape our feelings of pain. Endorphins are chemical signals that are natural opiates so, like morphine and other opiates, can block painful sensations. They are also released in response to stress and fear, and bring the energising and euphoric feelings after exercise. Sometimes their effects are powerful enough to completely override the pain, which can be why people who have been shot sometimes only feel pain after the fearful situation has ended.

The relief of a rub

So what we actually feel is a physical and emotional experience after the brain processes the various sensory signals from the body, and takes into account past experience, environment and mood.

These may be some of the reasons why a good hug or rubbing a painful area can bring some genuine relief from hurt.

 

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Welcome To Holland

I am currently working through a FutureLearn on ‘the genomics era’. The course introduced some of the genetic errors that can happen in certain diseases.

One of the errors occurs when cells divide to form reproductive cells (sperm or eggs) – a process called meiosis. Most cells in the body have 46 chromosomes, arranged in 23 pairs. Reproductive cells have half the number, so that when a sperm and egg fuse, the newly fertilised cell has the normal complement of 46.

Certain diseases, like Down syndrome, Edwards syndrome and Patau syndrome, are the result of an extra chromosome in the fertilised egg. So instead of 23 pairs, there are 22 pairs and one triplet (or ‘trisomy‘). This error occurs when the reproductive cells are made, if the chromosomes of the parent cell are unevenly split between two new daughter cells.

The course featured a moving video of two parents whose daughter was diagnosed with Down syndrome. The father explains a powerful analogy to capture the emotions and experience of being told of such a diagnosis. The essay, ‘Welcome to Holland’ written in 1987 by Emily Perl Kingsley about having a child with a disability, is narrated in the video below, and is incredibly touching.

Looking after kids: it’s lovely but is it work?

Last week, I sent this tweet:

My wife had gone on a well-earned break for the day with a friend, leaving me in sole charge of our two-year old son and five-month old daughter.

We spent the morning around the house, slowly getting dressed, fed, washed and dressed again (we have a five-month old, remember). Finally, blessed with some gorgeous weather, we made it to the local park in the afternoon, before back for tea, bath and bed. Phew!

My point, squeezed into a snippy 140 characters, was in reaction to those who can be heard saying something like: “I put earplugs in/don’t do the night feeds/need lie-ins at the weekend (*recycle as appropriate) because I’m the one who has to go to work.”

I’ve certainly heard it. In my experience, always from men, many of whom I’m fond of and respect. I assume that when it is said, it’s usually from men, given the societal bias for women to take the extended parental leave, though I’m relying mostly on anecdote and supposition.

But, as I was changing the fourth nappy (diaper, my American friends) of the day with a two-year old playing ‘horsey’ on my back, I thought: “this feels on awful lot like work”. And at my office, I can make regular cups of tea, zone out for five minutes to check the news/Twitter and (usually) go the toilet when I want. I would like to see the bladder infection rates amongst parents, because I find myself ‘holding it in’ an awful lot.

From Men’s Health News

Don’t get me wrong, I had a lovely day and adore spending time with my kids. But it is hard graft.

Which is why this attitude really grates. My wife, who is currently on her second period of maternity leave, looks after the kids for the five working days, with our two-year old being at nursery school (preschool, my American friends) a couple of mornings the only partial respite. I did it for one day and felt the pinch.

But as Ian Curtis sang, routine bites hard. Day after day, going through those endless cycles of nappies, changes of clothes, feeding, shushing to sleep, is draining. And when you’re drained, doing it all over again sets up a tiring negative feedback loop.

This becomes even more acute when one considers that stress and lack of support can increase the risk of post-natal depression. Even without leading to such extreme consequences, it is beneficial for a child’s development for the parents to be less stressed. In fact, one study showed that minor daily hassles, which all mothers experienced regardless of background or family set-up, were related to more child behaviour problems, less satisfied parenting and poorer functional family status. The study also emphasised maternal emotional support, either from friends, communities or partners, as an important buffer from these adverse effects and to maintain mothers’ psychological well-being. I can’t even begin to imagine what it’s like to be a single parent, but find my anger rising as society moves to remove support for this group.

Again, I should say, we both get so much joy from looking after them and wouldn’t change them for the world. But it IS hard graft, and is why my wife’s break was more than fully earned.

Obviously, everyone’s situation is different. Many, many partners who ‘go to work’ are committed to helping a stay-at-home partner in the evenings and at weekends. Many people’s work is also incredibly demanding and stressful (more than mine), and this post is not a prescription of what ‘working’ parents ought to do, as it will depend hugely on circumstances.

But if you find yourself justifying an act with, “well I’m the one that works”, then you may want to have a second think.

How to engage a baby

When you share a laugh with your baby, it can be one the warmest feelings as a parent. But is this a genuine mutual exchange, and how does it come about?

This is a video of what is now a classic experiment in developmental psychology. It shows a mother happily engaging face-to-face with an equally happy baby. The mother then ceases all facial engagement – the “still face” – to which the baby reacts by trying, with all its might, to reestablish the happy interactions. It’s quite a marked and powerful effect:

A historical review of the experiment quotes the researchers who first documented the effect:

“the infant first “orients toward the mother” and “greets her expectantly.” But then, when the mother “fails to respond appropriately,” the infant …

… rapidly sobers and grows wary. He makes repeated attempts to get the interaction into its usual reciprocal pattern. When these attempts fail, the infant withdraws [and] orients his face and body away from his mother with a withdrawn, hopeless facial expression.”

The experiment, in this form, was first presented at a scientific conference in 1975, but it wasn’t the first to document what happened when infants are exposed to varying social interactions. It was, however, the first to use “then-novel videotape technology” on the conference hall’s big screen. Adamson and Frick, in their historical review, suggest that the  immediate and dramatic illustration of the phenomenon contributed to the broad interest this experiment gained. An early lesson in the power of ‘modern’ technology for effective science communication and to maximise research impact.

This may all seem a little obvious to some parents. You may feel that you don’t need a psychologist with a video camera to tell you that a baby is happiest when you are engaging them face-to-face. But there are a number of reasons why the methodical description of this effect has had profound and lasting influence.  

What this experiment first showed, by deliberately manipulating the parent’s engagement, was that the baby is an active player in this exchange. The infant’s social behaviours can influence the parent’s level of engagement, just as the parent can influence the baby, and it can subtly alter these depending on the context. It’s not simply the parent reacting to the baby’s randomly generated cues. It has even been detected in babies as young as a few weeks old.

As Jason Goldman at The Thoughtful Animal says:

“The still face experiment demonstrated that very young infants already have several basic building blocks of social cognition in place. It suggested that they have some sense of the relationship between facial expression and emotion, that they have some primitive social understanding, and that they are able to regulate their own affect and attention to some extent. The infants’ attempts to re-engage with their caregivers also suggest that they are able to plan and execute simple goal-directed behaviors.”

But one reason why this experiment has been so important and enduring is that it provided a standard and reproducible way of measuring children’s social emotional development.

By using the same set-up time-and-time again, it has shown how a child’s social and emotional development becomes richer as they grow older. The response becomes increasingly complex with age, and can include deftly timed facial cues, dampened smiles, sideways glances at their parent and yawns. Adamson and Frick cite a lovely example for the original set of experiments in which a five-month old boy, upon encountering a still face, stopped being wary and…

“…looked at the mother and laughed briefly. After this brief tense laugh, he paused, looked at her soberly, and then laughed again, loud and long, throwing his head back as he did so. At this point, the mother became unable to maintain an unresponsive still face.”

An experience I’m sure many a parent can relate to when – armed with a stern face – they try earnestly to tell off their child, only to be met with a cheeky grin or giggle!

The experiment has also allowed researchers to deconstruct these parent-baby social interactions into visual, auditory and tactile components. Vision and hearing, it seems, is especially important as children get older, but touch can be enough to, at least partially, lessen an infant’s anxiety when confronted with a still face.

Nevertheless, a still face is usually enough to produce the basic negative reaction in a child, even if it’s in response to their mother, father, a stranger or someone on television. Children make a distinction, however, for inanimate objects, even if they appear quite human-like, demonstrating their ability to form genuine social relationships.

This experimental set-up has also revealed possible negative consequences of a parent’s still face. According to Adamson and Frick, children actually show a more dramatic reaction to a still face than to a brief period of separation or to situations in which the parent interrupts interactions to talk to a researcher. Babies assimilate and react to a negative social cue, rather than simply becoming distressed at the lack of stimulation.

The “still face” experiment has shown its use in further understanding various developmental disorders, such as Down’s syndrome, deafness and autism, as well the effects of environmental conditions like infants exposed to cocaine prenatally or to depressed mothers.

The still face experiment has been used to ask questions about how early social and emotional engagement may affect later behaviour. The strength of an infant’s still face effect has been linked to their mother’s normal sensitivity and interactive style, and it may predict the degree of later infant attachment, depression or anxiety, and even behavioural problems.

Clearly, parents who may have a lower level of engagement, such as those experiencing postpartum depression, should not be guilt-tripped, especially as this could have an exacerbating effect. But the still face experiment has shown that simple procedures can help in these situations – depressed mothers who are encouraged to provide more touch stimulation are often able to offset the lack of visual or auditory engagement to bring about more positive social interations.

As Ed Tronick – one of the original researchers of the “still face” experiment – says on his website:

“An infant’s exposure to “good, bad, and ugly” interactions with the mother, as repeatedly communicated by her facial expressions or lack of expression (i.e., a still-face) has long-term consequences for the infant’s confidence and curiosity, or social emotional development, with which to experience and engage the world.

Though let’s not forget the role of fathers, or other partners, either.

[Thanks to mum-in-law Jenny (once again) for the video and @matthewcobb for the Adamson and Frick article]

Alternative medicine in parenting – part 1 out now!

Just a quick update to flag that the first instalment of a three-part look at the use of complementary and alternative medicine (CAM) in parenting has been posted at The 21st Floor blog. This post focuses on the many CAM therapies advocated in pregnancy and childbirth, from acupuncture and reiki to improve fertility, enzyme therapy and herbs to prevent miscarriage, through to homeopathy and aromatherapy during labour.

I look at the evidence behind the claims and ask whether it’s so wrong if people want to do it. Part 2 will look at the role that some healthcare professionals play in its promotion (and whether this is OK), plus issues around the regulation of its use. Part 3 will focus on “alt med” care for children and the problems this may cause for the population.

As ever, let me know what you think!

In the meantime, here are a couple of comics about homeopathy. Enjoy!

XKCD: Dilution

Saturday Morning Breakfast Cereal

Demanding babies and fraught mothers

There was quite a bit of coverage at the end last week about a report published by Essex and Oxford-based researchers that looked at the effects of on-demand feeding versus scheduled feeding. The researchers analysed just over 10,000 thousand babies born in the 1990s and checked whether babies fed in a particular way at 8 weeks and 33 months achieved better academic results later in their lives and whether the well-being of the mothers was affected.

The authors of the study reported an association between being fed on-demand as a baby and higher IQ scores at 8 years and better SATs exam scores at 5, 7, 11 and 14 years. This held true for breastfed and bottle-fed babies. Another effect they uncovered was that mothers who fed on-demand reported lower confidence, higher fretfulness and worse sleep patterns.

Photo by Anton Nossik*

Now I’ve mentioned quite a few times the mantra that “correlation does not imply causation”, and so my immediate reaction to seeing this in The Guardian was ‘here we go again’. Journalists often overlook the limitations of correlative studies in favour of neat and tidy story – after all, “this behaviour causes this effect” has a bit more punch than “this behaviour is associated with this outcome, but it may be acting through a third or multiple independent variable(s)”.

For an entertaining and revealing example of this issue, I would recommend reading stand-up mathematician Matt Parker’s ‘mobile phone masts cause increase in birth rates’ hoax story.

My first thought when my wife told me about this story was that, rather than on-demand feeding directly causing the higher IQ scores, it could equally be that a third factor was at play. As a speculative example, it could be that an attentive personality primes a mother to feed on-demand and also, independently, to spend more time with their child on educational development. This is an important distinction because it would mean that mothers wouldn’t be able to improve their child’s academic chances by feeding on-demand, rather they would have to pay more attention to educational development.

The authors were well aware of possible confounders and tried to take into account other differences between the groups to narrow down the possibilities as much as possible. This involved adjusting for family income, the education level of the parents, different parenting styles, the age and sex of children, and general maternal health. After all this, there was still a significant difference – children who were fed on-demand as babies had, on average, IQ scores 4 points better than children who were fed to a schedule.

This study has an advantage over many other correlative studies in that a third group presented itself – mothers who wanted to feed to a schedule but were unable to and so fed on-demand, i.e. they wanted to be in one group (scheduled feeding) but ended up as if they were in the other group (on-demand feeding). Crucially, the children in this third group achieved the same elevated academic achievement as seen in the other on-demand group.

Photo by Tom Carmony**

This meant that the authors were able to suggest that the improved academic outcomes weren’t due to having the type of mother who wishes to feed to a schedule, but that they were due to the actual act of being fed on-demand. This relies on an assumption that the mothers in the scheduled feeding group and the attempted scheduled feeding group had similar characteristics, and would therefore have similar approaches in other ways that may affect educational development. This may not be entirely true as other, more subtle differences could exist between these groups, but it’s a tantalising result that merits further investigation. I guess measuring the amount of time spent with the child on learning and development would be something at which to look.

There will still be other factors at play and it is still essentially a correlation, but it starts to narrow down the possibilites. The authors themselves admit the limitations in their study, with the lead author Dr Maria Iacovou telling Science Daily:

“At this stage, we must be very cautious about claiming a causal link between feeding patterns and IQ. We cannot definitively say why these differences occur, although we do have a range of hypotheses. This is the first study to explore this area and more research is needed to understand the processes involved.”

Dr Iacovou was also fairly even-handed on Channel 4 news, rightly highlighting that we still don’t know the mechanism for the observed effects and this is really the first step in establishing a causal relationship.

The final thing to note about the study, is that it was gratifying that the researchers looked at both sides of the issue – the outcomes for the baby (IQ, academic achievement) and the mother (well-being indicators). I’ve written before about the importance of looking at all knock-on effects, as it can be counter-productive to focus solely on the baby if it means a serious detrimental effect on the mother’s mental health.

If on-demand feeding really does drive academic development, then implementing a healthcare strategy to encourage this must take into account the negative impact this may have on the mother and include an appropriate support mechanism. Otherwise, the effectiveness of the intervention will be limited, as mothers will be more likely to give up in favour of a reassuring routine.

As Dr Iacovou said, “mothers are people too”.

—-

Hat-tip to mum-in-law Jenny who sent me this story.

*CC licence: http://creativecommons.org/licenses/by/3.0/deed.en

**CC licence: http://creativecommons.org/licenses/by-nc-nd/2.0/deed.en_GB

Natural’s not in it: the problem with homeopathy for babies

I never thought I’d end up writing about homeopathy for babies, but some things just take you by surprise.

For those that are unaware, a homeopathic preparation starts by taking a substance, usually one that would cause an ailment, and dilute it down to such a degree that none of the original substance remains. The belief is that this dilution can then be used to treat the ailment and that the more diluted the preparation, the more effective the ‘remedy’ is. To give an idea of the level of dilution of most standard homeopathic preparations, the Merseyside Skeptics made ‘homeopathic vodka’ and tested it on a few willing volunteers.

The arguments against homeopathy have been made effectively elsewhere, so I won’t re-tread those well-articulated paths too heavily, but will sum it up briefly. To support homeopathy, proponents usually either ‘cherry-pick’ flimsy, uncorroborated evidence to try and prove efficacy, suggest that a placebo effect is still a positive effect (and so what’s the problem?), or simply argue that everyone has a choice to decide what treatments they use. The primary problem for me (for it’s a problem among many) is that patients replace or delay conventional treatment in favour of alternative treatment, often at a serious detriment to their health. This is exacerbated by the decision to make homeopathic treatments available on the NHS – justified by the Government with the patient choice argument – that lends validity to the practice in many people’s minds. The Science and Technology Committee, however, conclude unequivocally that it’s not valid.

So why do I bring this up here?

Well, we’re fairly sure that my little boy’s teething at the moment. This can often be a pretty painful process, as anyone who can remember those first adult teeth poking through or who have been unfortunate enough to gain some wisdom teeth. We would, of course, like to reduce Reuben’s discomfort as much as possible, and so it is with this in mind that my wife bought some teething granules, on the recommendation of some her friends who swear by this particular brand.

Now imagine my surprise when I whipped out the box, in anticipation of riding to my son’s rescue and alleviate his pain, only to discover that these were homeopathic teething granules. First, the surprise that these even exist; and second, the puzzlement that my wife, knowing my somewhat sceptical nature, had actually bought them for our son. On the second point, she assured me that she didn’t realise they were homeopathic (this fact is revealed only on the back of the packet) and was going only on the testimonials of her friends (common ‘evidence’ homeopaths produce). So I’ll give her the benefit of the doubt on that score.

But the first point, that homeopathic pain relief exists for babies, has been troubling me since. The preparation is a 6C dilution of Chamomilla (or camomile). This means that it has been diluted 10-12, or 0.000000000001 of the original substance. In the ‘homeopathic vodka’ preparation, this would have been reached by the 6th cup of water. So a pretty extreme dilution. Leaving aside the pro-homeopathic argument that camomile doesn’t cause teething (‘like with like’ theory), there’s no evidence of this substance’s pain relief qualities (as advertised) nor, as far as I could tell, of its often assumed calming properties (also this). So at a 10-12 dilution, it seems extraordinary that there would be enough active molecules to have an effect (unless one subscribes to the ‘weaker makes it stronger’ argument).

As soon I saw that this was a homeopathic treatment, I convinced my wife that we needed to buy a proper teething pain relief. We bought some teething gel, with some well-tested analgesic and antiseptic compounds in it. And this, to me, demonstrates the crux of the issue: if we’d persisted with the homeopathic treatment, then we would have delayed using the more reliable teething gel and could have caused our son a few nights of needlessly heightened pain.

I guess it may have also subsided independently of the homeopathic treatment and we would now be telling our friends about this wonderful, magical treatment for teething. And the bandwagon would roll on.