Helen L Ball

... it is significant that we have previously lacked an anthropological perspective on pregnancy loss, for it is, as Roseanne Cecil points ... Finally, Jackson writes about legalistic attempts to distinguish between miscarriage and deliberate abortion, stillbirth and infanticide of illegitimate ...

To explore the link between breastfeeding duration and bed-sharing frequency among women reporting a prenatal intention to breastfeed. 870 participants in a randomised breastfeeding trial, recruited at mid-pregnancy, provided weekly snapshots of breastfeeding and bed-sharing behaviour for 26 weeks following birth. Strength of prenatal breastfeeding intent was recorded at recruitment using Likert-type scales. Outcomes were frequency of bed-sharing at home for at least one hour per week, and time to cessation of breastfeeding. There were insufficient data to classify bed-sharing pattern in 192/870 (22%) of mothers. Of the remainder, 44% (299/678) of participants 'rarely' or 'never' bed-shared, 28% (192/678) did so 'intermittently' and 28% (187/678) did so 'often'. These three groups did not differ significantly in marital status, income, infant gestational age, maternal age or delivery mode. Significantly more participants who bed-shared 'often'...

... functions such as temperature and breathing during the first few months of brain development.2,3 Human milk has a similar composition to that ... world cultures'.6 Since the mid-1930s, prolonged and independent night-time sleep has been the hallmark of a 'good baby' ...

Although breastfeeding initiation rates have improved, later prevalence is very low in the United Kingdom, and Northeast England is the region with the lowest rates. This study aimed to investigate novel in addition to well-established risk factors for cessation of breastfeeding among women in this region. Participants were 870 women considering breastfeeding prior to birth who were enrolled in the postnatal ward North East Cot trial at a tertiary hospital in Northeast England from 2008 to 2010. They provided weekly data on feeding and sleeping practices for 26 weeks postpartum using an automated telephone system with reminder postcards and contact by telephone, letter, or email if necessary. Cox proportional hazards regression was used to investigate factors associated with terminating any and exclusive breastfeeding in this period. Ninety-four percent of women started any breastfeeding and 66% initiated exclusive breastfeeding. By 26 weeks postpartum, 47% were still breastfeeding, but < 1% were breastfeeding exclusively. Multivariate analysis showed that women who exclusively breastfed for at least 4 weeks breastfed for significantly longer after supplementation started (P < .001). Bed-sharing at home during the first 13 weeks was a significant predictor of both any and exclusive breastfeeding, as well as any breastfeeding after supplementation (P < .001). We also confirmed some recognized socio-demographic predictors of breastfeeding cessation in this location. We found that exclusive breastfeeding for at least 4 weeks was significantly associated with longer breastfeeding continuation after supplementation, and bed-sharing at home was associated with longer breastfeeding regardless of the definition used.

Short sleep duration is associated with obesity in young children. This study develops the hypothesis that parental rules play a role in this association. Participants were 3-year-old children and their parents, recruited at nursery schools in socioeconomically deprived and non-deprived areas of a North-East England town. Parents were interviewed to assess their use of sleep, television-viewing and dietary rules, and given diaries to document their child's sleep for 4 days/5 nights. Children were measured for height, weight, waist circumference and triceps and subscapular skinfold thicknesses. One-hundred and eight families participated (84 with complete sleep data and 96 with complete body composition data). Parental rules were significantly associated together, were associated with longer night-time sleep and were more prevalent in the non-deprived-area compared with the deprived-area group. Television-viewing and dietary rules were associated with leaner body composition. Parental rules may in part confound the association between night-time sleep duration and obesity in young children, as rules cluster together across behavioural domains and are associated with both sleep duration and body composition. This hypothesis should be tested rigorously in large representative samples.

Children's sleep is critical for optimal health and development; yet sleep duration has decreased in recent decades, and many children do not have adequate sleep. Certain sleep behaviours ('sleep hygiene') are commonly recommended, and there is some evidence that they are associated with longer nighttime sleep. Parents of 84 British 3-year-old children were interviewed about their children's sleep and completed five-night/four-day sleep diaries documenting their children's sleep, from which daily sleep duration was estimated. Diaries were validated by actigraphy in a subgroup of children. Sleep hygiene behaviours (regular bedtime, reading at bedtime, falling asleep in bed) were associated with each other, and were more common in the high socioeconomic status compared to the low socioeconomic status group. Parents' reasons for not practicing sleep hygiene included difficulty, inability or inconvenience. Sleep hygiene behaviours were associated with significantly longer child sleep at night but not over 24 h. Longer daytime napping compensated for shorter nighttime sleep in children whose parents did not implement sleep hygiene behaviours. Parents may need to be advised that certain behaviours are associated with longer nighttime sleep and given practical advice on how to implement these behaviours. © 2014 The Authors. Infant and Child Development published by John Wiley…

We summarize the ethnographic literature illustrating that "abnormal birth" circumstances and "ill omens" operate as cues to terminate parental investment. A review of the medical literature provides evidence to support our assertion that ill omens serve as markers of biological conditions that will threaten the survival of infants. Daly and Wilson (1984) tested the prediction that children of demonstrably poor phenotypic quality will be common victims of infanticide. We take this hypothesis one stage further and argue that some children will be poor vehicles for parental investment yet are not of demonstrably poor quality at birth. We conclude that when people dispose of infants due to "superstitious beliefs" they are pursuing an adaptive strategy in eliminating infants who are poor vehicles for parental investment.

We report here on the use of interactive telephone technology for collecting longitudinal data in a large randomized non-blinded parallel trial. Data were primarily collected via an automated interactive telephone system which enabled data to be downloaded by researchers periodically via a secure website. Alternative methods were used by some participants to provide data; here we analyze the demographic profiles of groups by preferred data provision, and consider the cost-effectiveness and efficiency of such a system. The automated telephone system was used to provide the majority of data obtained (75.7%), however the group preferring to use this system to provide the majority of their data was on the whole older, more likely to be married, university educated, higher income and white compared to participants preferring to submit their data via personal phone call or post. We conclude that interactive telephone technology provides a means by which large quantities of longitudinal data may be collected efficiently. Depending on the target population, however, considerable staff time may be required to manage attrition and consequent data loss, and alternative strategies should be considered to minimize this.

To determine whether the use of sidecar cribs on the postnatal ward affects breastfeeding duration. A randomised non-blinded parallel trial comparing sidecar cribs with standalone cots. Postnatal wards of the Royal Victoria Infirmary, Newcastle upon Tyne. 1204 pregnant women intending to breastfeed were recruited at 20 weeks' gestation and randomised at 34 weeks to use either a sidecar crib attached to their bed (n=601) or a standalone cot adjacent to their bed (n=603). Duration of any, and exclusive, breastfeeding up to 26 weeks obtained by telephone follow-up. 334 mothers were withdrawn or lost to follow-up from the trial; infant feeding data were therefore obtained for 870 mothers (433 intervention; 437 controls). Using an intention-to-treat Cox regression analysis, no significant difference was found between the two groups for duration of any breastfeeding (sidecar crib vs cot, hazard ratio (HR) 0.96, 95% CI 0.79 to 1.18), or exclusive breastfeeding (HR 0.99, 95% CI 0.85 to 1.16) adjusting for maternal age, education, previous breastfeeding and delivery type. Bed sharing was not significantly more common in mothers randomised to sidecar cribs (67% vs 64%, adjusted difference 2.8%, 95% CI -3.5% to 9.0%). There were no adverse events. The use of sidecar cribs for mothers and infants did not improve the duration of any or exclusive breastfeeding, or frequency of bed sharing at home.

ABSTRACT Clinicians can help to reframe expectations of “normal” and support parents to develop coping strategies Parents of new babies often struggle with the problems of interrupted sleep, particularly when contemporary lifestyles, parental sleep needs, and infant biology conflict.1 Recent trends in Western infant care have led to misperceptions of normal infant sleep development. When we ask whether a young baby “sleeps through the night” this reinforces the idea that prolonged infant sleep is important and should be achieved early. It also does not recognise the role of night feeding in successful breast feeding because breastfed babies wake more often during the night than those who are not breast fed.2 Consequently, what we tell parents about normal infant sleep, and how we provide support, requires reframing.

Ball HL, Moya E, Fairley L, Westman J, Oddie S, Wright J. Infant care practices related to sudden infant death syndrome in South Asian and White British families in the UK. Paediatric and Perinatal Epidemiology 2012; 26: 3–12.In the UK, infants of South Asian parents have a lower rate of sudden infant death syndrome (SIDS) than White British infants. Infant care and life style behaviours are strongly associated with SIDS risk. This paper describes and explores variability in infant care between White British and South Asian families (of Bangladeshi, Indian or Pakistani origin) in Bradford, UK (the vast majority of which were Pakistani) and identifies areas for targeted SIDS intervention. A cross-sectional telephone interview study was conducted involving 2560 families with 2- to 4-month-old singleton infants enrolled in the Born in Bradford cohort study. Outcome measures were prevalence of self-reported practices in infant sleeping environment, sharing sleep surfaces, breast feeding, use of dummy or pacifier, and life style behaviours. We found that, compared with White British infants, Pakistani infants were more likely to: sleep in an adult bed (OR = 8.48 [95% CI 2.92, 24.63]); be positioned on their side for sleep (OR = 4.42 [2.85, 6.86]); have a pillow in their sleep environment (OR = 9.85 [6.39, 15.19]); sleep under a duvet (OR = 3.24 [2.39, 4.40]); be swaddled for sleep (OR = 1.49 [1.13, 1.97]); ever bed-share (OR = 2.13 [1.59, 2.86]); regularly bed-share (OR = 3.57 [2.23, 5.72]); ever been breast-fed (OR = 2.00 [1.58, 2.53]); and breast-fed for 8+ weeks (OR = 1.65 [1.31, 2.07]). Additionally, Pakistani infants were less likely to: sleep in a room alone (OR = 0.05 [0.03, 0.09]); use feet-to-foot position (OR = 0.36 [0.26, 0.50]); sleep with a soft toy (OR = 0.52 [0.40, 0.68]); use an infant sleeping bag (OR = 0.20 [0.16, 0.26]); ever sofa-share (OR = 0.22 [0.15, 0.34]); be receiving solid foods (OR = 0.22 [0.17, 0.30]); or use a dummy at night (OR = 0.40 [0.33, 0.50]). Pakistani infants were also less likely to be exposed to maternal smoking (OR = 0.07 [0.04, 0.12]) and to alcohol consumption by either parent. No difference was found in the prevalence of prone sleeping (OR = 1.04 [0.53, 2.01]). Night-time infant care therefore differed significantly between South Asian and White British families. South Asian infant care practices were more likely to protect infants from the most important SIDS risks such as smoking, alcohol consumption, sofa-sharing and solitary sleep. These differences may explain the lower rate of SIDS in this population.

This paper reports findings from a study that investigated infant care practices in a small population of Northeast England in order to determine whether parent-infant bedsharing is common parenting behavior. In a year-long prospective study we examined the opinions and practices of parents with regard to their infants' nighttime sleeping strategies before and after the birth of their babies. Results confirm that parents pursue a heterogeneous array of nighttime parenting strategies and that 65 percent of the sample had actually bedshared. Parents with no previous intention to do so slept with their babies for a variety of reasons. One of this study's most important findings is that babies were being brought into bed with both parents. Ninety five percent of the bedsharing infants slept with both mother and father. This study has shown that bedsharing is a relatively common parenting practice. Despite initial worries and fears, mainly concerning overlaying, some parents found bedsharing an effective option yet were covert in their practices, fearing the disapproval of health professionals and relatives.

The 'insurance ova' hypothesis (Anderson, 1990) views dizygotic twinning as a by-product of selection for multiple ovulation which sometimes--in error--results in the birth of twins. From this viewpoint, polyovulation is a mechanism which reduces the risks of fertilization failure or embryo defect/mortality. If DZ twin births are a 'side-effect' of a mechanism which compensates for defective embryos one might predict that embryo defect rates and twinning rates will covary. This prediction is tested using national-level data on twinning rates and rates of trisomy-21 (Down's syndrome), and a strong positive correlation is found, even when controlling for maternal age. One suggestion that follows from this finding is that intra- and interpopulation variation in both twinning rates and Down's syndrome rates may result, in part, from individual variation in pre-implantation rejection of embryos in the very early stages of pregnancy. In this paper it is proposed that the 'insurance ova' explanation for twinning in humans could be expanded to incorporate a model of rejection of anomalous embryos, be they anomalies of number or type. Variation in the efficiency of an embryo rejection mechanism, combined with variation in frequency of polyovulation, would have consequences for individual reproductive success.