Attachment parenting

thumb|William Sears advises mothers to carry their baby on the body as often as possible.

Attachment parenting (AP) is a parenting philosophy that proposes methods aiming to promote the attachment of mother and infant not only by maximal parental empathy and responsiveness but also by continuous bodily closeness and touch. The term attachment parenting was coined by the American pediatrician William Sears. There is no conclusive body of research that shows Sears' approach to be superior to "mainstream parenting".

History

Context

Although the term "attachment parenting" was first used only in the late 1990s, the concept is much older. In the United States, it became popular in the mid-20th century, when several responsiveness and love-oriented parenting philosophies entered the pedagogical mainstream, as a contrast to the more disciplinarian philosophies prevalent at the time. Attachment parenting owes many of its ideas to older teachings, such as Benjamin Spock's influential handbook The Common Sense Book of Baby and Child Care (1946). Spock had advised mothers to raise their infants according to their own common sense and with plenty of physical contact – a guideline that radically broke with the preceding doctrines of L. Emmett Holt and John B. Watson, which recommended discipline and emotional distance. Spock's book became a bestseller, and his new child-rearing concept greatly influenced the upbringing of the post-war generations.

Thirty years later, Jean Liedloff caused a stir by a "continuum concept" that she presented to the public in a book of the same title (1975). In Venezuela, Liedhoff had studied Ye'kuana people, and later she recommended to Western mothers to nurse and to wear their infants and to share their bed with them. She argued that infants, speaking in terms of evolution, have not arrived in the modernity yet, so that today's way of child care – with bottle feeding, use of cribs and baby carriages, etc. – does not meet their needs. Later, authors such as Sharon Heller and Meredith Small contributed further ethnopediatric insights.

In 1984, developmental psychologist Aletha Solter published her book The Aware Baby about a parenting philosophy that advocates attachment, extended breastfeeding, and abstinence from punishment, similarly to what William Sears later wrote; however, the point that Solter stressed most was an encouragement of the child's emotional expression to heal stress and trauma.

In the 1990s, T. Berry Brazelton invigorated the discussion. He contributed new research about the capacity of newborn infants to express themselves and their emotions, sensitized parents for these signals, and encouraged them – just like Spock – to follow their own judgment.

Controversy

Since 2012, there has been a controversy about Sears' positions which has been mostly carried out in the English-speaking world.

It began in 2012 with a cover picture on Time magazine that showed a Californian mother breastfeeding her almost 4-year-old. In the accompanying article "The Man Who Remade Motherhood", journalist Kate Pickert tried to argue that even if William Sears' positions are much less radical than those of his followers, they are 'misogynistic' and give mothers a chronically guilty conscience, and that they frequently disagree with relevant research results. The cover picture and article became the starting point of disputes in many media, criticizing Pickert.

At the same time, attachment parenting attracted attention of sociologists like Ellie Lee, Charlotte Faircloth, Jan Macvarish, and Frank Furedi who described the phenomenon an example of 21st century "Parental Determinism". As early as in 1996, sociologist Sharon Hays had described the sociocultural phenomenon of an "Intensive Mothering"; with attachment parenting, this phenomenon finally became tangible and recognizable. In 2004, media critic Susan J. Douglas and philosopher Meredith W. Michaels followed with their account of a "New Momism".

Time cover picture and article

The Time magazine cover picture and article were published May 21, 2012.

Origin

William Sears, a pediatrician, came upon the term "attachment parenting" in 1982 by reading Liedloff. Initially, he referred to his new philosophy as "the new continuum concept" and "immersion mothering". When he published his book Creative Parenting in 1982, the concept was largely elaborate already. The "7 Baby-Bs" were not explicitly presented as a canon yet, but as basic elements of a new parenting philosophy, they were distinctly clear even at that early point. In 1985, William Sears and his wife Martha Sears began to link the concept – ex post – with attachment theory which they had begun to recognize at that time. From then on, they used the term "attachment parenting".

In 1993, William Sears and Martha Sears published The Baby Book which became the first comprehensive manual for AP-parents and which was occasionally dubbed "the attachment parenting bible". The first attachment parenting organization, Attachment Parenting International, formed in 1994 in Alpharetta, Georgia, and was founded by Lysa Parker and Barbara Nicholson. The first book that carried the term attachment parenting in the title was written by Tammy Frissell-Deppe, a mother who gave an account of her personal experiences and of those of her friends and acquaintances. In 1999, blogger Katie Allison Granju followed with another book, to which William Sears contributed a foreword, before he, together with Martha Sears, published his own work, The Attachment Parenting Book in 2001. All three books stood – with their opposition against a crude behavioristic infant anthropology – in the tradition of Spock, but radicalized the concept of a contingency-oriented parenting on the one hand, and incorporated Liedloff's idea of an instinct-guided resp. "natural" childrearing on the other hand.

In the same year as Sears and Sears' Attachment Parenting Book, Jan Hunt published her essay collection The Natural Child. Parenting from the Heart. Hunt who sees herself as a child advocate, campaigned in this book not only for attachment parenting, but also for unschooling. A more recent AP proponent is parenting advisor Naomi Aldort, who published her book Raising Our Children, Raising Ourselves in 2006.

In practice

Baby Reading

Consistent with the founders of attachment theory, especially Mary Ainsworth, William Sears teaches that a strong mother-child-attachment emerges from contingency, that is, when mother and child are attuned to each other, which in turn is based on the mother's sensitivity. Since the mother "reads" the signals of her infant, Sears speaks in this context of "baby reading". Another metaphor that he uses is "to be in the groove".

The Seven B's

William Sears strongly believes in the existence of child rearing practices that support "baby reading" and that augment maternal sensitivity. The methods of attachment parenting include seven practices/principles that according to Sears form a "synergetic" ensemble and that are based on the child's "biological needs".

• Birth bonding
• Breastfeeding
• Baby wearing
• Bedding close to baby
• Belief in the language value of your baby's cry
• Beware of baby trainers
• Balance

Until 1999, Sears named only five Baby Bs. The last two were only added in 2001 with the publication of the Attachment Parenting Book.

Birth bonding

thumb|Mother with newborn

William Sears postulates the existence of a brief time slot immediately after birth during which the newborn is in a "quiet alert state" and particularly accessible for bonding. He refers to this birth bonding as "imprinting" and bases himself on a study by Drs. Marshall Klaus and John Kennell from 1967; however, Klaus and Kennell later modified their original assumptions, including the one cited by Sears. Sears advises women to abstain from analgesics during childbirth, since those drug the child, too, and according to Sears interfere with the birth bonding.

Breastfeeding

William Sears argues that breastfeeding greatly accommodates mother-child-attachment because it triggers the release of oxytocin in the mother which supports her emotional bonding with the child, notably in the first ten days after childbirth. In opposition to bottle feeding which tends to be done in three to four hour intervals. Breastfeeding enables the mother to perceive the child's moods and needs exactly. Since the half-life period of the hormones prolactin and oxytocin (which promote bonding) are very short, Sears recommends to breastfeed very frequently, newborns in particular (8 to 12 times a day). He claims that the hours between 1 am and 6 am are the most beneficial for breastfeeding. In general, Sears argues that breastfeeding is beneficial for the health of both child and mother. He claims that infants up to six months should be exclusively fed with breast milk, since he believes that, at that age, children are allergic to all other foods.

William and Martha Sears advise mothers to breastfeed every child for 1–4 years:

William Sears advocates extended breastfeeding, since he is convinced that breastfeeding supports attachment even of older children and that it is a valid instrument to comfort older children or to bring mother and child together on turbulent days. Neither does he object nighttime breastfeeding of toddlers. As early as in 1992, Norma Jane Bumgarner had campaigned for extended breastfeeding.

Sears' recommendations are in accordance with the WHO guidelines on breastfeeding, which recommend exclusive breastfeeding in the first six months and complementary breastfeeding in the first two years for all countries.

Since breastfeeding studies are, for ethical reasons, never conducted as randomized controlled trials, critics have repeatedly suspected that studies may have produced the superiority of breastfeeding as an artifact. Both the physical, emotional and mental development of children and the preferences of women for a feeding method are strongly determined by socioeconomical factors such as the mother's ethnicity, social class, and education. If researchers go without randomization and turn a blind eye to those possible alternative factors, they fundamentally run a risk to falsely credit the feeding method for effects of socioeconomic factors. A loophole from this problem was first presented by Cynthia G. Colen (Ohio State University), who successfully factored out socioeconomical determinants by comparing siblings only; her study demonstrated that formula fed children showed only minimal differences to their breastfed siblings, insofar as their physical, emotional and mental thriving was concerned.

William Sears' assumptions about the benefit of breastfeeding for the attachment have been studied. In 2006, John R. Britton and a research team (Kaiser Permanente) found that highly sensitive mothers are more likely than less sensitive mothers to breastfeed and to breastfeed over a long time period. However, the study showed no effect of the feeding method on the attachment quality.

Baby wearing

thumb|A child in a sling

Sears advises mothers to wear infants on the body as many hours during the day as possible, for example in a sling. He argues that this practice makes the child happy and allows the mother to involve the child into everything she does and never to lose sight of the child. He advises working mothers to wear the child at least 4–5 hours every night in order to make good for her absence during the day.

In 1990, a research team from New York revealed in a randomized study that children of lower class mothers who to the age of 13 months spent a lot of time in a child carrier on their mother's body showed significantly more frequently a secure attachment as defined by Ainsworth than the control group children, who spend more time in an infant seat. For middle-class families, an equivalent study doesn't exist yet.

Sears argues furthermore that baby wearing exercises the child's sense of balance; since a child who is worn on the mother's experiences more of her conversations, he believes that baby wearing is also beneficial for the child's language acquisition. However, there are not studies that confirm such effects.

It is undisputed that baby wearing can calm children down. Infants cry the most at the age of six weeks; in 1986, a research team at McGill University showed in a randomized study that infants of that age cried significantly less if their parents wore them a lot on the body during the day. Sears recommends babywearing for the purpose of settling a baby to sleep, too. He approves on the use of a sling up to the age of three, since child wearing can also be used to calm a misbehaving toddler down. Other pediatricians find it disputable to wear children beyond the age of nine months permanently on the body, arguing that this is against the child's natural desire for autonomy.

Co-sleeping

thumb|[[Christian Krohg: Mother and Child, 1883]]

William Sears states that any sleeping arrangement that a family practices is acceptable as long as it works; but he advises mother to sleep close to the child. He thinks of co-sleeping as the ideal arrangement and refers to it as the nighttime equivalent of baby wearing: co-sleeping supports, in his opinion, the mother-child-attachment, makes breastfeeding more convenient, and prevents not only separation anxiety, but also SIDS Sears is convinced that mother and child, in spite of frequent nighttime breastfeeding, have the best sleep when they sleep close together. He is also convinced that due to the extra nighttime feedings, a child that sleeps close to the mother thrives better than a child "crying, alone, behind bars". Moreover, Katie Allison Granju argued that co-sleeping is beneficial for children, too, because it gives children a vivid notion of the concept of bedtime.

The idea of co-sleeping was not new in modern Western societies; as early as in 1976, Tine Thevenin had campaigned for the "family bed". Sears doesn't see a problem when a three-year-old still shares their mother's bed every night. He doesn't even object if a child is in the habit of spending the whole night with her mother's nipple in her mouth, except when the mother really feels uncomfortable. Sears advises working mothers to co-sleep on all accounts in order to compensate the child for her daytime absence.

Sudden infant death syndrome (SIDS) occurs with an incidence of roughly 33 per 100,000 live births. James J. McKenna studied five pairs of co-sleeping mothers and infants and found them to synchronize nighttime arousals. With the study, he raised the questions of 1) whether there's a relationship between these synchronized nighttime waking and breathing stability and 2) whether this could be related to some forms of SIDS. Studies that investigate SIDS directly have shown that co-sleeping raises the SIDS risk instead of lowering it. Things that increase the risk of SIDS include: 1) when the infant is younger than four months, 2) the parents were especially tired, 3) the parents consumed alcohol, 4) parents were smokers, 5) slept on a sofa, or 6) the baby was in a duvet. Even in the absence of these risk factors, studies have still shown there to be an increased risk of SIDS when bed sharing. The U.S. Consumer Product Safety Commission also warns against co-sleeping. Attachment Parenting International issued a response which stated that the data referenced in the Consumer Product Safety Commission statement were unreliable, and that co-sponsors of the campaign had created a conflict of interest. The American Academy of Pediatrics' policy on SIDS prevention opposes bed-sharing with infants, although room-sharing is encouraged.

In general, research doesn't confirm an advantage of co-sleeping over separate beds. A meta study from Israel has pointed out in 2000 that sleeping aids such as pacifiers and teddy bears significantly improve the child's sleep, while co-sleeping and frequent nighttime breastfeeding if anything hinder the formation of wholesome sleeping patterns. Co-sleeping mothers breastfeed three times as frequently during the night as mothers who have their bed for themselves. The most important factor for a child to get a good sleep proved to be the mother's emotional accessibility, not her permanent physical closeness. Parents are challenged to "read" the crying – which is initially generalized – and to provide the child with empathic feedback in order to help them to differentiate and elaborate the repertoire of their signals gradually. Furthermore, he recommends prevention of crying: parents are advised not only to practice breastfeeding, baby wearing and co-sleeping as much as possible, but also to get into the habit of properly responding to the early warning signals so that crying doesn't happen in the first place. Likewise, parents must teach their child that some trivial occasions are no cause for alarm at all.

In general, Sears argues that infants should never be left crying because this would harm them. But as early as in 1962, T. Berry Brazelton had shown in a study that a certain amount of crying in young infants does not indicate emotional or physical problems, but is to be considered normal and harmless.

No sleep training

William Sears names two reasons why infants should not undergo sleep training: he believes that infant training hardens the mother emotionally and that children who underwent such training do not sleep better but merely resign and become apathetic, a state that he refers to as "shut down syndrome", although a condition of this name doesn't exist in DSM or ICD. Frissell-Deppe and Granju believe that sleep training is traumatic for children.

Sears argues that advocates of sleep training are professionally incompetent and merely business oriented, and that there is no scientific proof that sleep training is beneficial for children.

Balance

For parents and particularly for mothers, attachment parenting is more strenuous and demanding

than most other present-day ways of parenting, placing high responsibility on them without allowing for a support network of helpful friends or family. William Sears is fully aware of the arduousness of the methods. He suggests a whole package of measures that aim to prevent an emotional burnout of the mother, like the prioritization and delegation of duties and responsibilities, streamlining of daily routines, and collaboration between both parents. Sears advises mothers to turn to a psychotherapist if necessary, but to stick to attachment parenting at all costs.

Sears finds the burden of attachment parenting just and reasonable, and describes the opponents of this philosophy as "authoritarian males ... caught up in their role of advice giver". Granju, too, takes a swipe at "the male dominated 'scientific' childcare guidance". She argues that the low reputation that breastfeeding, namely extended breastfeeding in the Western world has, arises from a sexualization of the female breast: from the perspective of a sexist society, the breast "belongs" to men, not to children. Mayim Bialik, too, considers attachment a feminist option, since it constitutes an alternative to the – male dominated – superiority of physicians who traditionally shaped the spheres of pregnancy, childbirth, and motherhood.

Since attachment parenting poses a considerable challenge to the reconcilability of motherhood and female career, the philosophy has been greatly criticized, most notably in the context of the attachment parenting controversy from 2012.

Parental authority

Sears states that in attachment families, parents and children practice a highly developed and sophisticated type of communication that makes it unnecessary for parents to use practices such as scolding; often, all it takes is a mere frown. He is convinced that children who trust their parents are cooperative and do not resist parental guidance. He therefore recommends positive discipline. But in contrast to many AP parents, he is not fundamentally opposed to confrontative methods (firm, corrective response), and he gives high significance to child obedience and conscience. Sears is a decided advocate for authoritative parenting.

As studies have shown, it is indeed possible to use discipline strategies that are sensitive and, therefore, one should not equate discipline and insensitive caregiving.

In theory

Claim

Like Benjamin Spock before them, William and Martha Sears consider their parenting philosophy as a common sense and instinct-guided ad hoc way of parenting. In contrast to Spock who derived his ideas in a straight line from Freud's psychoanalysis, the Searses in fact did not start out from a theory; even the tie to attachment theory was only engineered ex post, when the philosophy was already largely complete. Apart from Liedloff's rather eclectic thoughts, they came to their ideas mainly from their own personal impressions:

Their belief in such scientific proof doesn't hinder the Searses to advise AP parents not to engage in discussions with AP critics. They also favor some science while they refuse other: