Tuesday, May 25, 2010

Attachment Parenting

I became familiar with Bowlby and Ainsworth's Attachment Theory during my coursework in psychology and researched it in more depth throughout the last year as I was working on my Master's in Counseling. In short, the theory posits that infants (and adults) develop an attachment to their primary caregivers. A "healthy" attachment is generally formed when parents respond sensitively and lovingly during interactions with the child. This is called "secure" attachment. Children who develop a secure attachment to their caregivers are comfortable exploring their environment--they often grow up to be leaders, high achievers, develop a sense of empathy for others, and have a positive self-concept, listing just a few of the many positive benefits.

When parents do not respond or barely respond to a child, the child may develop an "avoidant" attachment, where he or she avoids contact with the caregiver. If the caregiver is inconsistent, being loving at one moment and neglectful the next, the child may develop an "ambivalent" attachment, where he or she is distressed when the parent leaves but then, upon the parent's return, acts angry and reluctant to interact with the parent. Finally, children can have a "disorganized" attachment, displaying contradictory responses to the parent's interactions...children who display this attachment style often have parents who are highly intrusive, frightening, and abusive.

Obviously, most parents would strive to raise a child who is securely attached. While an early insecure attachment does not necessarily mean that the child will never develop secure relationships with others, if this style continues throughout childhood and into adulthood, it is more likely that the person will have difficulty forming healthy relationships, developing a positive social identity, and makes them more vulnerable to high risk behaviors (drinking, drugs, sex). The children with the worst outcomes are those labelled "disorganized." These children are often aggressive or completely withdrawn and are more likely to develop personality disorders and abusive tendencies in adulthood.

Therefore, as parents, Brian and I have decided to do our best at raising a securely attached baby girl. Attachment Parenting has emerged from Attachment Theory and it lists 8 Principles of Parenting (according to Attachment Parenting International), developed to create strong and caring connections between parents and children.

1. Prepare for Pregnancy, Birth, and Parenting
It is important for parents to prepare themselves emotionally for the arrival of their little bundle of joy, as well as to educate themselves on the stages of child development and develop realistic expectations.

2. Feed with Love and Respect
As we all know, breastfeeding is the most ideal way to feed an infant, because it creates closeness and gives the baby "skin to skin" contact. However, as I discovered when I was unable to get Lily to breastfeed, bottle feeding can still meet these needs if the parent holds the child closely and mimics breastfeeding behaviors.

3. Respond with Sensitivity
Develop a strong and trusting relationship with your child early. Listen to what the baby is "telling" you and respond appropriately. Babies and toddlers need to learn how to regulate their emotions properly, and they learn from the way their parents respond. Responding with sensitivity encourages empathy and trust in others.

4. Use Nurturing Touch
A loving touch makes a baby feel loved, secure, and meets a baby's need for physical contact. So, give your baby all the hugs and kisses that you want!!

5. Ensure Safe Sleep, both Emotionally and Physically
Be responsive to your baby's needs throughout the night. This might mean that you need to re-evaluate your sleeping arrangements. Is your baby comfortable in their crib/bed? Are you comfortable with a co-sleeping arrangement?

6. Provide Consistent and Loving Care
Continually show your child that you love them. Keep them on a flexible schedule and, if seeking outside childcare, pick someone who will be able to develop a strong relationship with the child.

7. Practice Positive Discipline
Don't just react to behavior--figure out what is causing it. Work with the child to create solutions to the problem and this will help the child develop a conscience and internal model for behavior while, at the same time, allows the parent to be empathetic and loving towards the child. This is why we choose not to spank...

8. Strive for Balance in Personal and Family Life
In order to take care of your family well, it is important to take care of yourself! This will help you respond better to each family members' individual needs and help you be more emotionally responsive.

This is our chosen style of parenting. We realize there are other methods and styles used by people that we love; ultimately, each family needs to discover what works best for them and allows them to become a loving and productive family system.

Saturday, May 22, 2010

A *Must* Read...

Last Fall, I borrowed a book from my mother-in-law, Barb, called Three Cups of Tea. The book discusses the work of Greg Mortenson, a former mountaineer who, while attempting to climb K2 in Pakistan, stumbled into a small town called Korphe (KOR-FAY) and was nursed back to health by the villagers, who were extremely isolated from the outside world. This isolation also meant that the children and the adults of the village were largely uneducated and illiterate--yet, they strived for education. Greg made a promise that he would, somehow, come back to Pakistan and build a school for the children of Korphe. This endeavor launched the non-profit organization, the Central Asia Institute (CAI), that has subsequently built many schools all over the most rural regions of Pakistan.

So...you may be wondering why building schools in a foreign country makes for interesting reading. Well, it is not just that the people of Pakistan want to educate their children--they also want to educate their girls and provide a secular, non-extremist education. Greg Mortenson believes that the best way to combat terrorism in this country is by bringing education and, thus, hope, to the most remote areas of the country. It is through education, not bombs and war, that the War on Terror will be won. For instance, in many areas where the government has not funded schools, madrassas (or Islamic schools) funded by extremist groups have sprung up. Because the people in the areas are so eager for an education and this is their only option, their children are sent to these schools and are often indoctrinated with an extremist education--which fuels terrorism.

However, as much as I liked Three Cups of Tea, the book I really LOVED was the sequel, Stones into Schools: Promoting Peace with Books, Not Bombs, in Afghanistan and Pakistan.
Unlike the first book, which was co-authored and written in the third person, Stones into Schools was actually written by Greg Mortenson in the first person. In the second novel, Greg talks about his efforts, along with the "Dirty Dozen"--twelve men from Pakistan and Afghanistan who work for the CAI--to build schools in the war-torn country of Afghanistan, where the infrastructure is basically gone and the Taliban are still rampant.
This book goes beyond building schools to limit terrorism--it also discusses the broader idea of what it means to educate a woman. In the novel, Greg discusses the "Girl Effect," which goes by the idea that, if you "educate a man, you educate an individual. If you educate a woman, you educate a community." This may sound very feminist but he offers some very real and important examples. First of all, the women who acquire at least a fifth grade education raise their lifetime earnings significantly and, if they go on in their education, especially if they seek an education in maternal health care, the infant mortality rate and death during childbirth goes down dramatically. Also, women who are receiving an education are more likely to put off pregnancy until they are finished with school, which means they have fewer children, slowing population growth.
Moreover, in the Muslim world, it is not uncommon for sons to seek their mothers' approval before joining extremist groups. According to Mortenson, as a rule, educated women/mothers almost always say no. So--by educating a woman, it is much more likely that her family will not join an extremist group.
The CAI also discusses how they operate differently from a "typical" NGO. Instead of starting in a heavily populated area and working their way out, the CAI goes backwards--they start with the most rural areas and work their way in. This allows the most isolated and, often, deprived, communities to receive schools first.
The book, on the whole, is an excellent read that I definitely recommend to anyone who would like a different look and approach at the war on terror. It is a story about building relationships, respecting differences, and, most importantly, a story about hope that true change can occur in a country that has been at war in some shape or form for decades.

Saturday, May 8, 2010

The "Bump": A Hemangioma Update

Nearly a year ago, we were making endless and exhausting visits to doctors. When Lily was 7 weeks old, we noticed a small bump on her head. We were not sure what it was at first--I thought maybe she had been bitten by a spider or, maybe, she'd somehow bumped her head on one of our shoulders. However, within a week, this "bump" became quite swollen. Here is an early picture of the bump on March 26, 2009:

About a week later, we took her to the doctor, because the bump did not appear to be looking any better. It was a Saturday, and we had driven down to Scottsbluff from Hemingford (about an hour drive), so we took her to Urgent Care and saw the doctor that was on-call. He "diagnosed" her with an infected hair follicle and prescribed an antibiotic to clear it up. Within the week, Lily  had severe diarrhea and was subsequently diagnosed with C-difficle colitis, a result of all of the "good" bacteria being killed in her intestines by the antibiotic.

To make matters worse, when we took her to her regular GP, he was certain the bump was not an infected hair follicle. He believed it was a sebaceous cyst that would go away on its own. We, however, were beginning to feel more and more uncomfortable. Here is a picture of it on April 17, 2009:

Not believing that this was a sebaceous cyst that would just "go away" we decided to make an appointment with a dermatologist in Cheyenne, Wyoming. We drove through a horrific Spring snow storm to attend this appointment, almost missing it because the weather was so terrible. We knew that we would go crazy if we didn't receive some answers. And soon.

The dermatologist examined Lily and said she believed Lily had a dermoid cyst--a cyst filled with fluid, hair, bone, etc.. She said that, because it was close to the midline of her face, there was a slight chance that the cyst could be leading to her brain. If that was the case, she would need surgery.

We were, obviously, terrified. We hadn't expected anything like this. The next step was to make an appointment at the Children's Hospital in Denver, Colorado, for an MRI. The MRI itself was a fiasco. The tech signed us up for a "feed and sleep" so, instead of anesthetizing Lily (which we definitely didn't want to do), they thought that she was young enough (3 months, at this point) to eat and then get sleepy enough to sleep through the MRI. Of course, she was not tired after her feeding (we thought we'd lucked out, because she had slept the entire 4 hours to Denver). Our appointment was at 7:00 pm. Finally, at 10:00, Lily crashed out and we were able to complete the (very loud) scan. Thankfully, the tech was very flexible with us, because I was on the verge of bursting into tears after hours of rocking her and trying to get her to sleep! Not to mention, we would have had to reschedule for a different day--and make the drive all over again.

The next day, we met with the neurosurgeon. To make a long story short, he informed us that the "cyst" was actually a tumor--most likely a hemangioma, and she would need it removed as soon as possible.

We. were. shocked.

We hadn't done our research on tumors--just cysts. We went home and the surgery was scheduled for a week and a half later. I tried not to think about it. Upon our arrival the day before the surgery, the surgeon entered the room for Lily's pre-op appointment. This time, he brought the plastic surgeon, who is also a member of the vascular malformation clinic, into the room.

The plastic surgeon took one look at Lily and determined that she did not need surgery--he said that it was far too dangerous because of all of the blood vessels involved, and that they typically resolve on their own. A hemangioma, moreover, is a fairly common birthmark (as many as 1 out 10 infants had them), often called a "strawberry mark" when located on the skin. Lily's, however, was more rare (1 out of 100) and was a deep hemangioma, located under the skin.

Here she is on May 30, 2009, right after they cancelled her surgery.

Here is a picture of her on June 30, 2009:

I was shocked by the doctor's statement--confused about why a surgery was scheduled in the first place and worried that they might have it wrong--again. I went home and did research...a lot of research. I found an organization that had an "experts" page and gave them all of our information.

To my surprise, I was contacted by two DOCTORS--not nurses--within a few days. One doctor informed me that, because of the hemangioma's location (near the eye) and the likelihood that it would continue growing, we should have it removed immediately. Another, who was the "number one" expert in the field, recommended an experimental medication or surgery.

I was confused and panicked. I was terrified she'd go blind or end up with a lazy eye (which the doctor told me was a real possibility), tired of people commenting on her "bruise" and looking at me like I might have dropped my child, and torn that my baby had to go through this. I did not like the idea that she'd have this thing on her head until she was in late elementary school and would possibly be teased by children at school--but I did not like the idea of flying to New York or Boston for surgery or giving her a medication that is not meant to be given to infants.

Finally, my dear husband urged me to stop doing all the research. He said we need to take her to an opthamalogist and have her vision checked and decide if it was a real threat.

It wasn't. So I took a breath.

A few months later, in September, we took her back to Children's to the Vascular Malformation Clinic. They told us that the normal progression of a hemangioma was this: It emerged and grew very quickly, peaking in size by age one to eighteen months. By age two, we would notice some involution (where it would go back into the skin), although this would be a very slow process. Most children notice a significant change by age 5, while almost all notice complete involution by age 10. By kindergarten, the plastic surgeon said, Lily might need a small reconstructive surgery to repair her eyebrow--which had been stretched and disfigured.

I told them about all of the information I'd been given by the "experts" and asked why we were receiving conflicting information. They knew of the doctors that I spoke of, and informed me that they would cut anything that moved...which made me feel relieved that I did not push for an unnecessary surgery (with that said, however, I do realize that these same doctors may very well operate on children when it is deemed medically necessary--that is an entirely different story. For Lily, her bump was more of a cosmetic issue and it did not pose any actual risk to her vision or overall health).

We felt better. We could breathe. We could stop going to doctors and fearing the worst. And, together, we could wait this out and love Lily for the beautiful and amazing little girl she is. And, to our amazement, the hemangioma began to get smaller and smaller....

Here she is on December 5, 2009, at 10 months:

And at 14 months on April 26, 2010:

And, finally, on May 3, 2010, a day away from her 15th month birthday:

It is practically gone! And we waited--no surgery. What should have happened at age 5 happened by at age 1. Thank goodness we were patient and believed in each other...we are a much stronger family because of it!!

If you have any questions about our journey or are feeling conflicted about your own, please leave me a comment. I'd love to provide any kind of support I can. . .


Here we are now, in 2015, and Lily is now 6! The hemangioma nightmare seems SO long ago and, honestly, it is hard to remember how stressful of a journey it was now, considering we ended up doing nothing and she turned out absolutely fine! Here is an updated 6 year old photo of Lily: