Friday, October 17, 2014

Rushing in where angels fear to tread (my two cents on sleep training)

I am a member of a secret Facebook mommy group (the sort where you only join when a member adds you) that most consists of working Indian mothers living abroad, and a few in India as well, and some non-Indian moms as well. I cannot put my finger on why this particular group is so useful, but I think it is just the sheer density of very smart, very resourceful women on there: I've learnt many things on there, and I'm usually the one dispensing information like candy, whether people want it or not.

So, in this very,very useful and mostly positive group, I was taken aback to see a spate of articles making sleep training (specifically, CIO) sound like child abuse (there was one rather ridiculous one about a letter written by a baby undergoing sleep training, not going to share the link). Since there seemed to be almost a 50-50 split between moms who sleep-train and moms who stay far away from it, the battles were fierce, with both sides making preposterous claims about the results of both parenting styles.

Having spent a few of my initial sleepless nights aimlessly browsing what the "experts" say out of sheer curiosity (what I did in the end was totally based on instinct), I was familiar with the arguments made by both sides, and I decided to offer my own commentary on what they said, to try to offer some rational perspective that took a hard look at the arguments offered by both sides

My commentary was pretty well received and nobody came after me with pitchforks, and I figured since I spent so much time on it, it should be out here as well:
  • First, there is no such thing as a baby expert or a sleep training expert, IMO. People claim to be, but they are really just people who make stuff up as they go along, and want to produce enough talking points to fill a book. Anybody who claims they are “baby experts” are charlatans IMO. Trying to say that sleep training produces “better behaved, better-adjusted” children is part of the charlatan-speak. Finally, sleep is developmental, not behavioral: this basically means your baby’s brain needs to develop and mature till the point arrives that he/she can sleep 6+ hour stretches.
  • Why did sleep training come about? When did parenting go from an instinctive, intuitive thing that never involved ignoring your baby’s cues to a training and schedule-driven process? It did not come about as a “eureka” process to improve baby behavior. It came about to compensate for the fact that people no longer parent in an extended family. And that, the stopping of parenting in an extended family, IMO, is the true tragedy. There is now a very real need to reduce the burden of parenting, because parenting went from something the entire extended family did to something two individuals or even one individual had to deal with alone. So yes, some people need to sleep train just to keep going. 
  • The “experts” on the other side who talk about sleep training resulting in disassociated, disconnected individuals more often use parents who ignore their baby’s cues constantly as examples. I've seen articles talking about how sleep training produces disconnected children reference orphanages in Romania, which is just ridiculous. People who sleep train may practice dissociative parenting (where you do not respond to your baby’s cues) only at bedtime. The rest of the time, most sleep-training parents here WILL respond to their child’s cues, and the children do come to trust their parents and bond with them through this associative parenting
  • On the flip side, let us also talk about that new study which showed that babies were stressed (high levels of cortisol) even when they were no longer crying and had seemingly adjusted well to the sleep training. This is a black and white, no-frills point that shows very clearly that what is going on the surface is no indicator of what is happening inside. I read that study, and I wanted to know how long that cortisol elevation lasted. Was it still there a month into sleep training? Six months? Cortisol can mess with neuronal growth, so this finding is not good. However, what is the true impact of this? I refuse to believe that sleep training alone can produce mal-adjusted individuals. Can seemingly well-adjusted, successful, happy individuals be mildly affected by periods of stress during their babyhood? It is possible. Can you measure how much they have been affected? No. How much more healthier would they have been if they had not been sleep trained? Would they be more trusting or have had better relationships with their parents had they not been sleep trained? No one can tell. It is not possible to measure or extrapolate. It is possible sleep training has some mild to moderate psychological effect, depending on too many factors to enumerate, including the parenting style used the rest of the time, but it is impossible to figure out. However, I find it difficult that this prolonged elevation of cortisol at sleeptime could be too deleterious. It is also important to consider the effect of a perennially stressed parent, and the effect they could have on the child if they are stretched too thin. All of life is a balance, after all  
  • Finally, to bust some myths about what may happen if you do not sleep train: one can get a baby who sleeps through the night early without sleep training. Cosleeping and responding to your babies cues does not automatically spell misery for the parent who chooses it, or result in a maladjusted, cranky, child who cannot sleep at all. I cosleep with Gauri and respond to all her cues. She usually sleeps through the night (at 5-6 months of age). She does not spend all night kicking me (saw this a lot  in the case against cosleeping). She chooses her own schedule (no matter what I tried, she goes to sleep around 11:30 and wakes up at around 10 now, with an awakening at around 7:30 am for a feed). Rocking her to sleep is a waste of my time. After a bath+massage, I tuck myself in bed with her and just wait for the point that her own brain signals that it is time to sleep (usually 11:30 pm). We actually have some fun interacting in this time, where she crawls around, babbles at me, wails occasionally, wants to play, etc. It is not purgatory for me, and I do not begrudge her the time I have to spend doing it. Importantly, I know that the method I use to get her to sleep will keep evolving as she grows older, because she is also evolving. Finally, despite the lack of sleep training, and lack of scheduling of naps, she is not cranky during the day and naps adequately, if not at the same time every day. 
  • What I am trying to say is you can raise a happy well-adjusted child no matter what you practice. Which method you choose depends on multiple factors. Sleep training may not be suitable for high-needs babies, babies who get very upset when their needs are ignored (the ones who cry for a long time/ throw up, etc), or very young babies (sleep training a two-month old is not advised), because the risk that it can be detrimental is much higher in all these cases. IMO, it should not be chosen to improve behavior or because of the mistaken belief that it results in better-adjusted children, but it can be used safely in many cases when parental exhaustion is a problem, and many children may be fine with it.
I hope this is actually useful to somebody, and does not put anybody's back up. I cosleep and attachment parent, and the results are amazing for me, but I am also lucky in that I have a child whose brain maturation vis a vis sleep has been seemingly rapid. Even if this was not so, I am also lucky in that I would have had help if she continued to keep waking up at night.  Nonetheless, a very important take-home point I want to drive home is that every child will differ in when they acquire the ability to sleep through the night and self soothe, and that cannot be rushed, whether you wait it out or cry it out


Thursday, October 9, 2014

The goat milk formula recipe

As many of you know,  Gauri was born via surrogacy and hence did not have access to breast milk (see my post on why I decided against induced lactation).

Much before her birth, I started researching my formula choices, and was soon struck dumb at the awful, awful choices the infant formula industry has made (see here  and here as to why). So after much research, I decided to go with a homemade goat milk formula, to avoid the unnecessary additives, get a healthy source of sugar (lactose) and fats (extra virgin coconut oil), and go with the animal milk source that is kindest to the gut and is the most easily digested (this turns out to be goat milk). See herehere, and here  to understand the advantages goat milk presents over cow milk.

This post is to clarify the formula I have used, and explain the reasoning behind its formulation.

I should add, immediately after birth, my baby was put on a cow milk formula, as per hospital rules. She  did fairly well on this formula, but was splotchy (red splotches on her face and body, and interestingly, her upper lip would be very bright red when she was drinking), was mildly constipated, and had a diaper rash. All three issues disappeared after she was switched to this formula, suggesting that she was mildly intolerant towards cow milk protein, and her growth has been nothing short of phenomenal.  

per 8 oz
per 32 oz
Goat milk powder (scoops) (Myenberg whole goat milk powder)
Organic Lactose (teaspoons; tsp) (NOW foods)
Organic Unrefined Safflower oil (tsp) (Eden Organics)
Organic Extra Virgin Coconut oil (tsp)  (Artisana)
Organic Unsulphered Blackstrap molasses (Tsp) (different amounts are for 0-3 mo, 3-6 mo,  6-9 mo, and 9-12 mo). 


Additives (amount given per day, added to 32 oz formula for convenience; exception, probiotic)
Probiotic Lactobacillus reuteri (BioGaia Protectis or Gerber Soothe Colic Drops)
 5 drops --- add directly before feeding.
Baby's DHA (Nordic Naturals)
see package insert 
Vitamin D (Carlson's or Super D drops)
1 drop (400 IU) 
Acerola Cherry Extract to supply vitamin C (Madre Labs)
0-125-0.250 tsp

Vitamin B-12 (methycobalamin; Douglas Labs)
2 drops (2 mcg)

  • This formula base is very similar to the one provided by Joe Stout at Mt. Capra (major, major credit for coming up with it), but differs with the supplements used (the BioGaia probiotic, which is nothing short of miraculous in many cases, and has been extensively studied and tested in infants and children, and boosts immunity), and DHA, which is supplied by breast milk. I use a natural fish cold liver oil source that has been tested for PCBs and heavy metals, and since less is usually more, I use half the amount the company (Nordic Naturals) recommends. This addition is not required if you are doing a combination of breast feeding and formula feeding.
  • Another important difference is that I have not used the multivitamin in the Mt. Capra formula, because I dislike the formulation due to the use of preservatives such as sodium benzoate in a formulation containing vitamin C (together, they form benzene, which is carcinogenic), and generally prefer natural food-derived vitamins to their synthetically produced counterparts.
  • Lactose intolerance is extremely rare during infancy, and often, intolerance to cow milk protein is confused as lactose intolerance, resulting in the turning to other less healthy sugar sources in formula such as maltodextrin or rice syrup or corn solids. While the Mt. Capra formula suggests many alternatives (including lactose) for the sugar, I cannot endorse the the use of brown rice syrup (which raises arsenic contamination concerns) or turbinado sugar, and strongly recommend that only lactose be used, given its many health-promoting effects (improves iron absorption, helps in the setup of a healthy gut flora, which is truly crucial).
  • Goat milk is significantly low in folic acid and Vitamin B-12. Myenberg Goat milk is already folate fortified. I have added Vitamin B-12 back in the formula, as methylcobalamin, for cyanocobalamin. Note that while the Vitamin B-12 RDA is 0.5 mcg/day, I am adding back 2 mcg/day, as I discovered that sticking with the RDA left my baby with low levels (this is why I strongly emphasize a blood test).
  • The formula takes into account that other B vitamins, nucleotides, etc. are supplied via goat milk. While the stability of nucleotides following heat processing is unknown, B-vitamins are unlikely to be very affected by pasteurization (exceptions, Vitamin B-2; source B Vitamins are also supplied via blackstrap molasses.
  • Vitamin D is partially supplied via the goat milk (it is vitamin D-fortified), but if your baby does not get sun on a daily basis, this may be insufficient. The amount of vitamin D required to avoid deficiency is very unclear as well as controversial, and many sources suggest that 400 IU/day may be insufficient. I hence add an additional 400-800 IU/day, and I plan to test blood levels at the one-year point and adjust accordingly.
  • Vitamin E is low in goat milk, but its requirements are partially fulfilled via the Vitamin D drops (20% of the RDA per drop).
  • Vitamin A requirements are met via goat milk (fairly decent source) as well as the cod liver oil (Nordic Naturals DHA). Hence, supplementing this formula with a multi-vitamin may result in the exceeding of the Vitamin A RDA.
  • Vitamin C is low in goat milk; hence the inclusion of a small amount of Acerola cherry extract. This also facilitates the absorption of the iron supplied via blackstrap molasses. Note that Vitamin C is heat labile (destroyed over 70°C), so make sure to cool the water sufficiently before adding, and make sure not to overheat bottles during warming.
  • Iron requirements: The 3 different concentrations for the blackstrap molasses ingredient are based on diffing iron requirements for different ages. Goat milk is far better at facilitatingiron absorption than cow milk, but is most likely inferior to breast milk (has not been studied).The three different formula recipes for different ages differ only in the amount of blackstrap molasses. Now, blackstrap molasses supplies 3.5 mg iron per tablespoon (15 mL), so the formula is designed to deliver 0.58 mg iron per day between 3-6 months, and 1.166 mg per day between 6-9 months, and 2.33 mg/day from 9 months onwards.  The remainder of iron requirements should be made up via solids or supplements. A fingerprick for hemoglobin testing at 9 months is recommended. If the formula is used between birth and three months, no blackstrap molasses is added.
  • I STRONGLY recommend a blood test for Vitamin D, vitamin B-12, and iron at 9 months - 1 year, and adjusting the levels accordingly, if required. You can ask for this at the routine well baby check that is recommended around the one-year mark.
  • If you wish to supplement with a multivitamin (I do not like multivitamin formulations, see the first bullet point), then the only additives should be DHA and the BioGaia probiotic.
  • After 1 year, full strength goat milk may be given with no additions of lactose and safflower oil, but I recommend continuing with a small amount of the coconut oil (0.5 tsp per day), the probiotic, DHA, and Vitamin D. Other vitamins can be acquired via a healthy and balanced diet. 
  • Please see here for how certain components of this formula (Vitamin D, the BioGaia probiotic, extra virgin coconut oil), along with a few others are useful in strengthening immune defenses.

Formula Base

Minerals, Probiotics, Vitamins, and others 
Other requirements
 How to make the formula:
  • Sterilize all bottles, cutlery, whisks, and measuring spoons, and  boil reverse-osmosis filtered water (or whatever water of your choice) using an electric kettle (do this many hours before preparation, so it cools enough).
  • Add the goat milk powder and lactose, and oils and other ingredients (everything other than the probiotic) to the pyrex jar. Add 100 mL of warm to hot water and mix  with a spoon till the powder is assimilated. Use the milk frother to break up clumps and mix evenly, then add water, and keep using  the frother. Make it up to 32 oz and distribute into bottles that are stored at 4°C.
  • Bottles stored in the fridge should be used within 48 hours.  
Disclaimer: Breast milk is truly the best nutrition for the baby for as long as possible. If you wish to use this formula, I recommend that you do so only after a consultation with your pediatrician. Note that infants allergic to cow milk may also be allergic to goat milk, though many tolerate it well. Anphylaxis in response to milk proteins is extremely rare, but can occur.

Sunday, October 5, 2014

Six months!

There are some time periods during a baby’s development that have been termed wonder weeks, because that is when giant leaps in development occur. It seems like Gauri’s fifth month has been one continuous wonder week, all in all.

Around the start of this month, her previously erratic sleep patterns started gaining some regularity: she usually falls asleep at 11:30 pm (no, it is not possible to put her to bed earlier: she wakes up every 3 hours if we try this at 9 pm) and wakes up at 7:30 am. I went, YAY.  Before, if she would wake up by herself at say, 4:30 am she would usually need to feed to settle back to sleep….now she wakes up and often puts herself back to sleep, if she does not wake up all the way. YAYYYY! 

This kid (and interestingly, some of her half siblings too) hate being carried on laps, but still she would normally go to sleep after drinking a bottle on my lap. So my jaw dropped the first time she rolled herself off my lap and went to sleep by herself on the bed! She has been doing that intermittently since….serious leaps in independence!   

This child is also super social. She loves people, and cannot get enough of them. She smiles. She squeals. She converses. She is also sensitive. One day, my grandpa’s physiotherapist was home and started talking to her. This girl smiled and babbled. Then the physiotherapist said bye and went away to work with my granddad, and her face fell, the chin started quivering, and she burst into tears. Two days ago, my mother was mock scolding her…this baby got that the inflection of her voice was “scoldy” and that chin quiver began and she was wailing a minute later. The sensitive aspect to her personality (especially during social interactions) makes me a little worried, because there are so many ways that a young child can be hurt.  As her mother, I want to protect her from it all, but that is simply impossible. I guess life is all about building armor, and I just have to make sure she gets the right tools. To that end, being in India drives me nuts in so many ways, but it is wonderful for her. The entire family as well as the extended family dotes on her, and a child like this thrives on affection, and needs a ton of human interaction to keep her from being bored.

She has also had her first vacation, complete with adventures such as the warming up of bottles in moving cars: Thank you Pura Kiki, for coming up with a wonderfully designed, easily warmable bottle--- all you need is refrigerated mixed up formula, an icebox, some really hot water and a cup, and you can be on the road for 6 hours. So, thus armed, we really pushed this poor child’s boundaries. We woke up and hit the road at the crack of dawn, and then we stayed out a good part of the day, and she was surrounded by people who just wanted to talk to her all day, and of course she talked and played and had naps interrupted every time the car stopped and we got out. We did this two days, and on the second day, she was cheerful and happy all day, and at night came Armageddon. She got a rest yesterday and today we are back home now after 4 hours on the road, but it may take a while for her system to forgive us.

She is also in a major hurry to get past babyhood, it seems. She is standing with assistance and manages to wriggle/roll/drag herself all over the bed, but cannot crawl yet or sit up without assistance for long periods, which makes her really mad. Once she crawls and can sit up, my job becomes easier and harder. Currently her lack of total mobility is a source of great frustration for her, and the only way I can alleviate said frustration is by singing to her. I’m so totally her trained monkey. She is very selective about which songs she likes, and gets mad at me if I change the lyrics, so I have faithfully sung the Do Re Mi song only about 15 times a day every day for the past 2 months.  Joy.

In the past week, there has been a massive leap in her verbal skills. She is now “talking” in that she is saying the same sounds, one of which that sounds like a recognizable word  around 10 times a day…interestingly that one is “amma,” which is the tamil word for mom.

Never a dull moment with this child!