Full Text Shared by: Adolfo Gomez Papi, Josefa Aguayo Maldonado, M. Carmen Alonso Pallás
We have now reviewed the documentation for the withdrawal of custody of Alma by focusing on the initial report on her mother, Habiba, and on the specific “with her daughter."
The document begins by stating that, "it is hard for Habiba to respond adequately to the needs of Alma and she is not aware of the inadequacy of certain behaviors which can involve risk and neglect". In the next paragraph it is said, "eating patterns and sleep hygiene (Alma’s ) are not adequate” and then the above statements are justified with the following arguments each of which I shall discuss:
"The hours and type of food are chaotic" and " she uses breastfeeding as a pacifier and a toy, offering her breast any time the girl cries and letting her take it anywhere, no matter the time and context in which this happens (offices, corridors). "
WHO, UNICEF, The American Academy of Pediatrics, experts from the European Union, and the Breastfeeding Committee of the Spanish Association of Pediatrics recommend breastfeeding on demand and exclusively for at least the first 6 months, supplemented with other foods, to 2 years or more.
Because breast milk is the most complete food and the one with more nutrients and probiotic bacteria that provides more defenses during those first two or more years. “On demand” means when the child wants to and for as long as she wants to. But also when a mother breastfeeds her daughter she does not do it just to feed, but also to soothe, to shelter, as pain relief, comfort, etc. Habiba's attitude regarding her daughter, possibly even without her being aware of it, do follow the current recommendations on infant feeding.
"She gives her the pureed food that is already prepared by the shelter, but also other solid foods that are inappropriate for her age (like the ones Habiba eats). Over the weekends when she needs to make the pureed fruit herself, more often she doesn’t and breastfeeds instead."
The recommendations of the WHO and UNICEF and the Committee of Experts of the European Union regarding complementary feeding make it clear, again, that
the most complete food for a child of 18 months, such as Alma, is breastmilk. If a baby refuses the fruit and takes the breast instead, it will get a lot more calories, minerals and vitamin defences. The purpose of supplementary feeding is that the baby gets used to eating what their parents eat. This is why so many parents, from the first year, start seating their children at the table with them, offering in this way a great opportunity to become familiar with adult food. Once again, Habiba’s attitude is perfectly adequate and follows current recommendations.
"We attempted to regularize and limit breastfeeding times, but it did not seem possible, so the possibility of stopping breastfeeding was raised..." "...she continued to breastfeed. She was given pacifiers, but she didn’t use them either."
To this point the report is from a completely distorted perspective of breastfeeding and ignores all international recommendations. From here on you decide to intervene: Let’s stop the breastfeeding on demand and should Alma need to be consoled she can do it with a pacifier. It is the first big mistake and, unfortunately, not unique. Luckily, Habiba followed her instinct - she continued to breastfeed Alma and continued to do what was best for her daughter..
"She (Alma) does not have proper sleep patterns. From the first moment Habiba didn’t want the girl to sleep in her cot, and she lies with her in her own bed. She uses the cot to drop off things and toys and on very rare occasions to leave the girl..."
Currently, half of the world's children sleep each night with their parents. Not only has this practice been shown to be unharmful to babies, it has been proved that the sleep pattern of the the mother and child are synchronized when they sleep together allowing the mother to react quickly to any contingency or for any need of the child. The child feels much more safe and secure in contact with her mother’s body and the breast can be accessed easily with the mother barely awake. It is reported that co-sleeping (sleeping in the same bed as their parents) promotes breastfeeding on demand. Children who co-sleep every night with their parents do so until they are ready to sleep alone, which usually starts happening from when they are two years old.
"Habiba is very affectionate with Alma, uses physical contact and verbal expression as a means of communication. The child is constantly searching for visual reference from her mother and has been some anxious fear towards the separation."
Although this paragraph of the report praises Habiba’s caring attitude, it ends suggesting that this has negative consequences. Another big mistake caused by ignorance. It is long since J. Bowlby described the different types of attachment relationships between infants and their caregivers. Babies who have been lucky enough to be cared for by a caring mother, ready to satisfy their hunger, thirst, needs, concerns, fears, quickly learn to self regulate through their mother's responses and they develop what is called a secure attachment relationship with her. Adults who have enjoyed a secure attachment relationship with their mother have warmer personalities. Because their mothers have been warm with them they are more stable emotionally, and because their mother has given them emotional stability they tend to have more intimate relationships that are more satisfying. They are more positive, more integrated, have more coherent perspectives about themselves, and against popular belief they are more independent. Babies who have a secure attachment relationship with her mother organize their behavior around her and when their mother is missing, express fear (while in the stage of dependence to their mother). Later on, they will be more autonomous and ultimately more independent.
What Alma manifested in Habiba’s absence confirms that she is developing a secure attachment relationship with her mother and it is the result of her close and loving care, through carrying her constantly, sleeping with her and breatsfeeding her on demand.
WE CONCLUDE THAT:
The arguments in the report of which we have had access to, not only fail to justify that Habiba’s maternal relationship with her daughter could be harmful, but they actually demonstrate that Alma was perfectly fed, cared for and loved.
The decision to separate Alma from Habiba is harmful for both of them.
For Alma, because she was subjected to excessive stress, the stress of separation for which she is not yet ready, and is deprived of the best food and care she can receive, abruptly cutting off a secure attachment relationship with her mother.
Stress has physical (increased risk of infections, weight loss, etc) and psychological consequences.
The longer the separation, the greater the damage inflicted on Alma.
Such a decision should be reversed as soon as possible to minimize the damage.
To err is human; to rectify is wise.
Signed:
Tarragona, 13 June 2011
Adolfo Gomez Papi
Physician. Pediatric Service.
University Hospital of Tarragona "Joan XXIII"
Breastfeeding Committee of the Spanish Association of Pediatrics
Seville, June 13, 2011
Josefa Aguayo Maldonado
Chief of the Neonatology Section,
Hospital Virgen del Rocío. Sevilla
Breastfeeding Committee of the Spanish Association of Pediatrics
Madrid, June 13, 2011
M. Carmen Alonso Pallás
Head of Neonatology
Hospital 12 de Octubre. Madrid
Breastfeeding Committee of the Spanish Association of Pediatrics
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